WI0500096_GEO THERMAL_20040331

March 31, 2004
MEMORANDUM
To: File
From: Thomas Slusser
Hydrogeological Technician II
Underground Injection Control Program
Reference: UIC Permit# WI0500017
Issued to Dr. Harrie Chamberlain
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
This permit number for a Type 5QW injection well was originally issued in January 1995 and due to
expire in January 2000. Effective February 1, 1997, this type ofinjection well is deemed permitted
by rule and no longer requires a permit.
On this date the record for this permit was removed from the UICfile database, which keeps track of
injection wells that need permits, and added to the 5QWlist database, which keeps track ofinjection
wells that do not require permits. Likewise, the paper file was moved to a drawer that stores 5QW
injection well files.
N. C. Division of Water Quality / Groundwater Section
1636 Mail Service Center Raleigh, N.C . 27699-1636
Phone: [phone] Fax: [phone] Internet: http://gw.ehnr.state.nc.us
Customer Service
l-877-623-6748
Chora a rig.
PFSTAT Ver 2.04
Copyright (c) Trimble Navigation, Ltd, 1991, 1992. All rights reserved
R030816A.COR Statistics Version 2.13
Recs Mean Std Dev Minimum Maximum
Latitude 211 35354' 0.16739"N 6.87755 35%54'39.67194"N 35'%i54'40.64374"N
Longitude 211 79}01'41.16048"W 4.20999 79%01'41.51863"W 79%01'40.88076"W
Altitude 211 75.17413 5.63279 64.28602 94.97237
No velocity records in file.
No DOP records in file.
Start GPS Week #791 on 03/08/95 at 16:53:01
End GPS Week #791 on 03/08/95 at 17:00:43
Datum : WGS-84
Coordinate System : Latitude/Longitude
Altitude Mode : Height Above Ellipsoid
Altitude/Distance Units : Meters
Velocity Units : Meters/Second

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CHAPEL HILL, N. C.
N 1552.5--W 7900/7.5

t-1.-:iR-r-95 TUE 1--.. "": 2·::1
State of North Cc,.r.olina
Departm_ent of E. ironment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
GROUNDWATER SECTION
March 9, 1995
Dr. Harrie R. Chamberlain
1001 Arrowhead Road
Chapel Hill, NC 27514
RE: Injection Well Permit No. WI0500017
Dear Dr. Chamberlain,
.RA
DEHNR
In your memorandum to this office dated March 7, 1995
(attached), you indicate that the two variances granted to you
for Injection Well Permit No. WI0500017 are no longer relevant
and that the existing injection well on your property will be·
retrofited in accordance with the· permit and the rules.
Therefore, no variance to Permit No. WI0500017 is required.
Drilling may begin according to the plans described in your
memorandum and present.ed in the accompanying diagram of the well,
as soon this office has been advised that the Orange County
Health Department has affirmed your revised plans.
If I can be of assistance, please contact me (tel. number
[phone], ext. 431).
Sincerely, .rW'l\ a. ~
Karen A. Harmon
Underground Injection Control Program
cc: Jim Greer, RRO
P.O. Box 29536, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ l 0% post-consumer paper
1 001 Arrow head Roa d
Cha pel Hill , North Carolina 2 7514
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MEMORANDUM
To: Karen Harmon
Groundwater Section, NCDEHNR
Fax: [phone]
From: Dr.Harrie R. Chamberlin
1001 Arrowhead Rd.
Chapel Hill, NC 27514
Tel: [phone]
March 7, 1995
This document and the attachments constitute a request for a
variance to replace previous variances (of January 3 and January 23,
1995) for our proposed vertical closed loop heat pump .system at the
above address. While ~e had originally intended to drill a new well
(our original 1980 500 ft. well having somehow become blo~ked at a
depth of about 60 ft.), we have found a contractor who is willing to
"retrofit" our old well and also has the equipment to pump in
bentonite backfill.
Our original system was an "open loop" whereby all water
withdrawn from the well was, after passing through our LT40 Florida
Heat _Pump, returned to the well. This provided adequate heating and
cooling for the west half of our home for almost 15 years, until late
December, 1994.
A revised diagram of the proposed closed loop system is
attached. The 21 foot steel casing (from one foot above the ground
level to 20 feet below) will remain in place. The Heater Well
Company's 1980 report (copy attached) indicates the casing depth, the
fact that cement grout was used to that depth and that the casing
extends 10 feet into rock (shale). To keep the 1" polyethylene pipes
three feet below th~ land surface, a slit, just wide enough to
accommodate them vertically, will be cut in the casing to three feet
below ground level. Following placement and pressure testing (at 50
lbs. for 20 minutes) of the polyethylene loops (guaranteed for 55
years by the manufacturer) bentonite will be pumped (from the bottom
up) into the well (from which all material will previously have been
removed in the redrilling process to a depth of 410 feet).
The bentonite (surrounding the 1600 feet, in two loops, of
poly~thylene pipe) will completely fill the well to a point no less
than one foot below the bottom of the slit in the casing (or to
slightly more than five feet below the upper end of the casing). The
remaining five plus feet will be filled with cement, taking special
care to produce a water-tight seal of the casing slit. The ground
-will then be leveled so that the casing will extend one foot above
ground level, as before. As the polyethylene pipes will be deep
enough to prevent freezing only water will be circulated through them
in a completely closed system.
Our driller is:
Mr. Richard Simmons
Richard Simmons Drilling
Rte. 3, Box 236
Buchanan, VA 24066
Tel: [phone]
Our heatpump engineer is:
Mr. Edward Futch
Fax: (703} 254-1268
Mechanical Equipment Sales, Inc.
5025 Euclid Rd.
Virginia Beach, VA 23462
Tel: [phone] Fax : ( 8 0 4 ) 4 9 0 - 9 8 2 9
Thank you very much for your consideration of this request.
Harrie R. Chamberlin
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WCLL RECORD DIVISIUN OF ENVrRONMENTAL MANAGEMENT, GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH, N.C. 27S11
IIkULLING CON'IRAC'r ri f rp a r: _Vii' Li co _ NEG. NO. 1 WELL 1STRUC'1'ION PERMIT NO.
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Chapel Hill County: Orange Co
Quadrangle No.
tkoad,Community or Subdivision and Lot No..
OWNER: Dr. H. R. Chamberlin
ADDRESS:1001 Arrowhead Dr., Chapel Hill, ik:f'G1
r'1toM TO FORMATION DESCRIPTIQN
.1. TOPOGRAPHY: draw,valley,slope,hilltop,flat(circle one)
5. USE OE' WELL: home
DATE: 3-27-80
a. DOES TIIIS WELL REPLACE AN EXISTING WELL? IlO
7. TOTAL, DEVTli: .50t)' It1C '1'YiTOlt M:'I'i11117: a i r
K. 1'u1tA%A1'ION SA311,1,1:S C'1P1.1.1'311•:17: Y;s:: ' Nil
9. CASING: Depth inside Wall thick. tYpe
Dia. or weight/ft.
DRILLING LOG
0 - 10 clay
10 500 granite - shale
From 0 to 21 ft 61/4 13 1bs . black steel
10. GROUT: Depth Material Method
From 0 to 20 ft cement blowing
I1. SCREEN: Depth Dia. Type & Opening
From to ft
12. GRAVEL: Depth Sirr: Material
From to tt
13. WATER ZONES (depth) : 2 7 5 r - 8 gpm
400' - 1 gpm
rf a1m.tional space is needed, use back o —
LOCATION SKETCH.
(Shun 414:La rri: lu nui41)err:d ru:+cls, ur otkirr map reference points)
14. STATIC WATER LEVEL: 50 ft;abnvebelowLop of casing
Casing is ft. above land surface k,LEV:
15. Y1E:LD(gpm) : 9M::!'IIOO Oi' TESTING: blowing
16. PUMPING WATER LEVEL: Et.
after hours at gpm.
17. CHLORINATION: TypeAmount
ie. WATER QUALITY: TEM1'[:RJ1TUkE(0F)
19. PERMANENT PUMP: Date installed
Type Capacity (41pnt1IIP
Make l lli ,lki' 1).Y1 I h
Airline Depth
20. HAS THE OWNER BEEN PROVIDED A COPY OF THIS RECORD Ar@D INFORMED OF THE DEPARTMENTS REQUIREMENTS AND
RECOMM1::NDATIONS? Y e S
21. REMARXS
I do hereby certify tIVjt_this well was constructed in accordance with N.C.-Well Construction
Regulations and Standerd 217 hat his well record isf true and ecact.
A.
SIGNA'1'UHL OF L 'L'1:.AC'1'O[.1 f7TE{
Form CW-1 Revised 11/3J77
-Submit original to Groundwater Section and copy to well owner.

kJ,/ K-ecl-
Plat Showing
Lot No. 36of "GREENWOOD DEVELOPMNET", Plat Book 4
Chapel Hill. N. C.
Property of: Harrie Chamberlin and wife Elizabeth I, Chamberlin
Scale l" 40t
Page 104

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CHAPEL HILL, N. C.
N3552.5—VV7900/7.5

State of North Car �.na
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
Mr. Charles Collins
Hudson Well Co. Inc.
P.O. Box 05
Rougemont, NC 27572
A711
C7 11-1N111=71
Subject. Request for Variance - NORTH CAROLINA WELL
CONSTRUCTION STANDARDS Rules 15A NCAC 2C
.0213 (d) (1) (A) - Required extension of well casing
above land surface
Dr. Harrie Chamberlain Property, 1001 Arrowhead Road
Orange County, North Carolina
Dear Mr. Collins:
This is in response to the petition from Dr. Harrie
Chamberlain, on your behalf, requesting modification to the
approved variance from the referenced Rule. Rule 2C .0213
(d)(1)(A) requires that a well casing be installed which
extends from at least 12 inches above land surface to the top
of the injection zone. Dr. Chamberlain indicated in the
letter dated January 23, 1995 that the previously described
injection well construction method would not be possible due
to equipment limitations. Therefore, the well construction
details have been modified.
Factors that would act to mitigate any potential problems
which could adversely affect human health and/or the effective
operation of this well, because of not meeting the regulatory
requirements, are as follows:
1. The well will be completely backfilled with pea
gravel after installation of the closed -loop piping
in the well as described in the letter dated January
23, 1995 and illustrated in the drawing submitted
with the letter. A 20 foot well casing will be
installed and cement grout will then be emplaced
around the well casing and completely fill the
inside of the well casing from a depth of 20 feet to
the top of the well casing.
2 The fluid to be circulated in the vertical closed -
loop heat pump system will be potable water from the
local public water supply (OWASA).
P,O, Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Mr. Charles Collins
Variance to 15A NCAC 2C .0213
Page 2
Based on my review of the available information and
recommendations by our staff, it is my finding that the
combination of factors specified above are sufficient to
satisfy the conditions for approval of a variance from 15A
NCAC 2C .0213 (d) (1) (A) as defined in 15A NCAC 2C .0118. On
that basis, and with the additional requirement that you
notify the Raleigh Regional Office at [phone], at least
24 hours before any well construction activities are begun,
the requested variance from Rule 15A NCAC 2C .0213 (d) (1) (A)
is hereby granted.
The granting of this variance does not affect any of the
other requirements of the WELL CONSTRUCTION STANDARDS or of
the requirements of any other applicable laws or rules.
This variance replaces and shall also supersede any
previously issued variance for the referenced injection well
at 1001 Arrowhead Road, Orange County, North Carolina.
Sincerely,
1 ' _
L. Bush Jr., Assistant Chief
Groundwater Section
Division ❑f Environmental Management
CC:
UIC Files
RRO Files
Dr. Harrie Chamberlain
DATE:

DOCUMENTATION OF INJECTION WELL PERMIT REQUEST
FROM DR. HARRIE CHAMBERLAIN, CHAPEL HILL, NORTH CAROLINA
1. Dr. Harrie Chamberlain phoned on December 28,· 1994 and indicated to staff
that he intended to have constructed .a single borehole some 400 feet deep for
the installation of a vertical closed-loop heat pump system. He also revealed
that he did not currently have any heat in his home.
2. Staff informed Dr. Chamberlain that what he was proposing would require an
injection well permit and suggested that the permit applicati~n be faxed in
order to expedite the permitting process. The application was faxed on the
28th of December.
3. Later on the 28th a telephone conversation between staff and Dr. Chamberlain
determined that a variance to 2C .0213 (d)(1)(A) would be required for the
engineering of the vertical closed-loop heat pump system.
4. · Dr. Chamberlain indicated on his permit application which was faxed to the
Groundwater Section on December 29, 1994 that he was requesting a variance
to the previously discussed Rule.
5. On January 3, 1995 Dr. Chamberlain faxed a request for a variance to the
Rule after a phone conversation earlier that day with staff. Dr. Chamberlain
asked that staff give assistance as to the wording of the variance request and
staff agreed with supervisor's permission to provide suggested wording for the
variance request.
6. On January 23, 1995 Dr. Chamberlain faxed a request for a modification to the
approved variance to the Rule after a phone conversation with staff. Dr.
Chamberlain submitted a sketch describing the revised construction details of
the proposed injection well ·system. The proposed revised construction
methods are satisfactory to staff and the modification to the variance was
prepared on January 25, 1995.
J I-!ri t4--'y7 i u I!J : .s•
P.01
Glen Lennox
1201-F Rafeioh Road
Chapel Hill, NC 27514
[phone]
FAX [phone]
Facsimile Cover Sheet
This Transmission is 3 pages, including this cover letter.
Transmitted To:
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Transmitted From
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JAN-24~95 TUE 10:54
MEMORANDUM
T,): A. Elizabt?.th Morey
Groundwater Section1 NCDEHNR
Faxt 919-715-0568
From: Dr. Harrie R. Chamberlin~
1001 Arrowhead Rd.
Chapal Hill NC 27514
Iel; 919-942-4951
P.03
January 23, 1995
AtT~ched is~ rAvised diagram of our proposed vertical closed
·009 hAat pump system to indicate the form of backfill to be used
and the position of the casing after the top three feet (which would
e~tend slightly above ground level initially) have been unbolted and
removed. This procedure allows the closed loop polyethylene pipes to
remain below the land surface and, since they will circulate only
water. thus prevents then from freezing.
Casing will be used (according to the requirement for water
wP]l~ by OrRnge County) down to "consolidated material". The top 21
f~~t of the casinq (remaining after removal of the top three feet)
will be grouted on the outside with cement. Following placement of
the vertical poivethylene loops the well will then be filled with
n PR grAvel to a point at least 15 feet below ground water level.
From that point to the top of the casing it will be backfilled with
. ~;~ne , t: •
Please in f orm me if either the diagram or the above description
present any problems. Mr. Charles Collins, of the Hudson Well Co.,
Pxnects to Rtart drilling early next week (Monday, Tuesday or
WP.nnesdny, January 30th, 31st or February 1st, depending on the time
or completion of his preceding job). I will try to inform you of
more exact timing this Friday or, at the latest, early Monday so
that you may have an observer if desired.
Will the permit dated January 11th require revision? It seems
likely that the words 11 in accordance with the application dated
necember 29, 1994" may need changing.
A new letter to Mr. Collins does appear indicated. For some
r~ason. although I received the first one he never did. This may be
be~ause his Rougemont address is Box 05 rather than Box SO. In any
~vent could you Fa~ me a copy at the time you mail his (no Fa~ is
~va ilable to him) so that I will have both the permit and his letter
in nand if he fails to receive it in time.
Again, many thanks for your help and understandi.ng.
P. @2
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~ction code: ApplyOOOlO Facility ID Number: NCS000000140
~PPLICANT Name: Chamberlain, Dr. Harrie
State and Zip: NC 27514
Address: 1001 Arrowhead Road City: Chapel Hill
County: Orange Telephone#: [phone] Fax#: [phone]
FACILITY Name: Address: City:
State and Zip: County: Telephone #: • Fax#:
Permit Number: WI0500017 Application (new or renew): new Permit Type (conop): hpconop
Renew Not. Sent: 2nd Renew Not. Sent:
Appl. Rec-Incomplete: Appl. Return:
Appl. Acknowledge: 12/30/94
RO REQUESTED TO: Review Appl: 1/03/95 Inspect: 1/03/95
Appl. Rec.-Complete: 12/29/94
Analytical Report Recd: 12/29/94
Sample (renewal):
RO Sends Appl. Review to CO: RO Inspects: 1/03/95 RO Samples: Lab Report:
PERMIT: to Manager: 1/03/95 to Supervisor: 1/03/95
to Permit tee: 1 / 11 /'i<' Copy Filed: '/ u /1<
to ACGW: \/ ~ / 't Y Approved : \/I\ /q\
Copy to RO: 1 /Uftt< Entered Uicfile: J/ll/t:,("
Permittee Informs, Ready to Operate: RO Requested to Inspect: RO Inspects:
Analytical Report (New Source): GW-1 Received:
Permit Process Completed:
State of North Carolina
Department of Er .onment,
Heo#th and Naturur Resources
Division of Environmental Management
James B. Hunt, Jr„ Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr.. P,E,. Director
MEMORANDUM
To:
From:
GROUNDWATER SECTION
January 11, 1995
SUKr e?
Groundwater Section
Raleigh Regional Office
Karen Harmon 1ili ff"
UIC Group
Groundwater Section
Raleigh Central Office
Re: Issuance of injection well permit.
Atr5VA
DEHNR
Permit No. WI0500017 to use a well for the operation of a
vertical closed -loop heat pump system has been issued to Dr.
Harrie Chamberlain; a copy of the permit is enclosed for your
files.
cc: UIC Files
RRO Files
Enclosures
P.O. Box 29535, Raleigh, North Carolina 27526-0535 Telephone [phone] FM 919-715-0588
An Equal oppertuntty Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Facsimile Cover Page
NC DEHNR
DEM-Groundwater Section
512 N. Salisbury Street Raleigh, NC 27604
Phone: [phone]
Fax: [phone]
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State of North cc--~1ina
Department of El . _ aronment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
GROUNDWATER SECTION
January 11, 1995
Dr. Harrie R. Chamberlain
1001 Arrowhead Road
Chapel Hill, NC 27514
Dear Dr. Chamberlain,
AVA
DEHNR
In accordance with your application dated December 29, 1994,
we are forwa.rding Permit No. WI0S000l 7 for the construction and
operation of a well, for the purpose of operating a vertical
closed-loop heat pump·system, in Orange County.
This permit shall be effective from the date of issuance
until January 31, 2000, and shall be subject to the conditions and
limitations stated therein, including the requirement to notify
this office by telephone 48 hours prior to initiation of operation
of the facility.
In order to continue uninterrupted legal use of this well for
the stated purpose, you should submit an application to renew the·
permit six months prior to its expiration date.
The variance you requested to Rule 2C .0213 (d) (1) (A), whic;::h
requires that a well casing be installed which extends from at
least 12· inches above land surface to the top .of-the injecticin
zone, has been approved and is attached since it is a pre-requisite
for this permit to be issued.
If you have any-questions regarding your permit please feel
free to contact me at (919) 733 -3221, ext. 407.
cc: UIC Files
RRO Files
Enclosures
sa~er/l &fp1.
A. Eli:~eth MoJ~
Manager
Underground Injection Control Program
P.O. Box 29536, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 1 Oo/o post-consumer paper
State of North C ·,,:,line
Department of L ,vironment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
Mr~ Charles Collins
Hudson Well Co. Inc.
P.O. Box 50
Rougemont, NC 27572
AVA
DEHNR
Subject: Request for Variance -NORTH CAROLINA WELL
CONSTRUCTION STANDARDS Rules 15A NCAC 2C
.0213{d) {l) {A) -Required extension of well casing
above land surface
Dr. Harrie Chamberlain Property, 1001 Arrowhead Road
Orange County, North Carolina
Dear Mr. Collins:
This is in response to the petition of January 3, 1995,
from Dr. Harrie Chamberlain, on your behalf requesting
approval of a variance from the referenced Rule. Rule 2C
.0213 {d) {l) {A) requires that a well casing _be installed which
extends from at least 12 inches above land surface _to the top
of the injection zone. Dr. Chamberlain indicated in the
permit application and in subsequent telephone conversations
with staff that the well could not be-constructed in
accordance with the Rule due to the engineering requirements
of the proposed vertical closed-loop heat pump system that
would be installed inside the injecti6n well.
Factors that would act to mitigate any potential problems
which could adversely-affect human he~lth and/or the effective
operation of this well, because of not meeting the regulatory
requirements, are as-follows:
1. The well casing will be capped after installation of
the closed-loop piping in the well and the well will
be completely backfilled with bentonite grout to a
depth of 20 feet. Cement grout will then be emplaced
around the well casing from a depth of 20 feet to
the cap of the well casing.
2. The fluid to be circulated in the vertical closed-
loop heat pump system will be pota~le water from the
local public water supply {OWASA).
Based on my review of the available information and
recommendations by our staff, it is my finding that the-
combination of factors specified above are· sufficient to
satisfy the conditions for approval of a variance from 15A
P.O. Box 29536, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 1 Oo/o post-consumer paper
NCAC 2C .0213 (d)(1)(A) as defined in 15A NCAC 2C .0118. On
that basis, and with the additional requirement that you
notify the Raleigh Regional Office at [phone], at least
24 hours before any well construction activities are begun,
the requested variance from Rule 15A NCAC 2C .0213 (d)(1)(A)
is hereby granted.
The granting of this variance does not affect any of the
other requirements of the WELL CONSTRUCTION STANDARDS or of
the requirements of any other applicable laws or rules.
C C .
Sincerely,
tad L. Bush Jr., Assistant Chief
roundwater Section
Division of Environmental Management
UIC Files
RRO Files
Dr. Barrie Chamberlain
Tony Laws, Orange County Health Department

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, 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
Dr. Harrie R. Chamberlain
FOR THE CONSTRUCTION AND OPERATION OF AN INJECTION WELL for the
purpose of operating a vertical closed -loop heat pump system. This
well will be located at 1001 Arrowhead Road, Chapel Hill, North
Carolina, in Orange County, and will be constructed and operated in
accordance with the application dated December 29, 1994, and in
conformity with the specifications and supporting data submitted,
all of which are filed with the Department of Environment, Health,
and Natural Resources and are considered a part of this permit.
This permit is for Construction and 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 15 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 January 31, 2000, and shall be subject to the
specified conditions and limitations set forth in Parts I through
X hereof.
r
Permit issued this the // day of January, 1995.
ed L. Bush, Jr., Assistant Chief
roundwater Section
Division of Environmental Management
By Authority of the Environmental Management Commission.
PERMIT NO. WI0500017

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 secured with a
lockable cap.
6. Each injection well shall be afforded reasonable protection
against damage during construction and use.
7. Each injection well shall have permanently affixed an
identification plate.
8. A completed Well Construction Record (Form GW-1) must be
submitted for e~ch injection well, to the Division of
Environmental Management (Division), within 30 days of
completion of well construction.
PART II -WELL CONSTRUCTION: SPECIAL CONDITIONS
At least forty-eight (48)· hours prior to constructing each
injection well, the Permittee sh~ll notify the Groundwater
Section -Underground Injection Control (UIC), Central Office
staff, telephone number [phone].
PAGE20F7
PART III -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 Environmental
Management (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 36 days prior to the date of
the change. ·
3. The issuance of this permit shall.not relieve the Permittee
of the respo"nsibility of complying with any and all statutes,
rules, regulations, or ordinances which may be imposed by
other local, state, and federal agencies which have
jurisdiction. Furthermore, the issuance of this permit does
not imply that all regulatory requirements have been met.
PART IV -PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and
operated at all times so that ther~ is no contamination of
groundwaters which will render them unsatisfactory for normal
use. In the event that the facil:,ity fails to perform
satisfactorily, including the creation of nuisa~ce conditions
or failure of the. injection zone to adequately assimilate the
injected fluid, the Permittee shall take immediate corrective
actions inc:luding those actions that may be required by the
Division of Environmental Management such as the repair,
modification, or abandonment of th_e 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 groundwaters
resulting from the operation of this facility.
PAGE 3 OF 7
PART V -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 Groundwater Section -
Underground Injection Control (UIC) , Central Office staff,
telephone number [phone]. Notification is required so
that Division staff can inspect or otherwise review the
injection facility and determine if it is in compliance with
permit conditions.
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of
the Division of Environmental Management 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 maint.ained under the terms and conditions of this permit,
and may obtain samples of groundwater, surface water, or
inj ectio_n fluids.
2. Department representatives shall have reasonable access for
purposes of inspection, observation, and sampling associated
with injection and any related facilities as provided for in
N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and
appropriate samples associated with the injection facility
activities (see attached diagram).
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil
sampling) deemed necessary by the Division of Environmental
Management to insure surface and ground water protection,
will be established and an acceptable sampling reporting
schedule shall be followed.
PAGE 4 OF 7
2. The Permittee shall report by telephone, -within 48 hours of
the occurrenc~ or first knowledge of the occurrence to the
Raleigh Regional Office, telephone number [phone]
of 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 Permittee shall take such immediate
action as may be required by the Director.
PART VIII -PERMIT RENEWAL
The Permittee shall, at least six (6) months prior to the
expiration of this. permit, request an extension.
PART IX -CHANGE OF WELL S'l'ATUS
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 15 NCAC 2C .0113, 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 15 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
PAGE 5 OF 7
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 o~ the
permit.
(G) The Permittee shall submit a Well Abandonment
Record (Form GW-30) as specified in 15A NCAC 2C
.0213(h) (1) within 30 days of completion of
abandonment.
3. The written documentation required in Part IX (1) and (2) (G)
shall be submitted to:
Groundwater Section -UIC Staff
DEHNR -Division of Environmental Management
P.O. Box 29535
Raleigh, NC 27626-0535
PART X -OPERATION AND USE:SPECIAL CONDITIONS
NONE
PERMIT NO. WI0500017
PAGE 6 OF 7
All"l'ACIIMENT 1
••••- - • •. ••• •
' • , * • • •
• .•
• .•
• ••
• • • •
• '. •
• .;
. • . •
• 7*..
• •
4.0 •
•
• •
pERmiT NO. WI0500017
Sampling Tap
, (Effluent}
/6-r--dt-
Sampling Tap
' (Influent) •
••
▪ • .• •• • 6,
- HEAT
PUMP
• • • '• • • • •
: ' • .
. • • ••• . • • •
• I " • • •• • • • • %•.• • • • • •
• • •• il••••••,• .....
• • • •
• • .•
• • • $ • $ • • ,
▪ • • • • •
•
•
•
VERTICAL "CLOSED LOOP"
INJECTION WELL, USING
UNCASED BOREHOLE
• • • . . • • • .

Fabert Cheek
su ~~Lvisor, Permits and Compliance
,1 ndwater Section
I would like tc request a variance to the North
LoL·0,J.,ina well construction etandards, Rule 15A NCAC 2C.
J,~J(d)(l)(A) which requires a casing installed which
ex~ends from at least 12 inches above land surface to the
cop of the injection zonA. The variance will be for a
w~~l to be constructed for a vertical closed loop heat
pui 11p system at 1001 Arrowhead Road in Chapel Hill.
Barrie R. Chamberlin
II~ le· ~~·
January 3, 1995
P.0:2
JAN— 3-95 TUE 16:12
P.01
AIL
Iff?
INCORPORATED
Date
Glen Lennox
1201-F Raleigh Road
chapel Hill, NC 27514
[phone]
FAX [phone]
Facsimile Cover Sheet
This Transmission is 2. pages, including this cover letter.
Transmitted To:
rA C.f. 4
cinpany ? Nrry%iv f Pr PIL -r_SAj._[,Yr :arc.-i,ti�irs�rfS ct'4lrr+
FAX No: qL q - `? / S = pay 7_ __Phone No:
Message: f�`+ 1 ►'� /4.._ "L f h.!) ke d Nergri . n _par
Attention Receiver:
Please notify the individual identified above that his/her FAX Transmition has
been received. If you did not receive the entire transmition, Tease call us et
019) 933-4332 as soon as possible. Thank you.
Transmitted From
Name: !Tfrr►'; �1� L A&w6trif,
Company: — 10 AI,r C z
Prone Nc: I - 7 t t- -I

FruM `
12.29.t434 ie
P.02
F. 2
1 1
NORTH CAROLINA
�ONMEN"TAL MANAGEMENT COMMISSION
DEPAR"1; OE NVIRONMENT, HEALTH.. AND NATURAL RESOURCES
APPI� ICATION FOR PERtMlt TO CONSTRUCT AND/OR USE A WELL FOR INJECTION 1
J
WITH A HEAT PUMP SYSTEM
Class S Wells
172.Y3R NORTH CAR O1NADIV1.5iON OF ENVIRONMENTAL AiANAOEMENT
in accordance with the provtsioni of Article 7, Chapter 87; Article 21, Chapter 143, and regulations pursuant
?he-cto, ,APPLICATION is hereb> made Far a PEWIT to construct and/ ar use. a well or well system as described
rd in hr1y accompanying a2ta submitted as part of this APPLICATION.
Please type or prbie clearly.
R.. PERMM F APPLICANT
F.
Ciw-57 P,P
rya,-r,e' ?.
Addresq: _ !our
M
r1'iry. S.`•
Co.nyi
Teic1�`t one: 1_-
1
STATUS OF APPI..ICA.\
Feder - State _
Public..4_ _ _ _. Commercial _ _ Other
:iw Native Arncan l.arsds
PROPFRTY OWNER (it' different from applicant) -
?Fame:
Meat
R
�rri.RE.I t 4 —
t-4.nMlrr'j%!1
Ci ty:
-
CO1 .:
Te1epi ont:
Private
Zip
FACILITY (SITE)i)AT (Fill out ONLY if the Status of Owner is Federal, State, Public or Commercial)
Name/of Business or Facility: Nii
Address:
City:
Colinit.Telepant:
Contact ?crsan:
Zip code: -
13EATINO CONTRACTOR DATA . Sault : „_11r�i!w:rI _ ntu % / t ba ,,'re! if7. y_.-12)' rriell TA -
Addr ss: rALi r- F^r
City, MVPel- IAA L pr.t,4_,,.__ YA_____,_ Zip code: 2.14' ss
Cou tY: _ -- — G G.CW ern S.-4,1 r;
Tele hone: i�zoo -777` 76g7 Hr, r,•.a.,,, PIwril !,, , rc�,
Curt a Forma! _ 3 ma ”1 X dl•b„r„4..'f
4'G s 7f 1
INJECTION PROCEDURE (Rriefl describe how the injection well(s) will b used.) r4'.'.. -7rT-: rrr1
,�.� _h �7 • w, - y d. ,+ s, c l..r l I � _LetL__ s�w_.m All'? li'� 11-.,1 4,17P' ..r-" jr
:A.-4:.= ;r1'. ..A 12u j/ifCd�1• rf Ieac2-er.l7N� I'4i ev rtd : pal 6.0/ c�4 hi gel ..-_/� !
r r1 -gr �s[a.,, 4cPr Toms 7 &0rn a e�.v.I-r...+4
WELL USE WiI1 the eCtion well(s) also be used as the s f`Il(s)r. ,hero of the
following: ,• kr�
�nj ( apply weI1(s) for either ti7a following:
(a) The injcCtion operation? YES____ _, No v'x
() 'your personal e�5nso rnpLion? YES NO
{October I ; ;) Page 1 of 6

FROM
FRI 11 :12
P . 03
/2.29.1994 }'-2'A
P. S
H. dONSTRUCTION DArj (check one)
(1)
''2)
(a)
TING WELL being proposed for use as an injection wall. Provide the data
vn (1) through (7) below to the best of your Icnop.iledge. Attach a copy of
arm GW- (Well Construction Record) if available.
!PROPOSED WELL to be constructed for use as an injection well. Provide the
data in (1) through below as PROPOSED construction specifications. Submit
orm OW.) after construction,
(4) Cement grout;
(n Around !nue • or" rimary" casing: From 0 to? ft.
(t') Around oute• (pit) casing, if present: From w ft.
(5) :.;(soma (if vppli6:.>1hle):
nt Type: +i' a : Inner diameter:. inches
Dep:hrrin rt. to —feet below land surface
(6) Gravel (if applica'` le); From ZVR to feet below land surface
(7) N.C. State Regut onl; (Title 15A NCAC 2C Section .0200) mg the pet iittee to make
provisions for monitoring well head processes. A faucet on both nfluesnt (groundwater entering heat
pump) and cffluet t (water being injected into the well) lines is re4uired. Will there be a faucet on;
(n) the influent liner? ye.8, .no (b) the effluent lisle? yes. 1 no - (tip ''i:Mai • AAA ;rr�
NOTE THE WELL DULLING CONTRACTOR CAN SUPPLY THE DATA POR EITHER EXISTING OR
PROPOSED W£LttS IF THIS IN -FORMATION XS UNAVAILABLE BY OTHER MEANS.
I, PROPOSED OPERATiwG DATA
(a) In,�ection role: Average daily gallons per minute :•m) ,¢� 1F r-I:;I
(b)
ln�t tion volume: Average daily _gallons _ gallons yer day ) m.� 4../4,eot in
(C inle.ction pressure: Averse dall jj ounds/s uare inc •si -��..rt r,il rr ,..�t
(d) Injection Iper �perature: Annual Average degrees F 14, ti,rav,'Eewd
'� {
NMCT1ON FLUID ;A TA t,: b•rj
Well Drilling Con actor's Narne: iI d� Ca —r L'44•Ira C■//,s
NC l7ri r on _number i (gm) w 7? -7 701
Date to be construeted: -nn. if r> Approximate depth: 4 to,..._...
Well casing;
a Type: Galva,4iz d steel •r Black steel_--,_ Plastic Other(specify)
cInside diameter: s'.4,' inches; Wall thickness____ inches or schedule 1 .., 117
Casing do From 0 to -, ft. (reference rd land surface) i;�, ari .4- ►if
Casing extends above ground _. _ -- inches (must be et least 121nches) r tY,�r.(.: Hey ora
w � li f, I,1, 4141 Yr
..."I r.0 rif
(I) Fluid source, It t#nderground, from what depth, formation and type of rock/sediment unit will the
fluid be drawn (egg,, granite, limestone, sand, ete,), (--'t41.,r., ,41 !, £ led .n i. w:,4r-
�nnr rat yir AAA . rtiFt * 4-4 `.{ikor )
Depth:- _ U,t 1 Formation:_ - ,Rexklsedimertt unit: _
(a) SOURCE LI, CONSTRUCTION 3NFORMAT1ON ([if different from injection well).
Attach a co y ofForrrt GW-1 (Well Construction Record), If Form OW-1 is not available.
provide. the data in part H (1) through (7) of this app1iceuoh form to the best of your
knowledge;
(2) Chemical An aly4,1is of Source Water. Tic following chami4ai characteristics MUST accompany this
application' i eAy-*1 rr<A o vii Ira.--'yr�i I.t.—o1A(hrI A-,� eijetJA)
PH 7, It ; Fula! hardness 3 ( pprn (parrs per million or mgfl) iron < 01 p m;
blonde _J.'. 1 - -- pprn; Nitrate () a, pprn; Co 'form bacteria P (.t,i7 countsll00rrl.
NOTE: Assistance in determining these values may be Obtained b contacting (a) your local or county
health offs al, (b) a commercial water -testing laboratory, c) your well drilling contractor, or
(d) there, on al Hydrogeologlft, North Carolina Dept. of nvirortment, Health, and Natural
itesOurces
Gar-E7 hP (October 1 J94) Page 2 of 5
1

• -•• -FF2I I 1 : 13
FROM
p.04
12.29.1954 to 2s P. 4
47
K INNT.0MN-RE L& fin EQUIPMENT
Attach a diagram sf owing the engineering 1eycut of the (1) injeclign equipment, and
'2) ixtc•ror pi its ubing associated with the Injection operation. The manufacturer's brochure, Lf
detailed, should sap.sfy (1) above
To'oc w A.PHIC MAP I
Attach m scaled topographic map which extends one mile beyond the property boundaries of the
facility and indica:Ts the location of the facility. ,
LOCATIC N OF W1 LL( )
Attach a detailed, scaled map of the site of the facility, showing the location of and distances
between the proposed wells(s) (source wells end injection wells) and any waste (including hazardous
waste) treatment, "torage or disposal facilities; buildings; yropertboundaries; surface water bodies;
and any other ppot: r i tial source of groundwater contamination, Additionally, indicate on the map the
direction and disLnce to existing wells (injection wells, water supply wells, dry wells, abandoned
wells) located win 1,500 feet of the proposed injection well(s). Include with the reap a description
of each existing well, incorporating type, construction information, date drilled, and depth. indicate
on the map at r t two nearby reference paints such as roads, road intersections, streams, etc., and
identify them by 1;.S, NC or SR (county secondary roads) numbers or name, Label all fe.atatres
clearly. Include a r:tirth arrow on the map to indicate orientation.
C;" k T1FICATICN
"1 hereby certify, ender penalty of law, that I have, personally examined and am familiar with the
infcrrnation submit. in 'NS document and all attachments thereto and that, based on my inquiry of
those individuals immediately responsible for obtaining said information,1 believe that the information
is true, accurate an complete. I am aware that there art stgnitictuit penalties, including the possibility
of tines and imprisonment, for submitting false information, r agree to construct, operate, maintain,
repair, and if appli able, abandon the injection well and all related appurtenances in accordance with the
approved zpec[tffict ions and condirions of the Permit,"
(SignatureorOwner of AuUiatteea Agent)
Please s�t paply 4 tenter signed by the owner
authorising the above agent, aurhorued agent is signer.
O. CONSENT OF PROPEi? TY OWNER (Owner means any person who holds the, fee or other property rights
in the wall being cons • .rtekd. A wclI is real property and its construatiolt on land rests ownership in the
land owner in the abScne of contrary agreerne-nt [n writing)
if the property isfcwned by someone other than the applicant tilt property owner hereby consents to
allow the applicat to construct each injection well as ouli net in this application and that it shall be
the reapanst )11:1;y►► of the applicant to ensure that each injection watt conforms to the Well
Construction Standards (Title 15A NCAC 2C .0200)
Name of Propert Owner (Pratt); �' Ag i:: g. eetof s & E' L../N
Mailing Address; .' O 01 A J. - —
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( nature of Property °wrier if different
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ROAD CLASSIFICATION
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IMproved surface
Nrd surface _ . _ Unimproved road
) Interstate Route U. S. Route State Route
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‘,919) 933-4302
Ai tit] chapel Hill, NC 27514 FAX (9'19) 929..4 60
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This Transmission :s 7 pages, including this cover letter.
Transmitted To:
f�:, r. r.i MLICT V C
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Mention Receiver'
Pl.Pase notify the individual identified above that his/her FAX Transmition has
been received. If you did not receive the entire transmition, please call us at
( 1 a) 933-4302 as soon as possible. Thank you.
Transmitted From
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P Vie~ Ask Report Create Modify Image ·Forms Tools Scripts Exit ee[±Jeeeeeeeeeeeeeeeeee WELL DRILLER REGISTRATIONS 1994 eeeeeeeeeeeeeeeeeee[Je£
a O -----------------------------------0 REGISTRATION NO.
a REC#: 221 ° WELL DRILLER REGISTRATIONS FOR 1994 ° 9 Y
a O -----------------------------------0 DATE OF REGISTRATIONY
a O O 1/06/94 Y aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaY
a Y
OCONTRACTOR NAME OR SIGNING OFFICIAL: HUDSON Y
OCOMPANY NAME: HUDSON WELL CO INC Y
OADDRESS: PO BOX 05 CITY: ROUGEMONT STATE: NC ZIP: 27572 Y
a Y
OCOUNTY: DURHAM REGION: RRO CONTRACTOR PHONE NO.: 919 477 3708 ± aeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeY a . Y
OREGISTRATION CLASS (N,R,O,I): R BUSINESS CLASS (I,P,C,N): C Y
a NO. OF DRILL RIGS: 1 Y
OWELL TYPES (D,M,P,I,O): D,P Y
a NO. OF WELLS DRILLED: 163 Y aeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeY
a Y
OREGISTRATION POSTMARK DATE: 1/05/94 REGISTRATION FEE SUBMITTED: 50.00· Y
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aeeeee 221 of 448 eeeeeeeeeeeYYYYYYYYYYYYYYYYYYYYYYY±YYYYYYYYYYYYYYYYYYYYYYYai
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