WI0500030_GEOTHERMAL_20150914

AT'A
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Howard Moody
115 Carpathian Way
Raleigh, NC 27615
Re: Geothermal Permit Renewal Inspection
115 Carpathian Way
Raleigh, NC-Wake County
Permit #WI0500030
Dear Mr. Moody:
September 14, 2015
f<ECEIVED/DENR/DWR
SE P 1 6 2015
water Quality Regional
Operations Section
Donald R. van der Vaart
Secretary
A groundwater sample was collected from your geothermal well system and submitted to the Division of
Wa~er Resources Chemistry Laboratory for analysis on July 4_4, 2015. Samples were collected at the influent
(sample #AC21278) and effluent (sample #AC21279) ports.
The sample analysis report (attached) indicate that that the. following substances (but not limited to) were
detected in the samples: Zinc was detected at 14 parts per billion (ug/L) in the influent sample and 13 ug/L in the
effluent sample. Barium was detected at 42 ug/L in the influent sample and 41 ug/L in the effluent sample. The
detections do not exceed the 15A NCAC 02L .0292 groundwater standard for Zinc and Barium established at 1000
ug/L and 700 ug/L respectively.
A copy of the test results will be sent to the Department ofHealth and Human Services,.Occupational and
Environmental Epidemiology Branch for a drinking water health risk evaluation regarding the use of the water. A
copy of the evaluation will be mailed to you to following receipt of the report by this office.
If you have any questions regarding the results please contact me at [phone].
c: file
Wake County Health Department
Sincerely,
Eric Rice, Hydrogeologist
Division of Water Resources
Water Quality Regional Operations
Raleigh Regional Office
Central Office-DWR, Animal Feeding Operations and Groundwater Protection Branch (Michael Rogers)
Division of Water Resources, Raleigh Regional Office, Water Quality Operations Section http://portal.ncdenr.org/web/wq/aps
1628 MailService Center, Raleigh, NC 27699-1628 Phone: [phone]
Location: 3800 Barrett Drive, Raleigh, NC 27609 Fax: [phone]
An Equal Opportunity \ Affirmative Action Employer -Made in part by recycled paper
'ECEIVEDIDENPJDWR
= i ZOs5
y‘9°
North Carolina division of Water Resources
'_ Water Sample Co1(0ction 8:Submittal Form
Central La (Water Sciences Section)
"7.
u �f" f7. s,
?'
7oq
"�
'$ :••:.
• C�ib�(Is"e OpJ ' -_,
" Laboratory T'.=s_
1,4
:w�.��7
ototl G-
s 01Z s Wo 30
-�meera 29
4ionD4ir!on .
^-�
�/SCh„QP,d�`I`/ T j t/ �9 [ ( Z 1 6/[�
' C•
! (y�1 [
f .c
�/• 5y
*Cavntyr'i4
Ca,rcta
P 1or1t
W
Local ri
•
;�
� 1
``
ee etrl
a17
•;`�
e.s + R ,.p an: �'�
r f ]
OIVJt ce:
R !�
❑Ambient
m Qtae
Rt3
iieulve •
,....rt •r ,--"
'f .le?1+�1'J'v=='[l1�[t
—��/V_■I
°mr) '
1 fcD
❑ Surface
]Cana
stuary f
.'....,
k.:.
rl7ve
' °'e -._g
r-�
LJ Dunne
❑Stormwater
';V rrehred By } i TO
/ 'ems
+-:
7�x `� d1 a�S�
❑Compliance
❑MonitoringWeil
_ UStale Courier
-
NOME ,in. ciao,-
C,�
P."'`-in • . ji, ., �
`�r ?e Tithe:. 4LI•❑Waste
COC
round
ate►Supply
❑Effluent ❑influent
•:*'
active _ atl: ❑Nand Delivery
:'d ' i El Other:
Chtornatd ❑qe chluritaled in Field
nsn.�"
9
6 UComposie
— Other:
❑Emergency
❑Blank
[Fleid Blank
[hip Blank
QFliter Blank
ea. ,,„❑
°pci�
Temp rrtur C.
Dissolved analysis: Enter'0I5"
❑ Filtered in Field
in dKck•bates for parameters
-: • '
SRmor., p ?r , _
! fl =1 F':+...
{2 nF-n-. w�
DOA
[]Solution
❑other.
nhirAral:.-'
;
' ::- ! _ . �, ...
o
rec., r' Comm n •
'
a►`l±li
•
■ati4ir r
mr',IHlaOtildki:i0Pgartiaters
ti�
M$A5'surfactants) mg/L
/
WletiliiwyKtehv. +"-, +: • ;. "�' ,
_
Tin (SO }rgl'L
Acidity, as CaCO3, LC pH 4.5/3.3 mg/L
Oil and Grease, HEM, Total Recoverable mg/i.
ti/
Aluminum (Al) pg/L
Titanium (Ti) pg.&
Alkalinity, as CaCO3, to pH 4,5/8.3• mg/L
Phenols. Total Recoverable . pg/L
Antimony (5b) 1Jg/L
Vanadium (V) ug/L
BOO: Biochemical Oxygen Demand, s•day mg/L
Residue: Total (Total Solids} mg/L
Arsenk (As) pg/L
Zinc (Zn) Pg/L
cacao: Carbonaceous BOD, 5-day mg/L
Residue: Volatile/Fixed, Total mg/L
Barium (Ba) IJg/L
Collform: Fecar NSF /1OOm1
Residue: Suspended (Suspended Solids) mg/L
Beryllium [Be) • pg/L
Boron (B). Total µg/L
Callform: Total MF /1COm1
Residue: VOIatlle/Flxed. Suspended mg/L
Cadmium (Cd) lig/L
Mercury 1631, low-level ng/L
Conform: Tube Fecal /lOOml
ins - Total Dissolved Solids mg/L
Cakium (Ca) mglL
Conform: Tube Total /1Wm1
Silica mg/L
•
Chromium (Cr), Total pg/L
i,4$o¢gAnlcs,P,grihi€ceps: jiarrg'
Specific Conductance, at 25 °C umhes/ua
Sulfide mg/I.
Cobalt (Co) }t fIL
Add lierbiddrs
IOC- total Organk Carbon mg/L''
Tannin & Llgnln a rnj1t
Copper (Cul pg/L
Organochiorlrie Pesticides
rTurbidity NTU
Iron (Fe) tI /L
Organonitrogen Pesticides
`1:
ptheF meters: ? _:
Lead (Pb) )Jg/L
organaphosphorus Pesticides
etjChe�nl'stry"; i ash tern: �'• h``
pH s.u.
lithium 0 4 ug/L
t CBS (polychlorinated biphenyls)
Bromide mg/L
Hardness, Total as CaCO3 - by titration mg/L
MagL nesium'Mg) mgl
�
Yr
Chloride mg/L
Manganese(Mn) :pg/L
Semi -Volatile Organics'BNAs)
Fluoride mg/I.
Mercury (Hg) .pg/L
TPH Diesel Range
r
Sulfate mg/I.
lut"rJerets�0:1iinet0s: - ' iaffliffiEgli
,,
Molybdenum (Mol _ IiBIL
Chlorophyll a Ail
Ammonia as N1NIt3-N) mg/I
4
Nickel (Ni) NgfL
Volatile 0rpanits (VOA)
Color: ADMt cu.
'Nitrate -Nitrite as N (NO3+N01-N( mg/L
Potassium (9 mg/L
Color, Platinum Cobalt c.u.
Rai KJeldahl Nitrogen as N (TICK mg 1.
Selenium (5e) ' IlgIL
TPH Gasoline Range
COD: Clremltal Oxygen Deming mg/L
_
Total Phosphorus as P VP) rnp/L
Silver (Ash Pa
Cyanide, Total mg/L
Nitrite as N (NO -N) mgll.
Sodium (Na) MIA
.
alblellaiMEavitZgigiMrs*Sitgal
Phytoplankton / Algae
Formaldehyde rng/L
Nitrate as N (NCG-N calculated} mg/L
Strontium (sr) pg/1.
Hexavafent Chromium (Ctrs+) mg/L
,Nitrate
as P (PD4) mg/L
Vt1 Thallium (TI) 'Pe -
LAB COMMENTS :
r. .md~
Field•ParameterstnRrinnolJ:
Revision:2/1360
.i1V j ? , 3
L "hj �' 0solVed:[]iiYB Q I
•
Firms °nu• •• lJ tmr ' a niintstj

----------------------------------------------------
AC21279 NC QYW~ Water Sciences Section-Cnemistry £a6oratory ~sufts
County: WAKE
River Basin
Report To RRO
Coflector: E RICE
Region: RRO .
Sample Matrix: GROUNDWATER
Loe. Type: WATER SUPPLY
Emergency Yes/No
COC Yes/No
I Location ID: 5P09~WI0500030
DWR
Division of Water Resources
Final Re port
VlsitlD
Loe. Descr.: HOWARD MOODY
I Collect Date: 07/24/2015
Sample ID:
PO Number#
Date Received:
Time Received:
Labworks LoginlD
Final Report.Date:
Report Print Date:
I coilect Time: 13:40
AC21279
15W4690
07/24/2015
14:40
TASCENZ01
8/21/15
08/21/2015
I Sample Depth I
If this report is labeled preliminary report, the results have not been validated. D_o not use for Regulatory purposes.
CAS#
LAB
WET
Analyte Name
Sample temperature at receipt by lab
7440-62-2 Ion Chromatography
Fluoride
Chloride
Bromide
Sulfate
NUT
NO2+NO3 as N in liquid
MEi
7440-22-4 Ag by ICPMS
7429-90-5 Al by ICP
7440-36-0 Antimony by ICPMS
7440-38-2 As by ICPMS
7440-38-3 Ba by ICP
7440-41-7 Be by ICP
7440-70-2 Ca by ICP .
7440-43-9 Cd by ICPMS
7440-48-4 Cobalt by· ICP
7440-47-3 Cr by ICPMS
7440-50-8 Cu by ICPMS
7439-89-6 Fe by ICP
7439-97-6 Hg 245.1
7440-09-7 K by ICP
7439-93-2 Li ICP
7439-95-4 Mg by ICP
7439-96-5 Mn by ICP
7439-98-7 Mo by ICPMS
7440-23-5 Na by ICP
7440-02-0 Ni by ICPMS
0.4
1.0
0.4
2.0
0.02
1.0
50
10
.2.0
10
5.0
0.10
0.50
50
10
2.0
50
0.2
0.10
25
0.10
10
10
0.10
2.0
Result/
Qualifier
4.2
_TITLE_
0.4U
5.5
0.4U
2.0 U
1.2
1.0 U
sou
10 U
2.0U
41
5.0 U
5.5
o.sou
sou
10 U
110
sou
0.20U
1.6
25 U
1.6
12
10 U
7.9
9.0
Units
oc
mg/L
mg/L
mg/L
mg/L
mg/L
mg/Las N
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
mg/L
ug/L
ug/L
ug/L
ug/L
ug/L
ug/L
tng/L
ug/L
mg/L
ug/L
ug/L
mg/L
ug/L
Method
Reference
EPA 300.0 rev2.1
EPA 300.0 rev2.1
EPA 300.0 rev2.1
EPA 300.0 rev2.1
EPA 300 .0 rev2.1
Analysis Validated by
Date
7/24/15 MSWIFT
8/6/15 RBYRD
8/4/15 RBYRD
8/4/15 RBYRD
8/4/15 RBYRD
8/4/15 RBYRD
EPA 353.2 REV 2 7/29/15 CGREEN
EPA200.8 8/7/15 ESTAFFORD1
EPA200.7 8/10/15 ESTAFFORD1
EPA200.8 8nt15 ESTAFFORD1
EPA-200 ,8 8/7/15 ESTAFFORD1
EPA200.7 8/10/15 ESTAFFORD1
EPA200.7 8/10/15 ESTAFFORD1
EPA200.7 8/10/15 ESTAFFORD1
EPA200.8 · 8/7/15 ESTAFFORD1
EPA200.7 8/10/15 ESTAFFORD1
EPA200.8 8/7/15 ESTAFFORD1
EPA200.8 8/7/15 ESTAFFORD1
EPA200.7 8/10/15 ESTAFFORD1
EPA245.1 7/29/15 · ESTAFFORD1
EPA200.7 8/10/15 ESTAFFORD1
EPA200.7 , 8/1 Q/15 ESTAFFORD1
EPA200.7 8/10/15 ESTAFFORD1
EPA200.7 8/10/15 ESTAFFORD1
EPA200.8 8/7/15 ESTAFFORD1
EPA200.7 8/10/15 ESTAFFORD1
EPA200.8 8nt15 ESTAFFORD1
WSS Chemistl'y Laboratory>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed description ~f the Qualifier codes refer to <htto :/ /nortal.ncden'r. org/web/wa/ ons/methods-and-oals>
Page 1 of 2
!JfC <D~ £a6oratory Section <R§su(ts
Location ID: 5P092WI0500030 Sample ID: AC21279 Collect Date: 07/24/2016 Collect Time:: 13:40
MET
CAS#
7439-92-1
7782-49-2
7440-31-5
7440-24-6
7440-28-0
7440-32-6
7440-62-2
7440-66-6
Ana lyt e Name PQL Result/ Units Method Anal~sis
Qualifier Reference o·ate
Pb by ICPMS 2.0 3.9 ug/L EPA200.8 8/7115
Se by ICPMS 5.0 5.0U ug/L EPA200.8 817/15
Sn by ICPMS 10 10 U ug/L EPA200.8 8"/15
Srby ICPMS 10 36 ug/L EPA200.8 8"/15
Thallium (Tl) ICPMS 2.0 2.0 U ug/L EPA200.8 8"/15
Ti (Titanium) by ICP 10 10 U ug/L EPA200.7 8/19/15
Vby ICP 25 25U ug/L EPA200.7 8/10/15
Zn by ICPMS 10 13 ug/L EPA200.8 8"/15
WSS Chemistry Laboratory>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For. detailed descriDlion of the aualifier codes refer to <htto :/ /oortal.ncdenr. ore/web/wa/ oos/methods-and-oals>
Page 2 of 2
Validated by
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFOR.O1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAfFORD1
ivAJy��y
qi/y
711- ai sr
�s
1.46 COMMENTS
'Fie@ Parantetersieprianep
'(ti p atn 3.3
� c Lit (pprii):---1
Condu m [m
Revisions 2/06/2035

AC21278 NC (l)~ 'Water Sciences Section-Cliemistry £a6oratory <.R§sults
Coun~: ~
River B1;1sln
Report To RRO
Collector: U!£§
Region: .BJiQ
Sample Matrix: GROUNDWATER
Loe. Type: .• WATER SUPPLY
Emergency Yes/No
COO Yes/~o
I Location ID: &PD92WI06DDD30
DWR
Dlvlslc,n ~.f. Water Res_our,es
Final Report ·
VlsltlD
Loe. ·Descr.: U9YYABP MQOPY
I· Collect pate: 07/24/2016
Sample ID:
PO Number#
Date Received:
Time Received:
Labworks LogtnlD
Flnal Report Date:
Rep~,rt Print Date:
I Collect Time: 13:30
AC21278
16W468$
O7/24i2016
14:40
TA,C~NZ01
8/21/15;
()8/21 /~0-15
I Sample Depth I
If this report Is labeled prellm-,nary report, the results have not been validated. Do not use for Regulatory purposes.
CAS # Analyte Name
LAB
Sample temperature at .receipt by lab
WET
Ion Chromatography
Fluoride 0.4
Chloride 1.0
Bromide 0.4
Sulfate 2.0
NUT
NO2+NO3 as N In llquld 0.02
MET
7440-22-4 Ag by ICPMS 1.0
7429-90-5 Al by ICP 50
7440;.36-0 Antimony by ICPMS 10
7440-38-2 As by ICPMS 2.0
7440-38-3 Ba by ICP 10
7440-41-7 Be by ICP 5.0
7440-70-2 Ca by ICP 0.10
7440-43-9 Cd by ICPMS 0.60
7440-48-4 Cobalt by ICP 50
7440-47-3 Cr by ICPMS 10
7440-50-8 Cu by ICPMS 2.0
7439-89-6 Fe by ICP 50
7439-97-6 Hg 245.1 0.2
7440-09-7 K by ICP 0.10
7439-~3-2 Li ICP 25
7439-95-4 Mg by ICP 0.10
7439-96-5 Mn by ICP 10
7439-98-7 Mo by ICPMS 10
7440-23-5 Na by ICP 0.10
7440-02-o Ni by ICPMS 2.0
Resu1t1·
Qualifier
4.2
·_TITLE_
0.4U.
4.8
0.4U
·2.ou
1.2
1.0U
sou
10U
2.0U
42
6.0U
o.sou
sou
10U
2.0U
SO·U
0.20U
1.6
25U
1.6
10U
10U
8.2
2.0U
Units Method Analysis YaHdgted by
Reference Date
7/24/16 MSWIFT
mg/L EPA 300.0 rev2.1 8/6/15 RBYRD
mg/L EPA 300.0 tev2.1 8/6/15 RBYRD
mg/L EPA 300.0 rev2.1 8/6/16 RBYRD
mg/L EPA 300.0 rav2.1 8/8/16 RBYRD
mg/L EPA 300.0 r~.1 8/8/15 RBYRD
'!19/L as N EPA 353.2 REV 2 7/29/15 CGREEN
ugiL EPA200.8 8"/15 ESTAFFOR01
ug/L EPA200.7 8/10/15 ESTAFFOR01
ug/L EPA200.8 8/7/16 ESTAFFORD1
Ug/L EPA200.8 Bll/15 ESTAFFORD1
ug/L EPA200.7 8/10/15 ESTAFFORD1
ug/L. EPA200.7 8/10/15 ESTAFFORD1
mg/L ·EPA200.7 8/10/15 ESTAFFORD1.
ug/L EPA200.8 8/7/15 ESTAFFORD1
Ug/L EPA200.7 8/10/15 ESTAFFORD1
ug/L EPA200.8 817/15 ESTAFFORD1
ug/L EPA-200.8 Bn/16 ESTAFFORD1
Ug/L EPA200.7 8/10/15 ESTAFFORD1
ug/L EPA245.1 7/29/15 ESTAFFORD1
mg/L EPA200.7 8/10/16 ESTAFFORD1
ug/L EPA200.7 8/10/15 ESTAFFORD1
mg/L EPA200.7 8/10/15 ESTAFFORD1
ug/L EPA200.7 8/10/15 ESTAFFORD1
Ug/L EPA200.8 8/7/15 ESTAFFORD1
mg/L EPA200.7 8/10/15 ESTAFFORD1
Ug/L EPA200.B 8ll/15 ESTAFFOR01
WSS Chemistry Laboratory» 1623 Mall Service Center, Raleigh, NC 27699-1623 (919) .733-3908
For I datallad de1Cflptlon of Iha QUlllffer cod•• ref~r to <htto :'! /oortal.ncdenr, or2'w~b/wa/ ops/methods-and-pals>
Page 1 of 2
••
:NC <D'f4'\1{. £a6oratory Section <.R.§su{t'S
Location ID: 5P092WI0500030 Sample ID: AC21278 Collect _ Date:. 07/24/2016 Collect Time:: 13:30
MET
CAS# Ana(yt e Name PQL Result/ . · Units Method Analysis Validated by Qualifier Reference Date
7439;.92-1 Pb by ICPMS 2.0 2.01.i · ug/L . EPA200.8 8/7/15 ESTAFFORD1
778T-'4'9-2 SebylCPMS 5.0 5.0 _U ug/L EPA200.8 8/7/1.5 ESTAFFORD1
7440-31-5 Sn by ICP,MS 10 10 U ug/L EPA200.8 8/,7/15 ESTAFFORD1
7440-24-6 Srby ICPMS 10 35 ug/L \... EPA200.8 8/-7/15 ESTAFFORD1
7440-28-0 Thallium (Tl) ICPMS 2.0 2.0U ug/L EPA200.8 817/15 ESTAFFORO1
7440-32-6 Ti (Titanium) by ICP 10 10U ug/L EPA200.7 8/19/15 ESTAFFORD1
7440-62.;2 V by ICP 25 25U ug/L EPA200.7 8/10/15 ESTAFFORD1
7440-66-6 Zn by ICPMS 10 14 ug/L EPA200.8 8/7/15
WSS Chemistry Laboratory» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone]
For a detaUed d88cri0tl0n of the auatlfier cod11 refer to <htto:/ /oortal.ncdenr.orwweb/wa/oos/tnethods-and-oals>
Page· 2 of 2
ESTAFFORD1
I
Permit Number
Program Category
Ground Water
Permit Type
WI0500030
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SWRule
Permitted Flow
Facility
Facility Name
Howard and Mary Frances Moody SFR
Location Address
115 Carpathian Way
Raleigh NC
Owner
Owner Name
Howard E
Dates/Events
Orig ls.sue
6/21/1999
App Rec~ived
7/8/2015
Reg ulated Activities .
Heat Pump Injection
Outfall
Waterbody Name
27615
Moody
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS
Permit Tracking Slip
Status
In review
Project Type
Renewal
SWP
8/20/2015
Version Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Howard E. Moody Jr.
115 Carpathian Way
Raleigh
Region
Raleigh
County
Wake
NC
Issue Effective
27615
Expiration
Req uested /Received Events
RO staff report requested
RO staff report received
Streamlndex Number Current Class
7/9/15
8/12/15
Subbasin
ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
August 21, 2015
Howard E. and Mary F. Moody, Jr.
115 Carpathian Way
Raleigh, NC 27615
Re: Issuance of Injection Well Permit
Permit No. WI0500030
Geothermal Heating/Cooling Water Return Well
Wake County
Dear Mr. aiid Mrs. Moody:
Donald R. van der Vaart
Secretary
In accordance with your permit renewal application received July 8, 2015, I am forwarding Permit
No. WI0500030 for the continued operation of geothermal heating/cooling water return well(s)
located at the above referenced address. This permit shall be effective from date of issuance until
July 31.2020, and shall be subject to the conditions and limitations stated therein.
PleaseNote:
• Samples from the influent and effluent sampling ports of your geothermal well system
were collected on July 24, 2015. Laboratory analytical results will be forwarded to you
when it becomes available.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit 120 days prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water Resources. If you have any questions regarding your permit or the Underground
Injection Control Program please call me at [phone].
Best Regards.
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
Division of Water Resources, NCDENR
Water. Quality Regional Operations Section
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: 91g-8E 7.64641 Internet: httpJiwww.ncwater.org
An Equal Opportunity I Affirmative Action Employer — Made +n part by recycled paper

Howard and Mary Moody, Jr.
cc: Danny Smith and Rick Bolich, Raleigh Regional Office
Central Office File, WI0500030
Wake County Environmental Health Department
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT.FOR THE USE OF A WELLFOR INJECTION .
In accordance with the provisicms ofArticle 7, Chapter 87; Article_21, Chapter 143; and other applicable
Laws; Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Howard E. and Mary F. Moody; Jr.
FOR THE CONTINUED OPERATION. OF 2 (TWO) GEOTHERMAL HEATING/COOLING WATER
RETURN WELL(S), defined in Title 15A North Carolina Administrative Code ·02C .0224(a),. which will be
used -for the ·injection of.heat pump effiue!J.t. · The injection well(s) located at 115 Carpathian Way, Raleigh,
Wake County, NC 27615 will be o·perated in accordance with the application_ submitted July 8, 2015, and
conformity with the specifications and supporting data received, 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 continued 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 July 31, 2020, and shall be
subject to the specified conditions and limitations set forthin this permit.
Permit issued thisthe·21st day of August 2015 .
.(JrAJ~~
J(l S. Jay Zimmerman,.P.G . . t Director,Division of Water Resources
By Authority of the Environmental Management Comniission.
Pennit#WI0500030 UJC/5A7
ver. 04/15/20 l 5
Page 1 of 5
PART I -PERMIT GENERAL CONDITIONS
1. The Permittee shall comply with all conditions ofthis permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94
2. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [15A NCAC 02<;: .021 l(a)].
3. 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 d~ta [15A NCAC 02C .0211(1)].
4. This permit is not transferable without prior notice and approval. 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; including any supporting materials as may be appropriate, at least 30 days
prior to the date of the change [15A NCAC 02C .021 l(q)].
5. The issuance of this permit shall not relieve the 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 [15A NCAC 02C .0203].
PART II -WELL CONSTRUCTION GENERAL CONDITIONS
1. The well supplying water for the geothermal heating and cooling system shall be constructed m
accordance with the requirements of rule 15A NCAC 02C .0107 except as required in Item #2 below.
2. Any injection well shall be constructed in accordance with the requirements of rule 15A NCAC 02C
.0107 except. that the entire length of the casing shall be grouted in such a way that there is no
interconnection of aquifers or zones having differences in water quality that would result in degradation of
any aquifer or zone. For screened wells, grout shall be em placed from the top of the gravel pack to the
land surface. For open-end wells, the casing shall be grouted from the bottom of the casing to the land
surface [15A NCAC 02C .0224(d)(2),(3)].
3. Bentonite grout shall not be used to seal any water-bearing zone with a chloride concentration equal to or
greater than 1,500 milligrams per liter. In areas where elevated chloride levels are known to exist or are
probable, such as coastal areas, chloride levels shall be verified in the field · to determine existing
conditions. [15A NCAC .0225(g)(8)].
4. The injection well system shall be constructed such that a sampling tap or other collection equipment
approved by the Director provides a functional source of water when the system is operational. Such
equipment shall provide the means to collect a water sample immeaiately after emerging from the water
supply well and immediately prior to injection into the return well [15A NCAC 02C .0224(d)(4)].
5. Each well shall be secured to reasonably insure against unauthorized access and use and shall be sealed
with a watertight cap or :"ell seal as defined in G.S. 87-85(16).
6. Each well shall have permanently affixed an identification p]ate [15A NCAC 02C .01070)(2)].
Pennit #WI0500030 UIC/5A7
ver. 04/15/2015
Page 2 of 5
7; A completed Well Construction Record (Form GW-1) shall be submitted as descrioed in Part V.5 of this
permit.
PART III-OPERATION AND USE CONDITIONS
1. The Pennittee shall comply with the conditions of this permit and properly operate and · maintain the
injection facility in compliance with the conditions of this permit and the rules of lSA NCAC 02C .0200;
even if compliance· requires a reduction or elimination of the permitted activity [ISA NCAC 02C
.021 IG)J.
2. The issuance of this permit shall not relieve the Permittee of the responsibility for damages· to surface
water· or groundwater resulting from the operation of this facility. In the event that the facility fails to
perform satisfa~torily, including the creation of nuisance . conditions or failure of the injection zone to
adequately assimilate the injected th.rid; the Pennittee shall take immediate corrective actions thatmay be
required, such as the -repair, modification, or abandonment of the injection facility [15_A _NCAC 02C
.0206]. ·
PART.IV ~INSPECTIONS [15A NCAC 02C ~021 l(k)]
1. Any dulyauthorized officer,.employee,.or representative of the Division of Water Resources (DWR) may,
upon presentation ·of credentials, enter and -inspect any-property, premises, or place on · or related to the
injection facility at any reasonable time for the purpose ·of determining compliance· with. this perm.it,. may
inspect or copy any records . that inust be . maintained under the terms and conditions of this permit, and
niay obtain· samples of groundwater, surface water, or injection fluids.
2. DWR representatives .shall have reasonable access for purposes of inspection~ observation, and sampling
associated with injection and any related facilities as provided for in N.C:.G.S. 87-90.
3. Provisions shall be made for coHecting any necessary samples of the: injection facility's activities.
P~RT V --MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction; repair, or abandonmen,t shall be submitted within 30 days · of completion of
such activities. Copies of such records: shall be retained on-site and available for inspection [15A NCAC
02C ·.0224(±)(2), ( 4)].
2. Monitoring of any well may be required to ensure protection of the groundwater resources of the State
and compliance with the groundwater quality standards specified in 15A NCAC 02L [l5A NCAC 02C
· . 02~4( f)( 1)].
3. The Pennittee shall report any monitoring or _ other information that indicates noncompliance with a
specific permit condition,. that a contaminant niay cause. a· violation of applicable groundwater quality
standards, or that a ·nialfunction of the injection system may cause _the injected fluids to migrate outside
the approved injection : zone or area. As specified in .rule 15A _NCAC 02C .021 l(r), noncompliance
notification shall be as follows:
(A) ·oral notification shall be given within 24 hours · of the occurrence, or first knowledge of the
occurrence, to the Raleigh Regional Office, telephone number 919~ 791-4200.
Permit #WI0500030 UIC/5A7
ver. 04/15/201.5
Page 3 of 5
(B) Written notification shall be made within five days of the occurrence and submitted tJ the
addresses in Item #5 below.
(C) The written notification shall contain a description of the noncompliance and its cause; the period
of noncompliance, including dates and times; if the noncompliance has not been corrected, the
anticipated time it is expected to continue; and any steps taken or planned to reduce, eliminate, and
prevent reoccurrence of the noncon1pliance.
4. The Permittee shall record the riumber and location of the wells with the register of deeds in the county in
which the facility is located. [15A NCAC 02C .0224(f)(3)].
5. All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff
Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Water Quality Regional Operations Section
DWR Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699
PART VI-PERMIT RENEWAL [15A NCAC 02C .0224(c)]
As required by rule an application for permit renewal shall be made at least 120 days prior to the
expiration date of the permit. · This permit condition does not apply if the Permittee chooses to
discontinue operation of the well for injection of effluent from the geothermal heating and cooling system
associated with this permit.
PART VII-CHANGE OF WELL STATUS [15A NCAC 02C .0240]
1. Procedures for temporarily or permanently abandoning a well are the same as those specified in rule 15A
NCAC 02C .0113. While some of those criteria are given below, the Permittee bears the responsibility of
complying with all applicable regulatory requirements.
2. If a well will no longer be used for any purpose, then it should be permanently abandoned according to
rule 15A NCAC 02C .Ol 13(b) in order to prevent the well from deteriorating and acting as a source or
conduit of contamination, which is prohibited by General Statute 87-88(c ).
3. If a well is taken completely out of service temporarily, the Permittee shall install a water-tight cap or well
seal that cannot be removed without the use of hand or power tools.
4. When injection operations have ceased at the facility and a well will no longer be used for any purpose,
the Permittee shall permanently abandon that injection well in accordance with the procedures specified in
15A NCAC 02C .0113(b), which in?lude, but are not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
such rem.oval 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.·
Penn it #WI0500030 UIC/5A7
ver. 04/15/2015
Page 4 of 5
(C) Each well shall be thoroughly disinfected prior to sealing in accordance with rule 15A
NCAC 02C .0l l l(b)(l)(A),(B), and (C)~
(D) Each well shall .be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In those cases when a subsurface cavity has been created as a result of the injection
operations,. each· wen · shall be abandoned in such a manner that will prevent the
movement of fluids into or between underground sources of drinking water.
(F} The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
ISA NCAC 2C .0224(f)(4) within.30 days of completion of abandonment.
5. The written docum_entatiori required in Part VII ( 4)(F) shall be submitted to the -addresses specified in Part
V.5 above.
Permit #WI0500030 UIC/5A7
ver. 04/15/2015
Page 5 of 5
Pat McCrory
Governor
I JJ_HI~ . ... ·.l1·····.·.·.· .... . ~ . . ' . . . . '
NCDEHR
North Carolina Department of Environment and Natural Resources
Donald R. van der Vaart
RECEIVED/OEN RID Secretary
August 10, 2015
Memorandum
AUG 1 2 2015
Water Quality Reg~onat
Operations Section
To: Michael Rogers
WQROS, Animal Feeding Operations and Groundwater Protection Branch
From: Eric Rice(/(..
Water Quality Regional Operations, Raleigh Regional Office
Through: Rick Bolich, Assistant Regional Supervisor ~ '{),
Water Quality Regional Operations, Raleigh ~ional Office
Subject: Geothermal Water Return-Renewal
Howard & Frances Moody SFR
115 Carpathian Way
Raleigh, N.C.-Wake County
Permit# WI0500030
Enclosed is the regional staff report regarding the submittal of a permit renewal
application for a geothermal water return system at the above listed address in Raleigh, N.C.
Influent and effluent samples were collected with pending report results. Please contact me at
[phone] if you have any questions about the staff report.
cc: file
Attachment: WQROS form
Division of Water Resources, Raleigh Regional Office, Water Quality Operations Section http://portal.ncdenr.org/web/wq/aps
1628 Mail Service Center, Raleigh, NC 27699-1628 Phone: [phone]
Location: 3800 Barrett Drive, Raleigh, NC 27609 Fax: [phone]
An Equal Opportunity \ Affirmative Action Employer -Made in part by recycled paper
I •
WATER QUALITY REGIONAL OPERATIONS STAFF REPORT
Date: August 10, 2015 County: Wake
To: WQROS AFO-GPB Permittee: Howard & Mary Moody
CO Reviewer: Michael Rogers Facility Name: Howard & Mary Frances Moody SFR
Regional Office Inspector: Eric Rice Permit # WI0500030
L GENERAL INFORMATION
1. This application is (check all that apply): D New IZ! Renewal
D Minor Modification D Major Modification
0 Surface Irrigation O Reuse·□ Recycle O High Rate Infiltration O Evaporation/Infiltration Lagoon
D Land Application of Residuals
D Distribution of Residuals
D Attachment B included
D Surface Disposal
D 503 regulated D 503 exempt
D Closed-loop Groundwater Remediation IZ! Geothermal Water Return
Was a site visit conducted in order to prepare this report? IZ! Yes or D No.
a. Date of site visit: July 24, 2015
b. Person contacted and contact information: Howard Moody
c. Site visit conducted by: E. Rice
d. Inspection Report Attached: D Yes or IZ! No.
2. Is the foliowing information entered into the BIMS record for this application correct?
IZ! Yes or D No. If no, please complete the following or indicate that it is correct on the current application.
For Disposal and Iniection 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. Looa-tioa(s):
b. La-titeae: Loagiteae:
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:
IZ! Heating/cooling water return flow
D Closed-loop heat pump system
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5L/''Non-Discharge")
D Other (Specify: )
FORM: WI0500030
WATER QUALITY REGIONAL OPERATIONS STAFF REPORT
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)?
pollution source(s)?
What is the distance of the injection well(s) from the
4. Quality of drainage at site: D Good
5. Flooding potential of site: ~ Low
~ Adequate D Poor
D Moderate D High
V. EVALUATION AND RECOMMENDATIONS
I
1. Provide any additional narrative regarding your review of the application.: System consists of three wells. One
influent well (also used as a water supply well) and two injection (effluent) wells. Mr. Moody indicated the
second injection well was added because the first effluent well installed was not adequate to handle the
injection volumes. It was stated that one of the two effluent wells which will be known as effluent well #1 for
this report is the primary well. Valves located inside the home can be mechanically altered to adjust the volume
of effluent to each injection well. At the time of the inspection effluent well # 1 appeared to be at capacity and
was discharging to the surface. A bleed hole on the wellhead piping was discharging a steady stream of water
including additional discharge from around the wellhead capping. A significant amount of iron staining and
other material (iron bacteria?) were noted covering a part of the outside of the surface casing. The effluent
sample was collected from this wellhead (#1). At effluent well #2 the cutoff valve was turned in the direction of
off and water was noted to discharge from the spigot at this well head indicating it was receiving some effluent
waters at the time of inspection. The grout on one side of effluent well #2 appears to have slump below grade.
A probe was used to check grout depth. No competent material was noted to about four feet. Samples were
collected for NO2 + NO3 as N, Chloride, and metals from the influent well and effluent injection well #1. It
should be noted that pH was measured at 5.33 in the influent field sample and 4.79 in the effluent field sample.
2. Do you foresee any problems with issuance/renewal of this permit? D Yes ~ No. If yes, please explain
briefly. __ .
3. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
4. 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:
FORM: WI0500030 2
WATER QUALITY REGIONAL OPERATIONS STAFF REPORT
Condition
Reason
5. 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
6. Recommendation: E Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; E Issue upon receipt of needed additional information; tE
Issue- sample results pending; ❑ Deny. If deny, please state reasons:
7. Signature of report preparer(s):
Signature of APS regional supervisor:f,
Date:
Attachments:
FORM: WI0500030 3

WATER QUALITY REGIONAL OPERATIONS"" I'�i8EC'TION_
APPLICATION REVIEW REQUEST FORM
Date:. July 9, 2015 L
Danny Smith and Rick Bolick NC DEN"
-I om: Michael Rogers, WQROS — Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] Entail: [e-mail]
A. Permit Number: WI0500030
B. Applicant: Howard and Mary Moody
C. Facility Name:
D. Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal
E. Comments/Other Information:
❑ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, anchor action. Within 30 calendar days, please return a completed WQROS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact
person listed above.
RO-WOROS Reviewer:
COMMENTS:
Date: l�
NOTES:
RECEIVEDIDENRJDWR
JUL 2015
Water Quality
Faulting Section
FORM: \VQROS-A RR .per. Q926 l 4 Page I of l

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW REQUEST FORM
Date: July 9, 2015
To: Danny Smith and Rick Bolich
From: Michael Rogers, WQROS — Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fa [phone] E-Mail: [e-mail]
A. Permit Number: W10500030
B. Applicant: Howard and Mary Moody
C. Facility Name:
D. Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal
E. Comments/Other Information:
❑ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a completed WORDS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return itto the appropriate Central Office Groundwater Protection Branch contact
person listed above.
RO-WORDS Reviewer:
COMMENTS:
Date:
NOTES:
FORM: WQRDS-ARR ver. 092614 Page i of 1

*TA
INCDERit
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
July 9, 2015
Howard and Mary Moody
115 Carpathian Way
RaIeielt, NC 27615
RE: Acknowledgement of Application No. WF0500030
Geothermal Heating/Cooling Water Return Welt
Wake County
Dear Mr. and Mrs. Moody:
Donald R. van der Vaart
Secretary
The. Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit application and supporting documentation received on July 8. 2015 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 Water Quality Regional Operations Section
(WQROS) requests your assistance in providing a timely and complete response to any additional
information requests.
Please note that processing, standard review permit applications may take as long as 60 to
90 days after receipt of a complete application. If you have any questions, please contact
Michael Rogers at [phone] car [e-mail]
Sincerely,
tieZ
Debra J. Watts, Supervisor
Animal Feeding Operations & Groundwater
Protection Branch
Division of Water Resources
cc: Raleigh Regional Office, WQROS
Permit File WI0500030
1635 Mail Service Center Raleigh. North Carolina 27699-1635
Phone: [phone] Internet htip:llwww.ncwaier,ora
Duel Ii. -M Fe'.^i :Kyced

cf/st/ir
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELL(S1
These well(s) inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
CHECK ONE OF THE FOLLOWING:
New Application Renewal* Modification Permit Rescission Request*
*For Permit Renewals or Rescission Request, complete Pages 1 and 4 (signature page) only
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplere
aa
DATE: ,20 PERMIT NOirirO (leave blank if New Application)
A. CURRENT WELL USE AND OWNERSHIP STATUS (leave blank if New Application)
1. Current Use of Well
a. Continue to use as eothermal Well Drinking Water Supply Other Water
Supply
h. Tenninate Use: If the well is no longer being used as a geothermal injection well and you wish to
rescind the permit, check the box below. If abandoned, attach a copy of the Well Abandonment
Record (GW-30).
❑ Yes, I wish to rescind the permit
2. Current Ownership Status
Has there been a change of ownership since permit last issued? n YES al<6
If yes, indicate new owner's contact information:
Name(s) --
Mailing Address:
City: _ - _State: Zip Code: -
Day Tele No.: Email Address.:
B. STATUS OF APPLICANT (choose one)
Non -Government: Individual Residence
Government:
Business/Organization
County:
State Municipal County Federal
C. WELL OWNER(S}/PERMIT APPLICANT — For individual residences, list owner(s) on property deed_ For
all others, lit name of entity and name of person delegated authority t stign
rj 14) 1,iC1?I >� A 1vile►Zy .f t41 J�
Mailing Address: 1x ��r1, ii-Y — -
City: - 12 r (4 - - - State:Jt G Zip Code: 15 County_ _tgot.eik
Day Tele No.: - 1 11 /P j 4Qb4 Cell No.: 5n711-
EMAIL Address: a{` ose e-ihrer i-.1 t'A) 9. 141' 4 Frastil4o.: 0e f oft
Geothermal Water Return Weil Permit Application (Revised Jan 2015) Paee 1

D. WELL OPERATOR (if different from well owner) -For individual residences, list owner(s) on property
deed. For all others, list name of entity and name of person delegated authority to sign on behalf of the
business or agency: ______________________________ _
Mailing Address: _______________________________ _
City: ____________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: -----------------=E=m=a1=·1=--=A=-=-=dd=r=-=e=ss=•.a....: ___________ _
E. LOCATION OF WELL SITE -Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: __________ County: _____ _
(2) Physical Address if different than mailing address): ________________ _
City: _______________ State: NC Zip Code: ________ _
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name: __________________________ _
NC Well Drilling Contractor Certification No.: _____________________ _
Company Name: ________________________________ _
Contact Person"'--: _______________ EMAIL Address: ___________ _
Address: ___________________________________ _
City: __________ Zip Code: _____ State: __ County: _________ _
Office Tele No.: ________ ·_Cell No.: Fax No.: ________ _
G. HV AC CONTRACTOR INFO~ TION (if different than driller)
H.
HVAC Contractor's Name: ____________________________ _
NC HVAC Contractor License No.: _________________________ _
Company Name: ________________________________ _
Contact Personc.c_: -----------------'EMAIL Address: ___________ _
Address: ______________ _
City: __________ Zip Code: _____ State: __ County: _________ _
Office Tele No.: Cell No.: __________ Fax No.: _______ _
WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
{I)
(2)
The injection operation?
Personal consumption?
YES ___ _ NO ___ _
.YES ___ _ NO ___ _
I. WELL CONSTRUCTION REQUIREMENTS -As specified in 15A NCAC 02C .0224(d):
(1)
(2)s
The water supply well shall be constructed in accordance with the water supply well requirements of
ISA NCAC 02C .0107.
If a sepc1rate well is used to inject the heat pump effluent, then the injection well shall be constructed
in accordance with the water supply well requirements of 15A NCAC 02C .0107, except that:
Geothennal Water Return _wen Permit Application (Revised Jan 2015) Page2
NOTE: In most cases an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells In relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand Also, a `layer' can be selected showing topographic contours or
elevation data
M. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .02111e) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by all the persons) listed on the property deed.
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am familiar withthe information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, l believe that the information is true, accurate and
complete. 1 am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of
the Permit."
,/
ae
Signature Property Owner/Applicant
Print or Type Full Name
Signature o�erty Owner/Applicant
► �(5 &eU 711
1 Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
Division of Water Resources
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Return Well Permit Application (Revised Jan 2015) Page 4

(a) For screen and gravel-:packed wells, the entire length of casing shall be grouted from the top
of the gravel pack to land surface;
(b) For open-end wells without screen, the casing shall be grouted from the bottom of the casing
to land surface.
(3) A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
____ *EXISTING WELLS PROPOSED WELLS -----
* For existing wells, please attach a copy of the Well Construction Record (Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
( c) Casing depth below land surface
( d) Casing height '"stickup" above land surface
(e) Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited for sealing water-bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .0107(1)(8 )
(f) Length of well screen or open borehole and depth below land surface
(g) Length of sand or gravel packing around well screen and depth below land surface
K. OPERATINGDATA
(1) Injection Rate: Average (daily) ga11ons per minute (gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average (daily) pounds/square inch (psi).
(4) Injection Temperature : Average (January) ° F, Average (July) __ ° F.
L. SITE MAP-As specified in 15A NCAC 02C .0224(b )(4 ), attach a site-specific map that is scaled or otherwise
accurately indicates distances and orientations of the specified features from the injection wel1(s). The site map
shall include the following:
(1) All water supply wells, surface water bodies, and septic systems including drainfield, waste
application area, and repair area located within 250 feet of the injection well(s).
(2) Any other potential sources of contamination listed in 15A NCAC 02C .0107( a )(2 ) located within 250
feet of the proposed injection well(s).
(3) Property boundaries lo~ated within 250 feet of the parcel on which the proposed injection well(s) are
to be located.
(4) An arrow orienting the site to one of the cardinal directions (north, south, west, or east)
Geothermal W ater Return Well Permit Application (!{cvi s c-d .Ian 2015) Page 3
Pat McCrory
Governor
ATA
NCDENR
North Carolina Department of Environment and Natural Resources
May 4,2015
CERTIFIED MAIL # 7014 1200 0001 3432 8473
RETURN RECEIPT REQUESTED
Howard and Mary Moody
115 Carpathian Way
Raleigh, NC 27615
Subject: Notice of Expiration (NOE)
Geothermal Water Retum/Open-Loop Injection Well
Permit No. WI0500030
Wake County
Dear Mr. and Mrs. Moody:
Donald R. van der Vaart
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above -referenced operating permit for the
geothermal injection well system located on your property at the above referenced address was
issued on October 12, 2010, and expires on September 30, 2015. Per permit conditions and
requirements per 15A NCAC 2C .0224(c), the renewal application must be submitted at least 120
calendar days prior to expiration of the permit if you wish to continue operating the injection well
on your property. Please submit your renewal application (attached) as soon as possible if you wish
to continue using the well for injection.
If Your Geothermal Water Return Well is Still Currently Beim Used for Injection:
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit the enclosed renewal
application (Application for a Permit to Construct or Operate Injection Wells — Geothermal
HeatinglCooling Water Return Wells). The form is also available on-line at our website
http: //portal.nedenr. orglwebfwglapslgwprolpermit-appl i cations.
If Your Geothermal Water Return Well_is NO LONGER Beim Used for Injection:
If the well is no longer being used for injection, you do not have to renew your permit. Check the
box in Part A of the attached renewal application that you wish to rescind the permit and indicate
the current status of the well (i.e., used as water supply well, irrigation well, inactive, plugged and
abandoned, etc.). If it is no longer being used for any purpose, it must be permanently abandoned
according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C, Section
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: [phone]\ Internet http:flwww.ncwater.org
An Equal Opportunity V Affirmative Action Employer - Made to part by recycled paper

Howard and Mary Moody Page2
.0240. When the well is plugged and abandoned, a well abandonment record-(Form GW-30) must
be submitted to our office to certify that the abandonment was properly conducted.
If There has been a Change of Ownership of the Pro pe rty :
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change" Form must also be submitted in addition to the renewal application.
This form is not enclosed but can be found at the website listed above~ Please submit the applicable
forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms in a timely manner may result in the assessment of civil
penalties in accordance with North Carolina General Statute 87-94. Thank you in advance for your
cooperation and timely response. If you have any questions, please contact me by phone at (919)
807-6406 or by email at MichaeLRo [e-mail].
Regards,
'~ ~I -
Michael Rogers, P.G. C & FL)
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: Raleigh Regional Office -WQROS w/o enclosures
Central Files -Permit No. WI0500030 w/o enclosures
'NC D`WO f a6oratory Section {Resrr(ts
County: WAKE
River aasin
Report To RROAP
Collector: L MCCARTNEY
Region: RR
Sample Matrix: GBOVNDWATE9
Loc. Type: WATER SUPPLY
Emergency Yes/No
COC Yes/No
Visit D
Loc. Caner.: HOWARD MOODY
Sample 10: AB64250
PO Numberlll 10G0658
Date Received: 1010712010
Time Received: 12:45
Labworks Login(D SMATHIS
Report Generated: 11/4/10
Date Reported' 11/04/2010
Location ID: 5P012W10500030-EFF Collect Date: 1010712010
Collect Time: 10:00
Sample Depth
CAS # Analyte Name
LAB
Sample temperature at receipt by lab
PQL
Res ult/
Qualifier
1.i
.0
Units
Method
Reference Date
Anal 518 Validated by
10/7110 SMATHIS
MIC
Colifarm, MF Fecal in liquid 1 i B2 01 CFU1looml APHA9222D-2001 10nn0 MOVERMAN
Coliform, MF Total in liquid 1 1 B2 Q1 CFU1100mI APHA92225-201h 10/7/10 MOVERMAN
WET
Ion Chromatography TITLE mg1L EPA 300.0 10/13/10 CGREEN
Chloride
1 2.4
m91L EPA 300.0 10/13110 CGREEN
Fluoride 0.4 0.4 U mg/L EPA 300.0 10/13/10 CGREEN
Sulfate 2 2.0 U mgtL EPA 300.0 10113/10 CGREEN
Total Dissolved Solids in liquid
12 54
m9/ APHA254OC-18TH 10/7110 MOVERMAN
NUT
NO2+Np3 as N in liquid
0.02 0.60 rng/L as N Lao10-107-04-1-C 10/11/10 CGREEN
MET
7429-90-5 AI by ICP 50 50 U
ug/L
EPA 200.7 10/13/10 ESTAFFORD1
7440-70-2 Ca by ICP
0.1 5.3 mg/L EPA 200.7 10/12/10 ESTAFFORD1
7440.43-9 Cd by ICPMS
1
1.0 U ug/L EPA 200.E 10/13/10 ESTAFFORDI
7440-47-3 Cr by ICPMS
10 10 U
ug1L
EPA 200.8 10/13/10 ESTAFFORDI
7439.89-6 Fe by ICP
50 50 U
ug/L
EPA 200.7 10/13/10 ESTAFFOROI
7439-95-4 Mg by ICP
0.1 1.4 mg/L EPA 200.7 10/12/10 ESTAFFOROI
7439.96.5 Mn by 1CP
10 10 U
ug/L
EPA 200.7 10/13/10 ESTAFFORD1
7440-23-5 Na by 1CP 0.1 6.3
mg1L
EPA 200.7 10/12110 ESTAFFORDI
7440-02-0 NI by ICPMS
10 15 ug&L EPA 200.8 10/13/10 ESTAFFORDI
7439-92-1
Pb by 1CPMS
10 10 U
ug/L
EPA 200.8 10/13/10 ESTAFFORD1
7440-05-5 Zn by ICP 10 17 up1L EPA 200.7 10/13/10 ESTAFFORO1
RECEIVED
N 1
NO DENA
Raleigh Regional Office
RECEIVED
NC DENR
Raleigh Regional Office
Laboratory SactJon» 1823 Mall Service Center, Raleigh, NC 27599.1823 [phone]
Fur ueIn led desplpl[nn el the qualifier p:.d6s reffir 1a h1I, , 0r1t/.nWlnr ernweplwaAad$iMillIfOACGIRESigiNtil 4s.H!i r GOA% .rilil2 2114A1 odRnr.vrun eW ,30131 RIE141,,(vlitenassiv,
Page 1 of 1

GROUNDWATER F1ELD/LAB FORM
Location code 5 P V,,2 U 1 o 5 cU t C. 5 U- E l f
County L)cJ e
Quad No Serial No.
Lat. Long.
Report To.: ARO, FRO, MRO RRO, aRO. WiRO.
WSRO, Kinston FO, Fed, Trust, Central Off., Other
Shipped by Bus. Courier, ; Other. Purpose n-1
Caliedor(s): �- /21 '-r + c I Date / U -1 16. Time /�,. ; �d asebine, Complaint, Compliarce)LUST, Pesticide Study, Federal Tnist, Other
SAMPLE TYPE
a,Waier
❑ 5o;!
❑ other
❑ Chan of Custody
SAMPLE PRIORm
❑ Routine
❑ Emergency
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
,occ6
Lab Number
1�7
ID Time:
From:Bus, Courier,
Ck:
and Del.,
FIELD ANALYSES Owner '--f C v..;n rdd / 7 c c. tr y
1 6- D Spec, Cond.,K 6- 0 at 25°C Location or Site 1/ C r cp Gi t 1) i Cif; r_1 c
Temnp.10 ' 6, °C Odor r) ci pi Description of sampling point ;-n j t' c t i c"e-r )4.' z 7 / .7f
Appearance r-1,- H r Sampling Method C j a- i'+ J.> -
Field Analysis By: �,. J7 c (-cam./ )- c Remade -7 , - i= e •7, / t, , , ,..,� iJ arum rir wci
LABORATORY ANALYSES / .,,.y+in•. sir +•iip. •c_)
Date Received
Rec'd By:
Other.
f-(fly F ,1f' Data Entry By:
Date Reported:
pH4m
BOO 310
Mat
COD High 340
mg1L
COD Low 335
IVA-
'<
Calicos: MF Fecal 31615
f100n1
:k
C0Tormn• MF Toth 31504
/100mi
TOC Be0
moll
w
Tumidity 78
f4711
Residue, Toted Stspsded 530
wept
pH 403
urges
Agraanity to pr14.5 410
mg&
Aarahnity la pH 6.3 415
moll
Carbonate 445
mglt.
Bicarbonate 440
mglt_
Carbon dto dde 405
MA-
Chtorlde 940
TngtL
Chromium: Hex 1032
KO -
Cater True 60
Cu
Cyanide 720
rng&L
,.(
Dim Saida 70300
mp/L
Fluoride 951
'Mg-
X.
Hardness: Total 900
Mt
+rareness (non -cars) 902
mglt.
Phenols 32730
ugh
S edlik Coed. 95
*Wigan
Snore 945
mprL
&A de 745
ma
Oil and Gress
NH, as N 010
moll
TKNasN6l25
m &
X
407 # NO3 as N 630
rnplL
P- Tr:4el se P 655
MA -
Hamill (NOr se N) 620
mglL
clothe [NO7 w Ni 615
mglL
(cram o rwl
Age 4e6ee
Al-Akani usr 46557
As -Arsenic 46551
Ballarium 48556
+4�
�9►L
Ca -Calcium 46532
Cd-Cadrriirm 46559
mgR
{
Cr-Cteeunken 4e559
Cu-Cappw 46352
Fe-Yan 46303
HQ -trammel, 71900
K-Paisiskem 4e553
.�2clei':A/ AC. aJ61
1
5
Sample interval
Ovi nec1lorine Paalki Srs
onwicercephoies
Nitrogen Peeatides
Add Herbicides
Serrivoleele Organics
TP11-0trrai Rer,ge
leg-Msgnemern 46554
lin-allongweas 4e665
X
lh-sodk.n 4e556
tii�iirluti
Pb-Lesd 465&
Lot
ug&
Se-Srlariem
in -Tire 48567
u0
Vd ;lie Organics NVQA belle)
TPH-Gesorrse Range
TPFt-BlE K Geurifnm Range
LAB USE ONLC
Temperature on arrive; (°C): I ,
Lab Comments
GW-54 REV 7/03 For Deedre d Analyses-sutingt filtered servos and write 't}IS' In bi__

.,.
AVA
MCDEMR
North Carolina Department of. Environment and Natural Resources
Divi~ion of Water Quality
Beverly Eaves Perdue
Governor
Howard and Mary Frances Moody
115 Carpathian Way
Raleigh, NC 27615
Re: Issuance of Injection Well Permit
Permit No. WI.0500030
Coleen H. Sullins
Director
October 12, 2010
Issued to Howard and I"1ary Frances Moody
Wake County
Dear Mr. and Mrs. Moody:
Dee Freeman
Secretary
In accordance with your application received July 7, 2010, I am forwarding Permit No. WI0500030 for the
operation of two 5A7 geothermal underground injectiol\ control (UIC) wells heat pump system located at the
above referenced address. This permit shall be effective from the date of issuance until September 30, 2015,
and shall be subject to the conditions and limitations stated therein.
Also attached is a summary of the laboratory sampling results from water samples collected from your
geothermal well on July 27, 2010. Laboratory analytical results of both the influent and effluent samples
indic~te exceedances in the maximum contamination level (MCL) or elevated levels for the following
parameter( s ):
Parameter Units MCL Results
pH (field) Units 6.5 ~ 8.5 5 (influent) . 5 ( effluent)
The source or cause of these exceedances is unknown. It is recommended before using water from this well for
personal consumption that you consult with the Wake County Environmental Health Department.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an application
to renew the permit four months prior to its expiration date. As indicated in the permit, this permit is not
transferable to any person without prior notice to, and approval by, the Director of the Division of Water
Quality. If you have any questions regarding your permit or the Underground Injection Control Program please
call me at [phone].
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh , North Carolina 27699-1636
Location : 2728 Capital Boulevard , Rale igh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588 ; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748
· Internet: www.ncwaterquality.org ·
An Equal Opportunity \ Affirma tive Action Employer
NirthCarolina
;Jvatural/11
Best Regards,
~;;--
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
cc: Jay Zimmennan -Raleigh Regional Office
Central Office File -WI0500030
Wake County Environmental Health Dept.
Attachment( s)
NC DIVISION OF WATER QUALITY
LABORATORY ANALYTICAL RE SUL TS
5A7 GEOTHERMAL UNDERGROUND INJECTION CONTROL (UIC) WELL
PERMIT NO.: WI0500030
PERMITTEE(S): Howard and Marv Frances Moody
SAMPLE COLLECTION DATE: July 27, 2010
Parameter Fecal Collfonn Total Collfonn
units CFU/100ml CFU/100ml
NC MCL and/or EPA Standard NC MCL=<1 NC MCL=1
Influent Sample Results <1 <1
Effluent Sample Results <1 <1
Parameter Nitrate Nitrite
units mgllasN mg/LasN
NC MCL and/or EPA Standard NCMCL= 10 NCMCL= 1
EPAPOWS=10 EPAPDWS=1
Influent Sample Results NA NA
Effluent Sample Results NA NA
Parameter Barlum,Ba Calcium,Ca
units µglL mglL
NC MCL andlor EPA Standard NCMCL=700 NS
EPA POWS = 2000
Influent Sample Results NA 3.5
Effluent Sample Results NA 3.4
Parameter Potassium, K Magnesium, Mg
units mglL mgll
NC MCL and/or EPA Standard NS NS
Influent Sample Results NA 1.1
Effluent Sample Results NA 1.1
Parameter Selenium, Se Zinc,Zn
units pg/L pglL
NC MCL and/or EPA Standard NC MCL=20 NCMCL=1000
EPAPDWS=SO EPA SDWS = 5000
Influent Sample Results NA 22
Effluent Sample Results NA 17
NC MCL = North Carolina Maximum Contamination Limits per 15A NCAC 2L .0200
EPA POWS = Environmental Protection Agency Primary Drinking Waler Standards
EPA SOWS= Environmental Protection Agency 13econdary Drinking Waler Standards
NS = No standard
NA = Not analyzed
Total Dissolved Solids Chloride,CI
mg/L mg/L
NCMCL=SOO NC MCL=250
EPA SDWS = 500 EPA SDWS = 250
62 3.8
54 3.8
Nitrate + Nitrite Sllver,Ag
mglLasN pg/L
NCMCL=10 NC MCL=20
EPAPOWS= 10 EPA SDWS = 100
0.85 NA
0.87 NA
Cadmium.Cd Chromium, Cr
pglL pgll
NCMCL=2 NCMCL= 10
EPAPDWS=5 EPA POWS = 100
< 1.0 < 10
< 1.0 < 10
Manganese, Mn Sodium,Na
pg/L mg/L
NCMCL=SO NS
EPASDWS=SO
< 10 5.6
< 10 5.7
pH(field)
units
NC MCL = 6.5-8.5
EPA SOWS = 6.5 to 8.5
5@22.6C
5@24C
Fluoride, FL
mg/L
NC MCL=2
EPA PDWS = 4.0
<0.4
<0.4
Alumlnum, Al
pglL
NS
EPA SDWS = 50 to 200
<50
< 50
Copper,Cu
pglL
NC MCL= 1000
EPA SOWS = 1000; PDWS = 1300
NA
NA
Nickel, NI
pg/L
NC MCL= 100
< 10
11
Sulfate, 504
mg/L
NCMCL=250
EPA SOWS = 250
<2
<2
Arsenlc,As
pgll
NCMCL= 10
EPAPDWS= 10
NA
NA
Iron, Fe
pg/L
NCMCL=300
EPA SOWS= 300
82
<50
Lead, Pb
pgll
NCMCL= 15
EPAPOWS=15
< 10
< 10
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
H oward and Mary Frances M.oody
FOR THE OPERATION OF TWO 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. These
injection wells are located at 115 Carpathian Way, Raleigh, Wake County, 27615, and will be constructed·and
operated in accordance with the application received July 7, 2010, 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 Cocje 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 September 30, 2015, and shall
be subject to the specified ·conditions and limitations set forth in Parts I through VIII hereof.
Permit issued this the lih day of October 2010.
~~w@'
Jt-.. Coleen H. Sullins, Director t Division of Water Quality
By Authority of the Environmental Management Commission.
WIC500030 . I .
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 permlt 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 injection well shall have permanently affixed an identification plate according to 2C
.0213(g).
8. A completed Well Construction Record (Form OW-1') must be submitted for each injection well to:
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section-Ral eigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
(919) 79 1-4 200
GW-ls must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) 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 ~ata.
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 Pennittee, 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.
W I0500030 2 .
3. The issuance of this permit shall not relieve the Pennittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
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.
PART III -PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all tim•es so that there is no
contamination of groundwater that 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 -OPERATIONS AND·MAINTENANCE REQUIREMENTS
· 1. . The injection facility shall be properly maintained and operated at all times.
2. The Permittee -must notify the Division and receive prior written approval from the Director of any
planned physical alterations or addltions 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 ~y 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 perm.it, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
s~pling 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.
WI0500030 3
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 [phone], any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any 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 ST ATOS
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 .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 15A NCAC 2C
.0214, including but not limited to the following:
WI0500030
(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.
4
(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.
(G) The Pennittee shall submit a Well Abandonment Record (:Form GW-30) as specified in
15A NCAC 2C .0213(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 Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
5
Routing Slip for 5A7 Well
Laboratory Review
Date: (o,L<r-J,-,
Permit No. ~~3y'
Permittee(s): ,4//
I have reviewed the attached laboratory analytical
results and have made any comments below.
~ Initial
/t1/¢c? Date
S:\UIC\GPU Routing Slip for 5A7 Well(s).doc
Permit Number WI0500030
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
Howard and Mary Frances Moody SFR
Location Address
115 Carpathian Way
Raleigh
Owner
Owner Name
Howard
Dates/Events
NC 27615
E Moody
Orig Issue
06/21/99
App Received Draft Initiated
07/07/10
Scheduled
Issuance
Central Files: APS_ SWP_
10/15/10
Permit Tracking Slip
Status
Active
Version
3.00
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Raleigh
County
Wake
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Howard E. Moody Jr.
115 Carpathian Way
Raleigh NC 27615
Public Notice Issue
10/12/10
Effective
10/12/10
Expiration
09/30/15
_R_e-g_u_la_te_d_A_c_ti_v_it_ie_s _______________ .::...::R=e-=g=u=es=t=e=d"--"/R-=e=c=e::..:...iv.::....::e=d=--=E-=--ve=n=t=s __________ _
Heat Pump Injection RO staff report requested
Outfall r UL
Waterbody Name
Additional information requested
RO staff report received
Additional information received
Stream Index Number Current Class
07/15/10
07/15/10
09/14/10
09/14/10
Subbasin
Permit Number WI0500030
Central Files: APS SWP
10/05/10
Permit Tracking Slip
Program Category
Ground Water
Permit Type
infection Heating/Cooling Water Return Weli (5A7)
Primary Reviewer
rnichael,rogers
Coastal SW Rule
Permitted Flow
Facility
Status
In review
Project Type
Renewal
Version Permit Classification
Individual
Permit Contact Affiliation
Facility Name
Howard and Mary Frances Moody SFR
Location Address
415 Carpathian Way
Raleigh
Owner
NC 27615
Major/Minor
Minor
Region
Raleigh
County
Wake
Facility Contact Affiliation
Owner Name
Howard E Moody
Dates'Everltr
Owner Type
Individual
Owner Affiliation
Howard E. Moody Jr.
115 Carpathian Way
Raleigh
NC 27615
Orig Issue
06/21/99
App Received
07/07/10
Re[- ulated Activities
Draft Initiated
Scheduled
Issuance
Public Notice Issue
Effective
Reauested/Received Events
Expiration
Heat Pump Injection
Outfa l i
RO staff report requested
Additional information requested
RO staff report received
Additional information received
07/15/10
07/15/10
09/14/10
09/14/10
Waterbody Name Stream Index Number Current Class Subbasin

AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: September 3. 2010
To: Aquifer Protection Central Office
Central Office Reviewer: Michael Rogers
Regional Login No: __ _
L GENERAL INFORMATION
County: Wake
Permittee: Howard Moodv
Project Name: 5A7 Geothermal Iniection Well
Application No.: WI0500030
1. This application is (check all that apply): D New ~ Renewal
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Re~ycle 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 regulated D 503 exempt
D Closed-loop Groundwater Remediation ~ Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare. this report? ~ Yes or D No.
a. Date of site visit: 07-27-2010
b. Person contacted and contact information: Howard Moody, [phone]
c. Site visit conducted by: Lin McCartney
d. Inspection Report Attached:~ Yes or D No.
2. Is the following information entered into the BIMS record for this application correct?
,~·
;..~. -~,.. c:·,: . .... ;.. .. ,
-or?;
:.t,.C
D",
-it..) f!.;f::·
~ Yes or D No. If no, please complete the following or indicate that it is correct on the current applicat~~n;s
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): 115 Carpathian Way, Raleigh, NC 27615
b. Driving Directions: Take Six Forks toward North for 6.6 mi. Tum right onto Carpathian Way.
c. USGS Quadrangle Map name and number: NIA
d. Latitude: 35-54-59 Longitud~: 78-38-55
II. 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: __
2. Are the new treatment facilities adequate for the type of waste and disposal system?
FORM: Staff.Report-Moody
AQUIFER PROTECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPL/CA TIO NS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description Of Well(S) And Facilities -New, Renewal, And Modification
1. Type of injection system:
'2sJ Heating/cooling water return flow (5A7)
D Closed-loop heat pump system (5QM/5QW)
D In situ remediation (SI)
D Closed-loop groundwater remediation effluent injection (SL/"Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? D Yes ~ No
3. Are there any potential pollution sources that may affect injection? D Yes ~ No
What is/are the pollution source(s)?
4. What is the minimum distance of proposed injection wells from the property boundary? 10 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 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: __
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 Onlv:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes ~ No. If yes, explain:
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:
3. For renewal or modification of groundwater remediation permits ( of any type), 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:
4. Drilling contractor: Name:
FORM: Staff.Report-Moody 4
AQUIFER PROTECTION REGIONAL STAFF REPORT
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 preparers):
Signature of APS regional supervisor:
Date:
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
The result of the ground water samples met North Carolina Ground Water standards.
FORM: Staff.Report-Moody 6

Locatbn code 'E-' 0 -1)
County w Q-0_ e-
Quad No Serial No.
Lau. Long.
Report To: ARO, FRO, MROtRRO WaRO, WVRO.
WSRO, Kinston FO. Fed. TruCenthi On., Other.
Shipped by: Bus, Coirier,fHeind Del Other
Collector(s): L r� C t"�; ;
FIELD ANALYSES Cy. o
pH 40a , Spec. Cold-94 (( at 25°C
Temp.10 U °C Odor c
Appearance 1-iz
Field Analysis By: , rt.
LABORATORY ANALYSES
BOO 310
mot
COO I. 343
ng&
COO tow 335
+
Condom MF FaGst 31010
C.ollonn: MF Total 31504 1100r1
•
TOC 603 npiL
Turbidity 75 "au
Residue, Told Suspender) 530 rtIgIL
pH 403
trails
Alkalinity bpH4.5410
AfraiiybpH5.3415
agR
Carbortals 445
ntgM1.
B *bonale 440
Big&
Carbon dioxide 405
7< Ctrloride 940
Cbrornum: Flex 1032
Color: Tn,e e0
cu
Donde 720
[CC/
Lab Number
Date Rene
Rec'd 8y:
f L Other
Elf) a r' `r Data Entry By: r Ck:
Date Reported:
fi��lN i1
1'a-)' h0 Tune: 1 30fu- -1
Frorn:Bus. Courier, I d�nd�l
lr
Date 7 - 21._: Time ��8aserine. Complaint. Corn lance', LUST, )Pesticide Study. Federal Trust Other
erm
Owner 1-4 6 w C.Yd P-10 C1 c Y
Location or Site f) . C. . r p c-
Desciipbon of sarneNng Pont ) )
Sampling Method (, r
Remarks Z-n r, L •= Lam`
X\ OWL Said. 70300
Fluoride 951
►� Madam Tolai Yoe
Nndnws lna vicerb) 902
Phut 32730
Sondra Cad 95
Sulela 945
Builds 745
mg/L
Oi and Grime
molt
elN010
melt
TXNesN625
Noi + NOs as N 630
P` Tom as P 6B5
WON [NO* sf N) 620
Mae (NO, se N) 615
LLf :ti J , hi:h Q " `1 , J1/ L ; 7 I
Sample Interval_
Mussing •na, et mom . re }
Ao-Barer 46566
AE Aim i urn 46557
As A eric 46551
Be-Rar44rn 4e556
x
ccau.., 46552
Gd-r airrim 46569
Cr-Chosen 46556
milt
Lon-
Cu-Copper 48512
Ferman 46663
Hp-rriartd%y 71600
1
1GPolsMa n 46555
Ilia-lidreelds 46554
rrgit
x
san-Iirnpararss 46565
lle-Sochan 46550
N1-INdkst
Pt-ias4 46564
Se-Seleritrn
Zn-Zdc 46507
oak
°gim WuYus Pesdridrs
Oroano apMnax P da:idsa
d evprn Pasicidss
Add t lerbioidee
PCBs
Sernirdsde Organics
TP4-Oesal Range
Voider OrAnics (VOA ha06e)
TPil-G oins Ranee
TPH-BTE 4 Gasoline Ranee
LAB USE ONLY
Temperature on arrival ('C):
uc �
Lab Comments
GWS4 REV. 7/03 For oissohed llrely is-eudn l Nerd sand mg will •P in l'le rt

Wr (DWO La6oratory Section tResu[ts
County- WAKE
River Basin
Report To RROAP
Collector L MCCARTNEY
Region: RRO
Sample Matrix: GROUNDWATER
Loc Type: WATER SUPPLY
Emergency Yes/No
COC Yes/No
Visi[ID
Loc. Descr.: HOWARD MOODY - EFFLUENT
Sample 1D; AB61437
PO Number a 1OG0484
Date Received: 07/27/2010
Time Received: 13:00
Labworks Logini0 SMATH1S
Report Generale& 8/20110
❑ale Reported: 08/20)2010
Location ID 5P092W10500030
Collect Date: 07/27/2010
Collect Time: 12:00
Sample Depth
CAS # Analyte Name
LAB
Sample temperature at receipt by lab
PQL
Result/
Qualifier
2.3 aC
Units
Method
Reference pate
Analysis Validated by
7/27/10 SMATHIS
MIC
Coliform. MF Fecal in liquid
1 1 82
CFL11100m1 APHA92220-201h 7/27/10 CGREEN
Collfarrn, MF Total in liquid
T 1B2
CFU1100m1 APHA9222B-201h 7127110 CGREEN
WET
Ion Chromatography TITLE
mg/L EPA 300.0 8112110 CGREEN
Chloride
1 3.8
mg/L EPA 300.0 8/12/10 CGREEN
Fluoride 0.4 0.4 U mglL EPA 300.0 8112110 CGREEN
Sulfate 2 2.0 U mg& EPA 300.0 8112)10 CGREEN
Total Dissolved Solids in liquid
12 54
mglL
APHA2540C-187H 712911❑ MOVERMAN
NUT
NC2+NQ3 as N in liquid
0.02 0.87
mg/L as N Lac10-107.04.1-c 7128110 CGREEN
MET
7429-90-5 Al by 1CP 50 50 U ug/L EPA200,7 8131f0 ESTAFFORD1
7440-70-2
Ca by ICP
0.1 3.4 mg/L EPA 200.7 812110 ESTAFFORDI
7440-43-9 Cd by ICPMS 1 1.0 U
ugIL
EPA 200.8 813110 ESTAFFORDI
7440-47-3 Cr by ICPMS
10 10 U ug/L EPA 200.E 8/3/10 ESTAFFORD1
7439-89-6 Fe by ICP
50 50 U ug/L EPA 200.7 8/3/10 ESTAFFORDI
7439.954 Mg by ICP
0.1 1,1 mg/L EPA 200.7 8/2/10 ESTAFFORD1
7439-96-5 Mn by ICP 10 10 U ug1L EPA 200.7 8/3/10 ESTAFFORD1
7440-23-5 Na by ICP 0.1 5.7 mg/L EPA 200.7 8/2/10 ESTAFFDRD1
7440-02-0 Ni by ICPMS
10 11 uglt EPA 200.6 8/3/10 ESTAFFORD1
7439-92-1 pb by ICPMS
10 10 U ug/L EPA 200.0 6/3110 ESTAFFORDI
7440-66-6 Zn by ICPMS
10 17
ug/L
EPA 200.5 8/3/10 ESTAFFORD1
AUG ?6
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27696-1623 1919) 733.3908
Furs de 4rYed descnpion of Ilea Quarrrier codes reler to b[ , ?},yitaLns�ipy.,_oygyyS.dAetilkir_' llbrgiae'thisSiM/Drj}L o.sbEe. i;:,+.ti.en1!li,'ILe7:tul dr.derltAl,g!w eliip ies S'-Su
Page 1 of 1

GROUNDWATER FIELD/LAB FORM
Location code r 0 .2 W I o 5 0 ca O 0
County 00- C-
Quad No Serial No.
Lat. Long_
Report To: ARO, FRO, MRO, (RRCONaRO, WiRO,
WSRO, Kinston FO. Fed. Trust. Central Off., Other.
Shipped by Bus. Courier, Other.
SAMPLE TYPE
,fit Water
❑ Sol
❑ Other
❑ chain of Custody
SAMPLE PRIORITY
0 Emergency
Nortft Carofnla
Department of E,xaronmerk and Natural Resources
DMSION OF WATER QUALITY -GROUNDWATER SECTION
t Th {�'Iu C ,-r t
Py�rl FJ
Gallectoi(s): L N ([G- r rr y Du •7 - :')- 0-:Time r ..00' Bm-dft Cwr►plaird. erriptiart_cai LUST, Pesticide Study. Federal Trust, Ottrer.
FIELD ANALYSES
pH 400 lf, + L, Spec. Cond.94 ( TO at 25°C
Temp.to ) L - 0 °C Odor el a r Q Description of sarrlpting point \.t, e . I +1 eel. Li — 7 +-, r j aF ,, y-
Lab Number 3(0
Date Received '' ' r JO Time: U ��
Appearance
Field Analysis By: '•11 t L. ck e
LABORATORY ANALYSES
BOO 310
mglL.
COO KO 340
rg&
COO Low 33.5
mall
X
Caponn: IAF Feral 31616
1100n1
)I
Co loam IAF Total 31504
tiortn1
TOC 660
mgii
Turtitlity 76
NM
Raaidrie, Total Sueprrded 530
Wit
pH 403
mite
AMID* lo pH 4.5 410
ng+<
J
Adraireity n pH 6.3 415
ma&
Catenate 445
'Mil
Hlcerb weds 440
R190-
Carbon dioxide 405
mglL
X
Ctdoride 640
mg+[.
Craoni nt I _• 1032
VI
CroloTrue 80
Cu
Cyari0e 720
ng&
Owner f-1
Location or Site / L THY p TL f h i 0- rt t.trd-Y
Redd By: 0 ' From:Bus, Courier, H
Other.
Data Entry By: Ck:
Date Reported:
Sampling Method C- r a. b
Remarks 2 f' i o
,i( r
Diu. Scads 70300
mgil
Firplle 651
mgii
J
Bien, ra4 Tsai 000
019,1-
Hrbrrs s (non -cub) sar
ngiL
PNwok 32730
ugli
Spam Card 95
WlOaalan
Sullies 945
mplL
Sulk% 745
wen -
ON end Gnaws
not
%mon N 610
mgA
T04asN625
mt.
X
1402+NO, alit 630
mplL
P. Total se P 066
PTO -
Firmer (NO,. N) 020
mill[.
Weil (N 02 ea N) 615
moll
t cm)
r►vras =ow e¢ s
RBI(. M, 4/C a'7 r_-. J£
Sample Interval
iPr ngangi err .dn. eta.
Ag-Slyer 46563
aC Al-Aeertirrt.n 46557
oat
AsAraerrc 46551
Rwandan 46556
7(' Ca -Calder 46552
u
Cd-Cadniti r44550
;{ Or-O 6+rrn 46550
Cu-Copper MEM
ultA-
u501-
u0-
7� Fe-Iai 44563
Ho-4arsarry 71900
K-Poleeeian 46555
)( 14p4Awpsaurri 46654
mglL
j{ hInaraprres 46565
He -Sod= 46550
1Y-FIYdtel
not
X Pb-Lead 46564
Se-ssiuian
X 7n-Zitrc 46667
ut
OrPesticides
Organq2hosphorue Pesticides
Nitrogen Pell idee
Add Herbicides
PCBs
SeineddM driver**
TPH-aYsel Range
VGadie Oryrnia (VOA bolae)
TPH-Cessna
Rugs
TPH-BTEX Gamine Rime
Laqt Q E ONLY
Temperature on arrival ('C): 3
Lab Comments
GW-54 REV- 7►03 For Diswara+d Me rsis.s d nit Herat sample and wnle'I7t5' In taxi_

1DWO Labot'c;tonr.St'ction {Revif s
County. WAKE
River Basin
Report To RROAP
Collector: L MCCARTNEY
Region: RRO
Sample Matrix: GROUNDWATER
Loc. Type: WATER SUPPLY
Emergency YeslNo
COC Yes/No
VisnUD
Loc. Descr.: HOWARD MOODY -INFLUENT
Sample ID: AB61436
PG Number a 10G0483
Date Received: 07/27/2010
Time Received: 13:00
Labworics LoginI0 SHIATHIS
Report Generated: 8120/10
Date Reported: 08/20/2010
Location ID. 5P092W10500030
Collect Date 07/27/2010
Collect Time: 12:00
Sample Depth
CAS # Analvte Name
LA B
Sample temperature at receipt by lab
PQL
Result/
Qualifier
2.3
Units
Method
Reference
Analysis Validated bg
Date
7/27/10 SMATHIS
MIC
Coliform, MF Fecal in liquid
1 1 B2
CFUlt00ml APHA92220-20th 7/27/10 CGREEN
Coliform, MF Total in liquid
1 1 82
CFUltooml APHA92228-201h 7/27/10 CGREEN
WET
Ion Chromatography _TITLE
mg1L EPA 300,0 8/12/10 CGREEN
Chloride
1 3.8
mg/L EPA 300.0 8/12/10 CGREEN
Fluoride
0.4 0.4 U
mg/L EPA 300.0 8/12110 CGREEN
Sulfate 2 2.0 U mg/L EPA 300.0 8/12/10 CGREEN
Total Dissolved Solids in liquid
12 152
mg/L APHA2540C-tBTH 7/29/10 MOVER MAN
NUT
NO2+Nd3 as N iri liquid
0.02 0.85
rng/L as N Lac10-107-04-1-c 7128110 CGREEN
MET
7429-90-5 At by 1CP
50 50 U ug(L EPA 200.7 8/3/10 ESTAFFORD1
7440-70-2 Ca by 1CP
0.1 3.5
mg/L
EPA 200.7 8r2110 ESTAFFORD1
7440-43-9 Cd by 1CPMS 1 1.0 U
ug/L EPA 200.8 8/3/10 ESTAFFORD1
7440-47-3 Cr by ICPMS
10 10 U ug/L EPA 200.8 8/3/10 ESTAFFOR01
7439-89.6
Fe by 1CP
50 82 ugfL EPA 200.7 8/3/10 ESTAFFORD1
7439.95-4 Mg by ICP
0.1 1.1 mg/L EPA 200.7 8/2/10 ESTAFFORDI
7419-86-5 Mn by JCP
10 10 U
uglL EPA 200.7 8/3/10 ESTAFFORDI
7440-23-5 Na by ICP
0.1 5.6 mg/L EPA 200.7 812110 ESTAFFORDI
7440-02-0 Ni by ICPMS
10 10 U ug/t. EPA 200.8 813110 ESTAFFORD1
7439-92-1 Pb by ICPMS
10 10 U og1L EPA200,8 8l3110 ESTAFFORD1
7440-66-6 Zn by ICPMS
10 22
ug(L
EPA 200.8 8/3/10 ESTAFFORD1
Laboratory Sections 1623 Mail Service Center, Raleigh, NC 27699-1623 1919) 733-3908
For der. Ord descnplwrr. of vie ¢.lifer codes rder Io r8rulcxst8.,J,;[ !.g5 A +.31atiLIA 81I vlyeh���s{Lr�,i,�,d_� ti8t L �14r •.� e� �,lppd'�I„n�• p,Iu�rvlw;�yrq({¢ I�IMrnrtrrha+son
Page 1 of 1

AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: Jul y 15 , 2010
To: D Landon Davidson, ARO-APS
0 Art Barnhardt, FRO-APS
0 Andrew Pitner, MRO-APS
IZI Jay Zimmerman, RRO-APS
□ David May, WaRO-APS
0 Charlie Stehman, WiRO-APS
0 Sherri Knight, W-SRO-APS
From: Michael Ro gers Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Mail: [e-mail]
A. Permit Number: WI 0500030
B. Owner: Howard and Ma rv Moody
C. ·Facility/Opera~on: _
D Proposed IZI Existing D Facility D Operation
D. Application:
1. Permit Type.,: D Animal D SFR-Surface Irrigation□ Reuse D H-R Infiltration
D Recycle D I/E Lagoon D GW Remediation (ND)
1Z1 · UIC -SA 7 Geothermal well
For Residuals: □ Land App. □ D&M
D 503 D 503 Exempt
D Surface Disposal
D Animal
2. Project Type: D New D Major Mod. D Minor Mod. IZI Renewal D Renewal w/ Mod.
E. Comments/Other Information: D I would like to accompany you on a site visit. I NOTE:
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within, please take the following actions:
IZI Return a Completed APSARR Form and attach laboratory analytical results, if applicable.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
D Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: _________________ _ Date: _____ _
FORM: APSARR07/06 Page 1 of 1
·~~ •!·· .. ~ ,: • a a ..... _..,
HCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
July 15, 2010
Howard Moody, Jr
Mary Frances Moody
115 Carpathian Way
Raleigh, NC 27615
Subject: Acknowledgement of Application No. WI0500030
Moody, Howard -SFR
Injection Heating/Cooling Water Return Well (SA 7)
Wake
Dear Mr. & Mrs. Moody:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on July 7, 2010. 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 -99 days after receipt of a complete
application.
If you have any questio1:1s, please contact Michael Rogers at 919-715-6166, or via e-mail at [e-mail]. If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to http ://h2o.enr.sta.te.nc.u.s/documents/dwg ornchart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Sincerely,
forD2~ ~
Supervisor
cc: Raleigh Regional Office, Aquifer Protection Section
Permit Application File WI0500030
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh. North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity\ Affirmative Aciion Employer
N°~i..c 1· 01u.1 aro. .ma
JVaturall!I
0G/24/2B1B 19:41 919-715-0588 NCDE8FP/WATER OWL
PAGE 04
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT ANDfOR USE A WELL FOR INJECTION
WITH A GEOTHERMAL HEAT FI)MF SYSTEM
TYPE 5A7 "OPEN LOOP" fNJEON WELL(S)
(chock otc) New Permit Application
Renewal
DATfJ(LLLL 204°
PERMIT NO.: WI (leave Wank ifNEW patnit application)
Modification
Aclurfor Protection SEW.
JUL 07 10ft.
A. PROPERTY O APPLICANT
Nance of etch owner liated on peoperty deed. For a iXilii3105 or government agency, state name of entity his
oasts ribPrAlrerr
(1)
(2)
tielitZgrifIA
thlebeta
Mai ddreas_ I I 0AllkA 141XL
City �] Sete
Home/Office Tele No:. `I 1 t7
Fax No.
County
r �II_ '! 7--� Cf11 No.: iq LPO q
Email Address:
fd7n1A �ECt4ety ieg14G1ei
Zap Code��'1
Physical Address ofWell Site (if differant tbaa above): SAW AS r 1 i 4
City. Stare: Zip Code County:
Home/Office Tele No.:
Fax No.
Cell No.:
Email Address:
B. PROPERTY OWNERSHIP DOCUMENTATION
Provide legal do lion of property ownership. such as a contract, deed, mice of ineceporatiate, etc, and
a PLAT map showiQg the property. This information may be obtained from meaty Register of Des or GIS
website- rate.
C. AUTHORIZED AGENT, IF ANY
If the property trimen'petmit applicant Nautili to authorize sonatone else to sign the permit on their behel± then
attach a aigged letter tram the property ownadpermit applicant specifying and authorizing their agent (well
driller, heat pomp contractor, or other type of contractor/ape) to sign this appiicttivn on ttrcir bebtalf
Company Name:
Contact Persona: Email Adds:
Address:
City. State: Zip Cate: County
Office Tele No.: Fax No. Cell No.
Webcire Address of Company, if any:
Type 5A7 Inject= Well Pssm z Application (Ray. Angus' 24:1059 Page 1 of 4

96/24/2818 19:41 919-715-8588 ~/WATER '1JAL PAGE 05
D.
E.
G.
B ..
~n:':_JNFO_~_no_•_'S_.;:;;_·~--------b ...... /Z.1---4(1_,.:..;lfJ.x..<...A.>...:::...-~---_.__~.:;;..;;._t(JJt~"T""":O~~--
we11 DrillingCouuaam'sName: ___________________ _
NC Contractor Certification No.: ______ --..l:ICgp~rau:,CfwPi,.Zcrson-...tL.: ---------
Company Website:':-· .llwww~~------------~&~aa0~· :.:AMJ44RM~&;.: ______ _
Addiess: __________________________ _
City: _______ State: _ZipCode: _____ County: ______ _
OfliceTeleNo.: _______ Fu:No.:. ______ CollNo.::..__ _____ _
BEAT PUMP~ JNFO~dB:tteat6u. Drlllcr)
·CompanyName-~e ort,[a.,~L ~ CgptagPmg:
Company Website:~· www~-=:.:.·-----------F-mm--·1 ~A=dd~ms:11111:1!:.l..' -------
Address: __________________________ _
City: _______ State:_ ZipCode: _____ Comity. ~------
Office Tele No.: Fax. No. Cell No .. ______ _
INJECl"IOM n.o;rc;;~, (brie8ydlllaibcllowdleDliection well(s) will bollSCd)
WELL tJSE Will the injeetioa '"8{s) alto 1,e -,ct as the -.,_1y weD(s) for the following?
(1) Tbeil\j~operatioa? YES __ V__ NO <
(2) P___, consumpti.aa? YES___ NO V
WELL CONSTRUCl'ION DATA :Jee ~
_____ PROPOSED Wcll(s) to be~ for11Be • • injecuon well Prov.iclc the data ia (1) tbrauah
(7) below as PllOPOSFD COIIIIIUCtioa specifications. Slllmit Pom GW-1 dlr C01181n1Ction.
__ _,EXISTING Well(s) behlg proposecl for use as an iqjectioD well. Provide the data in (1) tmougb (7)
below to die best of :,ovrbowledp. Allach a copy of the wen COllSD'llCtion 1tecold (Fonn
GW-l)ifavailable. .
(1) WellCom1ruclionDate: ______ Numba-ofborlap: __ _
Depth of each boring (&,et): _____ _
(2) Well casing. ls die wcll(s) cased?
(a) Yli'S __ If~ dlen provide tile casing fnfimnat.ion below.
Type:Gal~steel_Bldsteel_Plasdc_Othei(spedfy), _____ _
Casing thickness: __ diameter(iadles): __ deplh: aom __ to __ feet (relative to land surface)
Cuing mends above pound ___ inches
(b) NO
(3) Grout material surrounding well casing:
(a) Grout.type: Cement_ Bentoal~_ Olhet(spec:iiy) _____ _
•ByN1ectiagNdDair&S11111t-avariaaceisfla'CbyftClllaDlco lSA.NCAC2C.0213(cl)(lKA). 'lllaicllnqairmacemmtl)'pegsaat.
(b) Depth of gNllt around well casin& (relattve TO land sarfaco): from __ to __ feet
Type ,A.7 IDjcctioD Wcll Pcnnlt ApJlfaadon (Ile¥, Aap11200J) Pap2of4
06/24/2610 19:41 919-715-0508
NCEESI.PfW+lER Q1 PAGE 06
(4) Well Screen or Open Borehole depth (relative to land smiare): from to _ feet
(5) N.C. State Reguiatian3 (riche 1 SA NCAC 2C .0200) require the Per utter to make provisions for
monitoring wellhead processes. A faucet on both Influent (garouad r catering heat pump) and Effluent
(water being injected boat into dye feats is ivgoisvd. Win thaw be a faucet on:
(a) Nazi Yes V No (b) line' Yes i-No
(6) Santee Want Construction information, if the water source well is a different we1l than the injection
wcUI, attach a copy of the wall construction record (Faro GW-I ). If Partin OW -I is eat amiable, pcuvidc
the following data:
From what depth, formation, and type of rock/sedimeat nails will the groundwater be withdrawn?
granite, limestone, sand, etc.)
Depth Formation: _ Rack/sediment unit
NOTE' THE WELLDRLLWG OR I1EAT PUMP COXTRACTOR CAN HELP SUPPLY THE DATA IF Tins
DIFORMATION r5 UTifRW1SE'UNAVAIABLE.
(a4
L OPERATING DATA
(1) Injection Rate Average (dswly) (11._gallorts per minute (gpm).
(2) Injection Volume: Avarege (daily) _ galans lam' day ()-
(3) h jaction Pressure: Avg (fly) pounds/squire inch (psis)
(4) Injection Temperature: Average (]atmary) ° F, Average (Jury) ° F-
j° bE
J. INJECTION -RELATED EQ�
f
Attach a schematic diagrran or avax•�on of the wen eaonmetioa that shows the depth, th Cu cos g,
extent of gout, stickup, location of iaflna ntefftuent sampling pew, etc, bF this is a modification, show are
e l:veneering layout or proposed modification of the injection equipment and exterior piping/mbing associated with
the injection operation. The mks brochure may provide supplementary information if needed
K. LOCATioN OF wa:u4E95 i peoetx_N
lko5play&assusteiefiki4L
(1) Attach a site map (can be drawn) s limes and • _ • lines, water bodies,
potential sources of groundwater connenination, and the orientation of sad diggooss between the proposed
injection well(s) and any Other existing ors l(s) or waste disposal facilities such as agtcic tanks or drain fields
located within 1000 fleet oldie geothermal heat pump well system. Label all $eatum, clearly and u
n arrow.6OAI
(2) Attach a scaled topographic map of the area extending 1/4 mile from the property boundary that indicates
the facility's locas€cet, a north armor, and the map tame.
NOT& In most cases, as aerie! pftafegrep* of the properly parcel ah wiar property Nam and srtucfteres cern be
obtained and dowmkedo( from the applicable county Cd5 websita. Typically, Air property ean be marched by owner
name or addr# . The lotion of dto waifs in reimieR rr arty botamkrier, be set, se,* tanks. wilier faits, etc.
can then be drams frr by *and Also, e: `layer' can be selected sko'vinT topographic cowers or elevation data.
Type 5A7 Injection Wifl A: mit Applicnian(R v. Augur 2009)
Pegg 3 cif 4

06/ 24/ 2818 19:41 919-715- B588
h st /wAIER PAGE 07
L CIERTIFICATION (to be signed as required below cr by that persons autbe rized agent)
NCAC 15A 2C .021 1(b) requires titm all permit applications shall be signed as follows:
1. for a corporation: by a responsible ca pomte officer,
2. fox a partnership or sots 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 tanking publicly elected official;
4. for all others: by the well owner.
If an authorized agent is signing on behalf of the applicant, then =knit a rester ntgned by tie
applicant that names and authorizes their agent as speddled in Part C of this permit application.
"I hereby certify. sander penettty of law, that I have personally examined end am foriallisr with the infoaaarina submitted in
this document and all eenaac>5ments thereto and that, based on my inquiry of those individuals immediately responsible for
obtaining said information, 'believe that the information is true, accurate and complete. 1 am aware thatthure are significant
penalties, including the possibility of fines and impri1 ninent, for submitting false lamination. 1 agree to construct, opaate,
maintain, repair, and if applicable, abandon the injection well and all tatted appurtenances in accordance with the approved
speciific:Woos and cuenditiona of the Permit."
Signee e-61
Print nT TYPe Full Name
DENR l DIN12 + ■
Amyx.. n-.i,,•ti y SectiCgt
JUL 07 MI
Signature
Print or t Pull Nate
Signature of Authorised Agent, if any
Print or Type Poll Name
Submit TWO signed copies of the completed application package and all yenta m_
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Type 5A7 injection Writ Pmmit Apglir tan (Rev. August 2009) r.gr• 4 of 4

06/24/2010 19:41 919-715-0588
N[E8N2/wA7ER OWL PACE ee
State of North Carolina
Department of Environment and Natural Resources
Division of water Quality
STATUS OF INJECTION WEU. SYSTEM
RECEiVEO / OENR f Dvr
Aquifer Prnlec:tion Sermon
JUL 07 2010
Penult Number:
ienrdtree Name: i w, i j _ r
Address: 4 eAl OhrThligq Y t ` " ) Cl ` '�`"'l -k 46. 2' J t.+ Ir-_'
Please check the seiacaos which mrst closely d ibes tlx =via *MS of your injection well system:
I) V Well(s) still used for injection activities, or may be in the future.
2) Well(s) not used for injection bur Ware used for water supply or other purposes.
3) ❑injection discontinued and: a)0 Well(s) remFassriIy abandoned
b) 0 Well(s) permanently abandoned
c) ❑ Well(s) not abandoned
4) CI Injection well(s) never constructed
(sfizikikag cAL )
Current Use of 'Well
If you checked (2). dexuibe the well fuse (potable water supply, i-rii on, mcmiitonring, etc)., including pumping rate and other
relevant Informationpm__ �- pp/
z
Well Aba:zdanment
Ifyou checked (3Xa) or (3)(b), describe the method used to abandon the injection well. (Include a description of haw the well
was sealed and Aire type afmaterial used to fill the well 4fperasosteraly abandoned):
Permit Reacissicm:
Ifyou checked (2), (3), or (4) and will not use a well for irtjecoivts on this sire in the fixture, you should request rescission of the
permit. Do you wish to rescind the ?
❑ Yes
Certification;
"I hereby cerdly, corder penalty of law. that Ihave personally examined and am familiar with the info marian submitted
in this document, and that m the best of my knowledge the Infottstation Is true, accurate, te, and complete."
z(z5 gotp
Revised 5JO5 GWMRlMC

ci6/24/2e10 19:41 919-715-0588
NCDEZR/WATER °UAL PAGE 02
4_711
WDM
North Carolina Depar ntent of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Prue Cdeen 11. Stiles Doe Freeman
Governor Climax 'Secretary
May 24, 2010
Howard Moody
115 Carpathian Way
Raleigh, NC 27615
Subject: Notice of Expiration (NOE)
5A7 Geothermal injection Weil
Permit No. WI0500030
Wake County
Dear Mr. Moody,
RECEIVED ! DENR, DWQ
Aquifer Prat$t3ion Section
JUL 0-7 2010
The Underground Injection Cuutrvl (UIC) Program of the North Carolina Division of Wader
Quality (DWQ) is entrusted to protect the gmnndwatar quality told rev ounces of the Stowe of
North Carolina, and is responsible for tine regulation of injection well Bon and operation
activities within the state. Our records indicate that the above -referenced operating permit for
the Undergrotmd injection well SYSteln, which was issued to you on September 2, 2005, zed
expires on August 31, 20J 0, has not been Ire iewe d. If you wish to keep this penoit and operate
the injection well system, the permit' must be renewed and issued in your name. OUT records do
not indicate that the well system has been plugged and abandoned.
In order to comply with the regulatory requirements hated under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit a of the following
forms:
A, Application for Permit aRernewal) ro Construct and/or Use a Wee1(s) for injection with
G-eorhertnai Neat Pimp System for Type 5A7 Well(sj if the injection well systern on your
property is sill gig:
-OR-
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or pe man cd y abandoned.
there has been a change of ownership of the property, au Injection 'Well Permit
Name/Ownership Change Form must also be submitted.
AQUIFER 1noer
1636 Ial wi= Covet R2leth, hrorlh Care der 27s991636
Lgatinec ne Caelvd 6vkwab. Raleigh Fern Cargine tr avr
rigor I - 33.321 l FAX 1' 919-715 19311; FA.X 2 91S:154604B Cuale re 1 6746
Yntrnst
EPOpp:mm*0
Nthoi Caro21Ila
Va ralli

96►24►2919 19:41 919-715-0580
NUESI R/WAY R QUAL PAGE 03
If the injection well system is no longer big used for asry purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCA.0 Title 15A_ Subchapter
2C, Section .0214. When each well is plugged and abandoned the well abandonment record
(Form OW-30) must be submitted to our office to certify that the abaadanment was properly
conducted. If the injection well syst= is still active mid you wish to rrnew your permit, the
renewal application mast be submitted within 30 calendar love of the receipt of this letter to:
Aquifer Protection Section
Groundwater Mott Unit
LAC Program
1636 Mail Service Center
Raleigh, NC 77699-1636
Failure to submit these forms in a timely rummer m.ay result in the assessment of civil penalties
in accordance with North Carolina General Statute 87- 4. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available on-line at the DWQ website at
btttt:l(h.2o.emr.state,n ,ustaps/spuiforms.htm.
Thank you in advance for your cooperation snd timely response. If you have any questions,
please call me at [phone].
Sincerely,
6,44,_ 4,,,,AK
Eric G. Smith, P.O.
Hydrogeologist
Attachments
cc: R.ale igh Regional Office - APS vito enclosures
APS Central Files - Permit No. WI0500030 w/o enclosures
2

06/24/2010 19:41 919-715-0588
vacaimp '$ I •ail it i arGiI dISS 10
Department or Environment
and Natural Resources
Division of Water Quality
Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
Coleen Sullins, Director
NCEEOR/WATER QUAL
PAGE 01
Division of Water QuaHy
Aquifer Protection Section
Location: 2728 Capital Blvd.
Raleigh, NC 27604
Mono Add 1636 Mail Service Center
Raleigh, NC. 27699 1636
FAX: [phone]
[phone]
Dare:
RECEIVED IDENRIC Q
Aquifer Protection Section
JUL 07 2010
FAX TO: Nowhrii . A FAX NUMBER: fit - 8YC._ ULi z
FROM: i
PHONE 1' — 7,s-C21iG
NO. OF PAGES INCLUDING MIS SHEET: 8
If you receive this fax by mistake call: Aquifer Protection Section @ 919-733-3221

Beverly Eaves Perdue
Governor
NA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of ·Water Quality
Coleen H. Sullins
Director
May 24, 2010
Howard Moody
115 Carpathian Way
Raleigh, NC 27615
Subject: Notice of Expiration (NOE)
5A 7 Geothermal Injection Well
Perm.it No. WI0500030
Wake County
Dear Mr. Moody:
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
.Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above-referenced operating permit for
the underground injection well· system, which was issueq to you on September 2, 2005, and
expires on August 31, 2010, has not been renewed. . If you wish to keep this permit and operate
the injection well system, the permit must be renewed and issued in your name. Our records.do
not indicate that the well system has been plugged and abandoned. ·
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit one of the following
forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s) for Injection with
Geothermal Heat Pump System for Type SA 7 Well(s) if ~e injection well system on your
property is still active.
-OR-
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form. must also be submitted.
AQUIFER PROTECTION SECTION
1636 Mall Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard. Raleigh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Cu.sterner Service: 1-877-623-6748
Internet: www.ncwaterguality.org
An Equal Opportunity \ Affirmative Action Employer
One N orthCarolina
;Natura/tu
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter
2C, Section .0214. When each well is plugged and abandoned, the well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted. If the injection well system is still active and you wish to renew your permit, the
renewal application must be submitted within 30 calendar days of the receipt of this letter to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available on-line at the DWQ website at
http://h2o.enr.state.nc.us/aps/ou/forms.htm.
Thank you in advance for your cooperation and timely response. If you have any questions,
please call me at [phone].
Sincerely,
F (4747.141A
Eric G. Smith, P.G.
Hydrogeologist
Attachments
cc: Raleigh Regional Office - APS w/o enclosures
APS Central Files - Permit No. W10500030 wi o enclosures

0
25
50
100 Feet
Reid
Value
PIN
1708484688
Real Estate ID
0125107
Map Name
170801
Owner
MOODY, HOWARD
E & MARY
FRANCS
Mailing Address 1
115 CARPATHIAN
WAY
Meiling Address 2
RALEIGH NC
27615-1612
Mailing Address 3
Deed Book
08000
Deed Page
0045
Deed Dare
0410311998
Deeded Acreage
0.94
Assessed Building
$428,254.00
Value
Assessed Land Value
$180,000.00
Total Assessed Value
$808,254.00
Billing Class
INDIVIDUAL
Property Description
LO2 PANNONIA PH1
BM1962-00696
Heated Area
4142
Sfte Address
115 CARPATHIAN
WAY
City
Township
BARTONS CREEK
Year Buhl
1985
Total Sale Price
$528,500.00
Sale Data
4/3/1998 12:00:00
AM
Type and Use
Single Family
Design Style
Conventional
Land Class
RESIDENCE-c 10
ACRES -HOME SITE
Old Parcel Number
281-00000.0174
$((t J t
WI-o7Dc
row—
WAKE
COUNTY
KORZH i. d'Rn�a�A.

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
Coleen Sullins, Director
Division of Water Qualify
Aquifer Protection Section
Location: 2728 Capital Blvd.
Raleigh, NC 27604
Mailing Address: 1636 Mail Service Center
Raleigh, N.C. 27699-1636
FAX: [phone]
[phone]
Date:
FAX TO: F j r )
FAX NUMBER: 111- e 1.-Gtilz
FROM: Erg +- Ste►,
PHONE: ?1S -GI �1[.
NO. OF PAGES INCLUDING THIS SHEET: 9
If you receive this fax by mistake call: Aquifer Protection Section @ 919-733-3221

MA
M R
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly !:aves Perdue
Governor
Howard Moody
115 Carpathian Way
Raleigh, NC 27615
Coleen H. Suliins
Director
May 24, 2010
Subject: Notice of Expiration (NOE)
SA 7 Geothennal Injection Well
Permit No. WI0500030
Wake County
Dear Mr. Moody:
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division ·of Water
Quality (DWQ) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above-referenced operating permit for
the underground injection well system, which was issued to you on September 2, 2005, and
expires on August 31, 2010, has not been renewed. If you wish to keep this permit and operate
the injection well system, the permit must be renewed and issued in your name. Our records do
not indicate that the well system has been plugged and abandoned.
In order to -comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit one of the following
forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s) for Injection with
Geothermal Heat Pump System for Type 5A7 Well(s) if the injection well system on your
property is still active. ·
-OR-
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or. permanently abandoned.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard. Raleigh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748
Internet: www .ncwaterquality.org\
An Equal Opportunity\ Affirmative Action Employer
No~i..c .,. 01u1 ·arouna
;Nat11rall!f
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter
2C, Section .0214. When each well is plugged and abandoned, the well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted. If the injection well system is still active and you wish to renew your permit. the
renewal application must be submitted within 30 calendar days of the receipt of this letter to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available on-line at the DWQ website at
http:Ilb2o.enr.state.nc.uslapslL ulfarms.htm.
Thank you in advance for your cooperation and timely response. If you have anv questions,
please call me at [phone].
Sincerely,
4ifith",
Eric G. Smith, P.G.
Hydrogeologist
Attachments
cc: Raleigh Regional Office - APS w/o enclosures
APS Central Files - Permit No. WI0500030 w/o enclosures

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT.TO CONSTRUCTAND/OR USE A WELL FOR INJECTION
WITH A GEOTHERMAL HEAT PUMP SYSTEM
TYPE 5A 7 "OPEN LOOP" INJECTION WELL(S)
(check one) __ New Permit Application Renewal ---Modification
DATE: _____ 20 __
PERMIT NO.: _W'--'-',I ________ (leave blank if NEW permit application)
A. PROPERTY OWNER/PERMIT APPLICANT
Name of each owner listed on property deed. For a business or government agency, state name of entity and
name of person delegated authority to sign application on behalf of the business/agency: ______ _
(1) Mailing Address: ___________________________ _
City: _________ State: __ Zip Code:. ______ County: _____ _
Home/Office Tele No.: ---------------=C=e=ll-=-N-=-=o=.:'-----------------
Fax No. ___________ Email Address:. ______________ _
(2) Physical Address of Well Site (if different than above): ___ ~-----------
City: _________ State: __ Zip Code: ______ County: _____ _
Home/Office Tele No.: -----------~C~e=ll'-"N'-'-o=-".-'-: __________ _
Fax No. ___________ Email Address: ______________ _
B. PROPERTY OWNERSHIP DOCUMENTATION
Provide legal documentation of property ownership, such as a contract, deed, article of incorporation, etc. and
a PLAT map showing the property. This information may be obtained from county Register of Deeds or GIS
website.
C. AUTHORIZED AGENT, IF ANY
If the property owner/permit applicant wants to authorize someone else to sign the permit on their behalf, then
attach a signed letter from the property owner/permit applicant specifying and authorizing their agent (well
driller, heat pump contractor, or other type of contractor/agent) to sign this application on their behalf.
Company Name: ______________________________ _
Contact Person_-'-: ----------------=E=m=a=il'-=A=d~d=re=s=s~: __________ _
Address:---------------------------------
City: _________ State: __ Zip Code: ______ County: _______ _
Office Tele No.: ----------=Fc..::::ax=-=--=-N-'-=oC...C.... _________ C=-e=l;::....;1 N::....:...=..o "-'-.: _______ _
Website Address of Company, if any: _______________________ _
Type 5A7 Injection Well Permit Application (Rev. August 2009) Page 1 of 4
D. WELL DRILLER INFORMATION
Company Name: _______________________________ _
Well Drilling Contractor's Name: _________________________ _
NC Contractor Certification No.: --------~C~o_nta_ct_P_e_r_so_n_: ___________ _
Company Website-'--: ---'w-'--·ww--'-'--'--'--'--' --------------"'E=m=a'--i_l A~d=dr~e~ss'--: ________ _
Address:----------------------------------
City: _________ State: __ Zip Code: ______ County: _______ _
Office Tele No.: Fax No.: Cell No.: --------------------------
E. HEAT PUMP CONTRACTOR INFORMATION (if different than Driller)
· CompanyName: _______________ C=-==on=t=ac=--=t--=P---=e=rs=--=o=n"--: ___________ _
Company Website_: WWW ___ . ______________ E_m_a_il_A_ddr_e_ss_: ________ _
Address:----------------------------------
City: _________ State: __ Zip Code: ______ County: _______ _
Office Tele No.: Fax No. Cell No. ---------
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
G. WELL USE Will the injection well(s) also be used as .the supply well(s) for the following?
(1) The injection operation? YES____ NO ___ _
(2) Personal consumption? YES ____ NO ___ _
H. WELL CONSTRUCTION DATA
(1)
____ PROPOSED Well(s) to be constructed for use as an injection well. Provide the data in (1) through
(7) below as PROPOSED construction specifications. Submit Form GW-1 after construction.
____ EXISTING Well(s) being proposed for use as an injection well. Provide the data in (1) through (7)
below to the best of your knowledge. Attach a copy of the Well Construction Record (Form
GW-1) if available. .
Well Construction Date: _______ Number of borings: ___ _
Depth of each boring (feet): _______ _
(2) Well casing. Is the well(s) cased?
(a) YES If yes, then provide the casing information below.
Type: Galvanized steel __ Black steel __ Plastic __ Other (specify) ______ _
Casing thickness: __ diameter (inches): ___ depth: from ___ to ___ feet (relative to land surface)
Casing extends above ground ____ inches
(b) NO
(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 .0213(d)(l)(A), which requires a cement type grout.
(b) Depth of grout around well casing (relative to land surface): from ___ to ___ feet
Type 5A7 Injection Well Permit Application (Rev. August 2009) Page 2 of 4
(4) Well Screen or Open Borehole depth (relative to land surface): from ____ to ___ feet
(5) N.C. State Regulations (Title 15A NCAC 2C .0200) require the Permittee to make prov1S1ons for
monitoring wellhead processes. A faucet on both Influent (groundwater entering heat pump) and Effluent
(wat~ being injected back into the well) lines is required. Will there be a faucet on:
(a) Influent line? Yes No (b) Effluent line? Yes No __
(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-1 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 DRILLING OR HEAT PUMP CONTRACTOR CAN HELP SUPPLY THE DATA IF THIS
INFORMATION IS OTHERWISE UNAVAILABLE.
I. OPERATINGDATA
(1)
(2)
(3)
(4)
Injection Rate:
Injection Volume:
Injection Pressure:
Injection Temperature:
J. INJECTION-RELATED EQUIPMENT
Average ( daily) __ _._,gallons per minute (gpm).
Average (daily) gallons per day (gpd).
Average ( daily) pounds/square inch (psi).
Average (January) ° F, Average (July) __ ° F.
Attach a schematic diagram or cross-section of the well construction that shows the total depth, length of casing,
extent of grout, stickup, location of influent/effluent sampling ports, etc. If this is a modification, show 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 if needed.
K. LOCATION OF WELL(S)
(1) Attach a site map (can be drawn) showing: houses and other structures, property lines, surface water bodies,
potential sources of groundwater contamination, and the orientation of and ·distances between the proposed
injection well(s) and any other existing well(s) or waste disposal facilities such as septic tanks or drain fields
located within 1000 feet of the geothermal heat pump well system. Label all features clearly and include a
north arrow.
(2) Attach a scaled topographic map of the area extending 1/4 mile from the property boundary that indicates
the facility's location, a north arrow, and the map name.
NOTE: In most cases, an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by owner
name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other wells, etc.
can then be drawn in by hand. Also, a 'layer' can be selected showing topographic contours or elevation data.
Type 5A7 Injection Well Pennit Application (Rev. August 2009) Page 3 of 4
L. CERTIFICATION (to be signed as required below or by that person's authorized agent)
NCAC 15A 2C .021 l(b) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner.
If an authorized agent is signing on behalf of the applicant, then submit a letter signed by the
applicant that names and authorizes their agent as specified in Part C of this permit application.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information submitted in
this document and all attachments thereto and that, based on my inquiry of those individuals immediately responsible for
obtaining said infonnation, I believe that the 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 Property Owner/ Applicant
Print or Type Full Name
Signature of Property Owner/ Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit TWO signed copies of the completed application package and all attachments to:
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Type 5A7 Injection Well Permit Application (Rev. August 2009) Page4 of4
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATUS OF INJECTION WELL SYSTEM
Permit Number: __________ _
Permittee Name: __________________ _
Address: ________________________________ _
Please check the selection which most closely describes the current status of your injection well system:
1) □ Well(s) still used for injection activities, or may be in the future.
2) □ Well(s) not used for injection but is/are used for water supply or other purposes.
3) □ Injection discontinued and: a)□ Well(s) temporarily abandoned
b) □ Well(s) permanently abandoned
c) □ Well(s) not abandoned
4) □ Injection well(s) never constructed
Current Use of Well
If you checked (2), describe the well use (potable water supply, irrigation, monitoring, etc), including pumping rate and other
relevant information.
Well Abandonment
If you checked (3)(a) or (3)(b), describe the method used to abandon the injection well. (Include a description of how the well
was sealed and the type of material used to fill the well if permanently abandoned):
Permit Rescission:
If you checked (2), (3), or (4) and will not use a well for injection on this site in the future, you should request rescission of the
permit. Do you wish to rescind the permit?
□ Yes □ No
Certification:
"I hereby certify, under penalty oflaw, that I have personally examined and am familiar with the information submitted
in this document, and that to the best of my knowledge the information is true, accurate, and complete."
Signature Date
Revised 5/05 GW/UIC-68
DATE,TIME
FAX NO./NAME
DURATION
PAGE(S)
RESULT
MODE
TRANSMISSION VERIFICATION REPORT
06/24 19:41
98466212
00:02:12
08
OK
STANDARD
ECM
TIME 06/24/2010 19:43
NAME NCDE&NR/WATER QUAL
FAX [phone]
TEL [phone]
Michael F. Easley. Governor
(Dwo
`C
William C. Ross .lr„ Secretary
North Cantina Department of Envinonrnent and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
September 2, 2005
Mary and Howard Moody
1 15 Carpathian Way
Raleigh, NC 27615
Ref: Issuance of Permit W10500030
Type 5A7 Injection Well
Dear Mr. and Mrs. Moody:
hi accordance with your application submitted. August 18, 2005, the Division of Water Quality's Underground
Injection Control UIC) Program is forwarding Permit No. WI0500030 for the operation of a geothertnal heat
pump injection system at 115 Carpathian Way, Raleigh, in Wake County. This permit shall be effective from
the date of issuance until August 31. 2010, and shall be subject to the conditions and limitations stated therein.
Please read your permit carefully to make sure you thoroughly understand its requirements and your
responsibilities. In order to maintain uninterrupted legal status of the injection well, you must request an
extension at least 120 days prior to the expiration of this permit. Also enclosed is a copy of the laboratory test
results of water samples collected from your injection well system as part of the permit renewal process.
Please contact me at 919-715-6166 or Evan Kane at 9 ] 9-715-6182 if you have any questions regarding this
transmittal or the UIC Program.
Best Regards,
Thomas Slusser
Hydrogeologica] Technician 11
UIC Program
Enclosures
cc: Jay Zitninerman, Raleigh Regional Office
CO-UIC Files
Nam` hCarolina
zti ralllf
Aquifer Protection Section 1636 Mail Scrvice Center Raleigh. NC 27S99•I636
Inferrer: http:llh2o.etx.state.nc.us
2728 Capital Boulevard Raleigh, NC 27604
An Equal Opportunity/Affirmative Action Employer - 50% Recycledl10% Post Consumer Paper
Phone [phone]
Fax [phone]
Fax [phone]
Customer service
I-877-623.6748

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and
other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
HOWARD AND MARY MOODY
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL, defined in Title 1 SA North Carolina
Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat pump effluent.
This injection well will be located at 115 Carpathian Way in Raleigh, Wake County, and will be
operated in accordance with the application dated August 18, 2005 and in conformity with the
specifications and supporting data submitted, all of which are fled 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 ] 5A 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 issuance until August 31, 2010, and
shall be subject to the specified conditions and limitations set forth in Parts I through VII hereof.
Ear3
Permit issued this the 2 day of -j- ' )-k f , 2005.
aplaso, .
Alan W. Klirnek, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No. WI0500030 PAGE t OF 4
GWIUJC-5 per. 7/05

PART I -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 suppo11ing data.
2. This pem1it is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In th~ event there is a desire for the facility to change
ownership, or there "is a name change of the Permittee, a fonnal pennit 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 Pem1ittee 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. Furthem10re, the issuance of this
pem1it does not imply that all regulatory requirements have been met.
PART II -PERFORMANCE STANDARDS
1. The injection facility sha11 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
Pe1111ittee 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 Pei·mittee shall be required to comply with the te1111s and conditions of this pennit even if
compliance requires a reduction or elimination of the pennitted activity.
3. The issuance ofthis pe1111it shall not relieve the Pennittee of the responsibility for damages to
surface or groundwatei· resulting from the operation of this facility.
PART HI -OPERATION AND MAINTENANCE REQUIREMENTS
1:. The injection facility shall be properly maintained and operated at a11 times.
·2. The P,em1ittee must notify the Division and receive prior written approval from the Director of
any planned physical alterations or additions in the pennitted facility or activity not
specifica1ly authorized by the pennit.
3. At least fo11y-eight (48) hours prior to the initiation of the operation of the facility for
injection, the Pennittee must notify by telephone the Aquifer Protection 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
detennine if it is in compliance with pennit conditions.
Permit No. Wl0500030
GW/UIC-5 ver. 7/05
PAGE20F4
PART IV -INSPECTIONS
l. 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 · faci]ity at any reasonab]e 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 samp]ing associated with injection and any related facilities as provided for in
N.C.G.S. 87-90.
3. Provisions shall be made for collecting-any necessary and appropriate samples associated with
the injection facility activities.
PART V -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by
the Divi'sion ·of Water Quality to insure surface and ground water protection, will be
established and an acceptable sampling rep01iing schedule shall be followed .. ·
2. The Pennittee shall report by telephone, within 48 hours of the occurrence or first knowledge
of the occurrence, to the Raleigh Regional Office, telephone number [phone], any of
the fo] lowing: ·
(A) Any occmTence 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 Pennittee becomes aware of an omission of any relevant facts in a pennit
application; or of any incorrect infonnation submitted in said application or in any report to the
Director, the relevant and correct facts or infom1ation shall be promptly submitted to the
Director by the Pem1ittee.
4. In the everit that the permitted facility fails to perform satisfactorily, the Pe1mittee shall take
such immediate action as may be required by the Director.
PART VI -PERMIT RENEWAL
In order to maintain uninterrupted legal status of the injection well, the Permittee shall
request an extension at least 120 days prior to the expiration of this permit ..
Permit No. WI0500030
GW/UIC-5 ver. 7/05
-PAGE 3 OF 4
PART Vil-CHANGE OF WELL STATUS
l. The Permittee shall provide written notification within 15 days of any change of status of an
injection well. Such a change would include the discontinuation of use of a well for injection.
If a well is taken completely out of service temporarily, the Pennittee must install a sanitary
seal. If a well is not to be used for any purpose that well must be pe1manently 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 procediires specified in
15A NCAC 2C .0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment
procedures if the Director finds such removal will not be responsible for, or
contribute to, the contamination of an underground source of drinking water.
(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
detennines 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 wel1 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 tlu·ough 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 tenns and conditions ofthepermit.
(G) The Pennittee shall submit a Well Abandonment Record (Form GW-30) as
specified in 15A NCAC 2C .02B(h)(l) within 30 days of completion of
abandonment.
3. The written documentation required. in Part VII (1) and (2) (G) shall be submitted to:
Permit No. WI0500030
GW/UIC-5
Aquifer Protection Section-VIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
ver. 7/05
PAGE40F4
Date:
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
August 23.2005
To: ❑ Landon Davidson, ARO-APS
111 Art Barnhardt, FRO-APS
❑ Andrew Pitner, MRO-APS
Jay Zimmerman, RRO-APS
O F .9In:
f
Thomas Slusser , Groundwater Protection Unit
Telephone: [phone] ZSS
E-Mail: [e-mail]
A. Permit Number: WI0500030
B. Owner: HOWARD MOODY
C. Facility/Operation: HOME
❑ Proposed ® Existing
f
❑ David May, Wald,,4PS
❑ Charlie Stehma ,. WiRO-APS•
❑ Sherri Knight; WSRO-APS
C'\� C•
Fax: [phone]
Ee
AQUIFER PROTECTION SECTION
SEP 0 12005
❑ Facility ❑ Operation
D. Application:
1. Permit Type: ❑ Animal ❑ Surface Irrigation ❑ Reuse ❑ H-R Infiltration
❑ Recycle ❑ 1/E Lagoon ❑ GW Rernediation (ND)
® UIC - (5A7) open Loop geothermal
For Residuals: 0 Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt E Animal
2. Project Type: ❑ New ❑ Major Mod. 0 Minor Mod. ® Renewal ❑ Renewal w/ Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
JIM GREER HAS ALREADY INSPECTED AND SAMPLED THIS FACILITY!
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, please take the following actions:
® Return a Completed Form APSSRR.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
O Issue an Attachment B Certification from the RO*.
* Remember that you will be responsible for coordinating site visits, 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 09/04
Page 1 of 1

COUNTY : WAKE
QUAD NO:
REPORT TO RRO Regional Office
COLLECTORS) : J GREER
DATE: 7/26/2005
TIME: 10:30
PURPOSE.
LABORATORY ANALYSTS
BOD 310
mg/1.
COD High 340
mg/L.
COD Low 335
mg/L
X
Coiiform; MF Fecal 31616
1 B2
/100mI
X
Conform: -ME, Total 31504
1 B2
Il00ml
TOC
mg/I
Turbidity
NTLi
Residue., Suspended 530
mg/L
Total Suspended solids
mg/L
pit
5.9
units
X
Alkalinity to pli 4.5
14
mg/L
X
Alkalinity to pH 8.3
1U
mg/L
X
Carbonate
1 U
mg/L
X
Bicarbonate
14
mJJL
Carbon dioxide
mgll-
X
Chloride
5U
mg/L
Chromium: Hex I032
uglL
Color. True 80
c.u.
Cyanide 720
mg/I_
COMMENTS :
DIVISION OF WATER QUALITY
Chemistry Laboratory Report / Ground Water Quality
SAMPLE PR1OJtITY
El ROUTINE EMERGENCY
CHAIN OF CUSTODY
W❑ SAMPLE TYPE
Owner:
Location or Site:
Description orsampiing point
Sampling Method
Remarks:
HOWARD E. MOODY
2
X
l)iss. Solids 70300
33
mg/L
FI uoride 951
mg/L
Hardness: total 904)
mg/L,
Iaudness: (non-carb) 902
mg/L
Phenols 32730
uglL
Specific Cond. 95
urrrhoslcm2
Sulfate
mg/L
Sulfide 745
mg/L
MBAS
mg/L
Oil and Grease
mg/L
Silica
me/L
Boron
Formaldehyde
mg/L
X
NH3asN6i0
0.02U
mg/L
X
"11.1<.N as N 625
0.20U
rngfL
X
NO2 +NO3 as n 630
0.91
mg/L
P, Total as P 665
mg/L.
PO4
mgll.
Nitrate (NO3 as N) 620
0.91
mg/L
Nitrite (NO, as N) 615
0.01 U
mg/L
Ag-Silver 46566
ug/L
Al -Aluminum 46557
uWWL
As -Arsenic 46551
ug/L
Ba-Barium 46558
uglL
X
Ca -Calcium 46552
2.7 mg/L
X
Cd-Cadmium 46559
2.0U uglL
X
Cr-Chromium 46560
25U ug/L
X
Cu- Copper 1042
89 ug/L
X
Fe- iron 1045
95 ug/L
Hg- Mercury 71900
ug/L
K-Potassium 46555
mg/L
Mg- Magnesiurn 927
mg/L
X
Mn-Manganese 1055
10U ug/l..
Na- Sodium 929
rng/L
X
Ni-Nickel
18 uglL
X
Ph -head 46564
10U ugll.
Se -Selenium
uglL
X
''In -Zinc 46567
18 ng/L,
Lab Number : 5G1938
Date Received : 7/26/200S
Time Received 11740 AM
Received By _ DS
Released By : CC;
Date reported . 8/Z3/2005
Organochlorine Pesticides
Organaphosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
Semivolatiles
TPH-Diesel Range
Volatile Organics (VOA hurtle)
'TPH-Gasoline Range
TPH-BTEX Gasoline Range
5G193B.xts

COUNTY: WAKE
QUAD NO:
DIVISION OF WATER QUALITY
Chemistry Laboratory Report/ Ground Water Quality
SAMPLE PRIORITY
□ROUTINE □EMERGENCY
REPORT TO : _R_R_O __________ Regional Office □ CHAIN OF CUSTODY
~ SAMPLE TYPE E] COLLECTOR(S) :_J_G_R_E_E_R ______ _
DATE: 7/26/2005
TIME: 10 :0 0
PURPOSE: Owner: HOWARD MOODY
Location or Site:
Description of sampling point _______________________ _
Sampling Method:
Remarks:
LABORATORY ANALYSIS
BOD 310 mg/L x Diss. Solids 70300 33 mg/L Ag-Silver 46566
COD High 340 mg/L Fluoride 951 mg/L Al-Aluminum 46557
COD Low 335 mg/L Hardness: total 900 mg/L As-Arsenic 46551
X Coliform: MF Fecal 31616 1 82 /IO0ml Hardness: (non-carb) 902 mg/L Ba-Barium 46558
X Coliform: MF Total 31504 1 B2 /l00ml Phenols 32730 ug/L X Ca-Calcium 46552
TOC mg/I Specific Cond. 95 umhos/cm2 X Cd-Cadmium 46559
Turbidity NTU Sulfate mg/L X Cr-Chromium 46560
Residue., Suspended 530 mg/L Sulfide 745 mg/L X Cu-Copper 1042
Total Suspended solids mg/L MBAS mg/L X Fe-Iron I 045
Oil and Grease mg/L Hg-Mercury 71900
pH 5.6 units Silica mg/L K-Potassium 46555
X Alkalinity to pH 4.5 9 mg/L Boron Mg-Magnesium 927
X Alkalinity to pH 8.3 1U mg/L Formaldehyde mg/L X Mn-Manganese I 055
X Carbonate 1U mg/L X NH3 as N 610 0.02U mg/L Na-Sodium 929
X Bicarbonate 9 mg/L X TKN as N 625 0.20U mg/L X Ni-Nickel
Carbon dioxide mg/L X NO2 +NO3 as n 630 0.89 mg/L X Pb-Lead 46564
X Chloride SU mg/L P: Total as P 665 mg/L Se-Selenium
Chromium: Hex I 032 ug/L PO4 mg/L X Zn-Zinc 46567
Color: True 80 c.u. Nitrate (NO3 as N) 620 0.89 mg/L
Cyanide 720 mg/L Nitrite (N02 as N) 615 0.01U mg/L
COMMENTS:
Lab Number : 5G1937
Date Received 7/26/2005
Time Received 11:40AM
Received By OS
Released By : CG
Date reported : 8/23/2005
ug/L Organochlorine Pesticides
ug/L Organophosphorus Pesticides
ug/L Nitrogen Pesticides
ug/L
2.5 mg/L Acid Herbicides
2.0U ug/L
25U ug/L Semivolatiles
2.0U ug/L TPH-Diesel Range
190 ug/L
ug/L Volatile Organics (VOA bottle)
mg/L
mg/L TPH-Gasoline Range r ·, ---.:
10U ug/L TPH-BTEX Gasoline Range '
mg/L
10U ug/L
10U ug/L
ug/L
16 ug/L
5G1937.xls
C3�0C- W A rk,i,�G
i"11�If� 7
Micharl F. Easley, Governor
WilliatnG. Ross Jr., Secretary
North Carolina Deparlmen! of Environmen! and Natural ResourccA
Alan W. Klimek, P [. Director
Divrs too of Water Qttr I ity
August 24, 2005
Mary and Howard Moody
115 Carpathian Way
Raleigh, NC 27615
Dear Mr. and Mrs. Moody:
Your renewal application for a permit to use a
been received and is under review. Jim Greer
staff has already inspected the injection well and
If you have any questions regarding permit or
Evan Kane at [phone].
Cc: Jay Zimmerman, Raleigh Regional Office
t-CU-LUC Files
well for the injection of geothermal heat pump effluent has
of the Aquifer Protection Section's Raleigh Regional Office
collect water samples as part of the review.
injection well rules please contact me at [phone] or
Best Regards,
slaw,
Thomas Slusser
Hydrogeological Technician II
UIC Program
N�o�"hCarolina
;Naturallu,
Aquifer Protection Section 1636 Mail Service Center
Internet: http:llh2o.cnr.state.nc.us 2728 Capital Boulevard
Raleigh. NC 27699-1636
Raleigh, NC. 27604
An Equal Opportun Ity/Affi rmative Action Employer— 50% Recyciedita% Post Consumer Paper
Phone (9t9) 733-3221 Customer Service
Fax (919)7 I 5-0588 1-877-623-6748
Fax [phone]

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
RENEW AL APPLICATION FOR PERMIT TO USE WELL(S) FOR INJECTION WITH A
HEAT PUMP SYSTEM
Type 5A7 and SQM Wells
In accordance with the provisions ofNCAC Title ISA: 02C.0200
complete application and mail to address on the back page.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: Auc.o~ 1 ft"'-, 20~0 ____ 5 __ .
A. PERMIT APPLIC~
Permit Number: WI: 0£000..30 (WIO######, listed at the bottom of each page of your permit)
Name: ~ 6 W\%,'1 <H-, J, tL('4ae 4 ~ M.Q>J2'1
Address: \ \7 ~l':bJ kh't'/
City: ____,~'------"--~~·-~--------State: NC.. . Zip code: "'2,,:1-b l 5
County: __ W_ll--'-1'& ______ Telephone: j 11 · 6jb · bZ ( 2
B. PROPERTY OWNER (if different from applicant)
C.
Name: ~ 12. Mq1J,'1 .J,t , 1 »1ViilY £t2Jt/NC&S ~
Address: t l~ CAtf,tn{,AtJ WA y
City: ~41, H· State: JtJt_ Zip code: z:::tbt '2
County: vJltJt€ Telephone: Cf lq , fJLjb .. l::,2-/1-,
STATUS OF APPLICANT
Private: ✓ Federal:
Native American Lands: __ _
Commercial: ___ State: ___ Public: __
D. FACILITY (SITE) DATA (Fill out ONLY if the Status of Owner is Federal, State, Public or Commercial).
Name of Business or Facility: --~L.....#--/A-------a..-----------------
Address: _________________________ _
City: _____________ State: ___ Zip code: _____ _
County: Telephone: ____________ _
Contact Person: _______________________ _
Standard Industrial Code(s) which describe commercial facility: __________ _
Revised S/05 GW/UIC-57 HPR
RECEIVED/DENR/DWQ
AQUIF&R PROTECTION SECTION
AUG! 3 2005
Page 1 of3
E. INJECTION PROCEDURE (specify any modifications to the injection procedure since the issuance of the
previous injection permit) "'~
F. WELL USE Is(are) the injection well(s) also used as the supplywell(s) for either of the following?
(1) The injection operation? YES ✓ NO __
(2) Your personal consumption? YES_ NO ,,,,-,-
G. CONSTRUCTION DATA
H.
I.
J.
K.
L.
(1)
(2)
Specify any and all modifications to the well casing, grout or screens since the issuance of the previous
injection permit.
,Jo~
NC. State Regulations (ISA NCAC, 2C, Section .0200) require the permittee to make provisions for
monitoring well head processes. A faucet on both influent (groundwater entering heat pump) and
effluent (water being injected into th.5 well) lines is required. Is there a faucet on:
(a) the influent line? YES_v_ NO __
(b) on the effluent line? YESjz NO __
CURRENT OPERATING DATA
(I) Jnjecticm rate: Average (dat1y) ~ gallons per minute (gpm)
(2) Injection volume: Average (daily) ___ gallons per day (gpd) ?
(3)
(4)
Injection pressure:
Injection temperature:
Average (daily) ___ pounds per square inch (psi) ?
Annual Average degrees Fahrenheit (0 F) /)Z, 0 f 04/Ti:JF ~Pfq kJeU....
INJECTION-RELATED EQUIPMENT
Attach a diagram showing any modifications to injection equipment since the issuance of the previous injection
pennit including the engineering layout of the (I) injection equipment, and (2) exterior pipins'tubing associated
with the injection operation. The manufacturer's brochure, if detailed, should satisfy (I). tJ/A
LOCATION OF WELL(S) Attach a map
Include a site map (can be drawn) showing: the orientation of and distances between the injection well(s) and any
existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet of the
ground-source heat pump well system; include buildings, property lines, surface water bodies, any other potential
so~ces_ of groundwater contamination. L~pel all features clearly and incl~~,a north _ arrow to inJl!'i~~ .. ----
onentat1on. pi rile ~ ft£.,\ltDU, PB*lT. ~ H;1tv€ P;e/GN Ht!> ~
1ttJC€ tJ<ltet,~ tru~u:,,...)
PERMIT LIST: Attach a list of all pennits or construction approvals. received or applied for by the applicant
that are related to the site. Examples include:
(1) Haz.ar~~U:S Waste Manag~ent pro~ permits un~r RCM7 M(YJ~ ~rJ<,Tltl#J~ N~ ~ ,~0
(2) NC D1V1s1on ofWater QuahtyNon-D1SCharge pernuts t,D•J!. ,.r.AJ 11 ~L
(3) Sewage Treatment and Disposal Permits H"'f i"rr-"'-7 '""'-
OTHER MODIFICATIONS: Indicate any other modifications to the injection well system (equipment, fluid,
operation, etc.) that have occurred since the issuance of the previous injection permit and have not been noted
elsewhere on this application. ,JI\
Revised S/0S GW/UIC-S7 HPR Page2 of3
M. CERTIFICATION
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based ou my 'inquiry of those individuals
immediately responsible for obtaining said information, I believe thatthe information is true, accurate and
complete. 1 am aware that there are significant penalties, including the possibility of fines and imprisonment, for
submitting false information. I agree to 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 oell fir. er it Authdrix4� Agent)
If atahorized agent Ls acting on behalf of the well owner
please supply a letter signed by the owner
authorizing the above agent.
N. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property rights in the
well(s). A well is real property and its construction on land rests ownership in the land owner in the absence of
contrary agreement in writing.)
If the property is owned by someone other than the applicant, the property owner hereby consents to allow the
applicant to operate an injection well(s) as outlined in this application and that it shall be the responsibility of the
applicant to ensure that the injection well(s) conform to the Well Construction Standards (Title 15A NCAC
Subchapter 2C .0200)
Revised 5/05
Nei .1;iiFfMarr
(Signature of Property Owner if Different From Applicant)
Please return the completed Application package to:
{TIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
GWIUIC-57 HPR Page 3 of 3

Evan Kane
From: Evan Kane [[e-mail]]
Sent: Thursday, August 18, 2005 2:12 PM
To: [e-mail]
Subject: Renewal form
Mr. Moody,
I've attached a blank renewal form as requested by your wife this morning
Thanks for your attention to this. · ·
Evan 0. Kane, P.G.
Underground Injection Control Program Manager
evan. kane ncmail. net
Phone: [phone] <--NOTE NEW PHONE NUMBER
Fax:[phone]
North Carolina Department of Environment and
Natural Resources
Division of Water Quality -Aquifer Protection Section
USPS Address:
1636 Mail Service Center
Raleigh, NC 27699-1636
Shipping Address:
2728 Capital Blvd
Raleigh, NC 27604
-------
--I' {f"'ib--'/ Mv--Mn1J ~ &/n/d5"-ff -<fo-.--..t. ~ s~ t..../
i-------?""-~ ~ ~ _,L~ -~ <fa.-~ cPrv--~-,Jr.,,-./
A.-~#--.,__.,.., .Al~'( JC--z,5 7,,;JVS Y... ~ ~k--~
'fr {f' -r---7&. ~~~-'fo-.---~, J c:d/4--t ,,,{,~--~ ?,d ..e--.11-k.,/
);:__---fv,, Ft/ J'-f-~ ~J'U.-..:fr.,.,_~ ~le-~~l -1,---6~ 'lea A..
~~·0 j ~ io.L-~ ~-< ~ -r,.,,,.__,.,9-~ ~ ~ ~l '-
fre_ __ oj11;1is
8/19/2005
SENDER: COMPLETE I. iS SECTION
COMPLETE THIS SECTIO ■N DELIVERY
■ Complete items 1, 2,3. Also complete
Item 4 If Restricted Delivery] desired_
■ Print your name and address on the reverse
so that we can return the card to you.
a Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Artfcte Addressed to:
HOWARD MOODY
115 CARPATHIAN WAY
RALEIGH NC 27615
A. Signature
x-
B. R by(
D. Is del ryaddress different from item 1? 0 Yes
if YES, enter delivery address below: 0 No
14,7411
o Agent
0 Addressee
C. Date of Delivery
© Express Malt
f7 Return Receipt for Merchandise
O C.O.D.
4. Restricted Delivery? (Extra Fee)
Yea
a Article Number
(Transfer from service label)
7002 2410 0003 0273 6885
PS Form 3811, August 2001
Domestic Return Receipt 2ACPRl-03-Z-0985

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
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
7002 2410 0003 0274 0318
Howard Moody
115 Carpathian Way
Raleigh, NC 27615
Ref:
June 27, 2005
Notice of Regulatory Requirement
North Carolina Well Construction Standards
Applicable to Injection Wells - Subchapter 2C
UIC Permit No. WI0500030 issued to Howard E. Moody
Dear Mr. Moody:
The Underground Injection Control (UIC) Program of the Division of Water Quality is responsible for the
regulation of injection well construction and operation activities within the state of North Carolina. The
purpose of this letter is to inform you. as the current property owner, of your re_sponsibilities pertaining to
injection well rules.
The permit referenced above for the construction and operation of an injection well will expire on June 30,
2005. This office attempted to bring your injection well into compliance by sending you a notification of
expiration, a blank application for permit renewal, and an injection well status form in May of 2005. To date the
LTIC Program has not received either the renewal application or the status form.
In order to comply with the regulatory requirements listed under North Carolina Administrative Code (NCAC)
Title 15A, Subchapter2C, Section .0211, you must take one of the following actions:
1. Submit the form RENEWAL APPLICATION FOR PERMIT TO USE WELL(S) FOR INJECTION WITH A HEAT
PUMP SYSTEM (form GWIUIC-57 HPR) if the injection well on your property is still active;
2. Submit the form STATUS OF INJECTION WELL SYSTEM (form GWILTIC-68) if the injection well is
inactive or has been temporarily or permanently abandoned.
If the well is no lounger being used for any purpose, it must be permanently abandoned according to the
regulatory requirements listed under NCAC Title 15A, Subchapter 2C, Section .0214. if the injection well is to
be permanently abandoned, a well abandonment record must be submitted to our office to certify that the
abandonment was properly conducted.
One
NaCaroli Nna
turally
Aquifer Protection Section
Internet: httpJlh2o.enr.state.nc.us
1636 Mail Service Center Raleigh, NC 27699-1636 Phone [phone] Customer Service
2728 Capital Boulevard Raleigh, NC 27604 Fax [phone]
Fax [phone]
An Equal OpportunllyIAffirmative Action Employer— 50% Recycled11O% Post Consumer Paper

Mr. Howard M-oody
June 27, 2005
Page 2 of2
Again, we have provided you with the appropriate materials to update your UIC permit. You must respond
within 15 days of the receipt of this notice, or a Notice of Violation will be issued to vou, which carries the
possibility for an assessment of fines or cessation of operation of the injection well system. Please contact
Thomas Slusser at [phone] or myself at [phone] if you have any questions about this
correspondence, the UIC Program, or the enclosed forms.
Sincerely,
Evan Q. Kane, L.G.
UIC Program Manager
cc: DWQ - Raleigh Regional Office
CO-UIC Files
Enclosures

SENDER: COMPLETE TFKIS SECT(ON
• Complete Items 1, 2, and 3. Also complete
item 4 if Restricted Delivery Is desired.
NI Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the hack of the malipfoce,
or an the front if space permits.
1. Article Addressed to:
Mr. Howard E. Moody
115 Carpathian Way
Raleigh, NC 27615
COMPLETE THIS SECTION ON DELIVERY
A. Signature
x
r
C. Date of Delivery
0 Agent
13 Addressee
D. Is dettvery address ditreran from item t7— p Yes
if YES, enter delivery addrei,peiow;_9312
C
3. Service Type
In Certified Mall ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mali ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
3
7002 2411:I 0003 0273 7011
PS Farm 3811, August 2001
Domestic Return Receipt
2ACPRf-03-Z-0a85

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
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
7002 2410 0003 0273 7011
Mr. Howard E. Moody
115 Carpathian Way
Raleigh, NC 27615
Ref:
May 23, 2005
Notification of Expiration
North Carolina Well Construction Standards
Applicable to Injection Weiss - Subchapter 2C
UIC Permit No. WI0500030 Issued to Howard E. Moody
Dear Mr. Moody:
The Underground Injection Control (UIC) Program of the Division of Water Quality is responsible for the
regulation of injection well construction and operation activities within the state of North Carolina. Our records
show that the operating permit referenced above for the injection well on your property will expire on June 30,
2005. In addition, our records do not indicate that the well has been abandoned.
In order to comply with the regulatory requirements listed under North Carolina Administrative Code (NCAC)
Title 15A, Subchapter 2C, Section .0211, you must take one of the following actions:
1. Submit the form RENEWAL APPLICATION FOR PERMIT TO USE WELL(S) FOR INJECTION WITH A HEAT
PUMP SYSTEM (form GW/UIC-57 HPR) if the injection well on your property is still active;
2. Submit the form STATUS OF INJECTION WELL SYSTEM (form GW/UIC-68) if the injection well is
inactive or has been ternporarily or permanently abandoned.
If the well is no longer being used for any purpose, it must be permanently abandoned according to the
regulatory requirements listed under NCAC Title 15A, Subchapter 2C, Section .0214. If the injection well is to
be permanently abandoned, a well abandonment record must be submitted to our office to certify that the
abandonment was properly conducted. The appropriate form(s) should be forwarded to us within 30 days of the
receipt of this notice, to allow adequate time for well water sampling and analysis.
NIZ Carolina
aturaUi
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Phone [phone] Customer Service
Internet: http://h2o.enr.state.nc.us 2728 Capital Boulevard Raleigh, NC 27604 Fax [phone]$88 1-877-623-6748
Fax [phone]

Mr. HowardE. Moody
May 23, 2005
Page 2 of2
Please submit the appropriate form within 30 days of the date of this letter. If you have any questions regarding
the permit and injection well rules or would like assistance completing these forms please contact Thomas
Slusser at [phone] or myself at [phone]. ·
cc: RRO-UIC Files
CO-UIC Files
Enclosures
Sincerely,
fane W~
Jesse Wiseman
Processing Assistant
UIC Program
Name
Date
Initials
Type of permit
Mark Pritz!
to 0,,.
five
Evan Kane
Vtg f¢L:"
'° �^'"
+{'`
�c ��E, s ..�
r
£tom
1 .—€..�.4 u pari..,r►�-
-�
Debra Watts
4t2-A\DI'
tj+��
`

DIVISION OF WATER QUALITY
GROUNDWATER SECTION
June 24, 2002
MEMORANDUM
To: Jay Zimmerman, L.G., Regional Groundwater Supervisor
Groundwater Section
Raleigh Regional Office
From: Mark Pritzl 'ft1f, [e-mail]
Hydrogeological Technician II
UIC Group
Groundwater Section
Raleigh Central Office
Re: Issuance of a Open-Loop Geothermal Injection Well System (T-ype 5A7.):
Permit Number WI0500030 to operate two wells for the injection of an open-loop
ground-source heat pump system has been issued to Howard Moody, iri Raleigh, North Carolina.
This is a renewal permit and the Underground Injection Control Group appreciates Jim Greer's
assistance with the inspection and review_ tasks. Please retain the application and paper work for
the RRO-UIC files. If you have any questions regarding this permit or the UIC program, please
contact me at [phone] or Evan Kane at [phone].
cc: CO-UIC Files
Enclosures
MEMORANDUM June 11, 2002
To: Mr. Howard E. Moody
From: ftP-Mark Pritzl tel. [phone]
Re: Groundwater Sampling Results from December 6, 2001
Effluent# 2 Water Sample Effluent# 3 Water Sample
Coliform, total <1/l00ml Coliform, total <1/l00ml
Coliform, fecal <1/lO0ml Coliform, fecal <1/l00ml
pH 7.1 pH 7.3
Chloride, Cl 4mg/L Chloride, Cl 3mg/L
Dissolved Solids 32 mg/L Dissolved Solids 34 mg/L
NO~/+ NO3-as N 0.77 mg/L NO2-+ NO3-as N 0.78 mg/L
NH3 asN 0.58 mg/L NH3 asN 0.82 mg/L
TKNasN 2.2 mg/L TKNasN 0.89 mg/L
Cadmium, Cd <2.0mg/L Cadmium, Cd <2.0 mg/L
Chromium, Cr <25 ug/L Chromium, Cr <25 ug/L
Copper, Cu 100 ug/L Copper, Cu 68 ug/L.
Iron,Fe <50 ug/L Iron,Fe <50 ug/L
Mercury, Hg ns Mercury, Hg ns
Potassium, K ns Potassium, K ns
Magnesium, Mg ns Magnesium, Mg ns
Manganese,Mn <10 ug/L Manganese,Mn <10 ug/L
Sodium, Na ns Sodium, Na ns
Nickel, Ni <10 ug/L Nickel, Ni <10 ug/L
Lead, Pb 14 ug/L Lead, Pb <10 ug/L
Selenium, Se ns Selenium, Se ns
Zinc, Zn 24 ug/L Zinc, Zn 29 ug/L
Groundwater Sampling Results from December 6, 2001, continued
Influent or Water Su pp lv Sam ple
Coliform, total 31100ml
Coliform,· fecal <1/lO0ml
pH 6.12
Chloride, Cl 3mg/L
Dissolved Solids 32 mg/L
NO2-+ NO3-as N ns
NH3 asN ns
TKNasN ns
Cadmium, Cd <2.0mg/L
Chromium, Cr <25 ug/L
Copper, Cu 3 ug/L
lron,Fe <50 ug/L
Mercury, Hg ns
Potassium, K ns
Magnesium, Mg ns
Manganese,Mn <10 ug/L
Sodium, Na ns
Nickel, Ni <10 ug/L
Lead, Pb . <10 ug/L
Selenium, Se ns
Zinc, Zn 29 ug/L
State Groundwater Quality Standa~
Classifications and Water Quality Standards Applicable To The Groundwater's of North Carolina
(North Carolina Administrative Code Title 15A: 02L.200)
Coliform, total_ <1/100 ml
Coliform, fecal <1/100 ml
Chloride <250 mg/L
Total Dissolved Solids <500 mg/L
NO2· + NO3-as N <10 mg/L
Cadmium <5.0 ug/L
Chromium, Cr <50 ug/L
Copper, Cu <1,000 ug/L
Iron,Fe <300 ug/L
Manganese,Mn <50 ug/L
Nickel, Ni <100 ug/L
Lead, Pb <15 ug/L
Zinc, Zn <2,100 ug/L
Arsenic, As _ <50 ug/L
Mercury, Hg <l.lug/L
Barium, Ba <2,000 ug/L
Zinc, Zn <2,100 ug/L
mg/L = milligrams per liter= parts per million
ug/L = micrograms per liter = parts per billion
1,000 ug/L = 1 mg/L
ns = not sampled
(1 gram/1,000grams )/1,000grams
(lgram/1,000,000grams)/l,000grams
MEMORANDUM
To: Mr. Howard E. Moody
From: f{f Mark Pritzl tel. [phone]
Re: Groundwater Sampling Results from May 22, 2002
Influent or Water Su pp ly Sample
Coliform, total
Coliform,. fec~l
31100ml
<1/l00ml
June 11, 2002
Effluent Water Sample
Coliform, total
Coliform, fecal
<1/l00ml
<1/l00ml
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
-, DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and
other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Howard E. Moody
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL(S), 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 system is located at 115 Carpathian Way, Raleigh, in Wake County, North
Carolina, and will be operated in accordance with the application received on October 26, 2001,
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 June 30, 2005,
and shall be subject to the specified conditions and limitations set forth in Parts I through IX
hereof.
Jt-
Permit issued this the )\ day of ~V'\ -E._ , 2002.
JAcr~-~
f Ted L. Bush, Jr., Assistant Chief
Groundwater Section
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No. WI0500030
ver.3/01 GW/UIC-5
Page 1 of 5
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 Applica~le to Injection Wells (1 SA 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 pe_rmit shall become voidable unless the facility is constructed in accord.a.nee 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 injection well shall have pemianently affixed an identification plate.
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 submitte~ to the Director, including any supporting materials as maybe
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.
Permit No. WI0500030
ver.3/01 GW/UIC-5
Page 2 of 5
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 inj ec_tion 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 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.
Permit No. WI0500030
ver.3/01 GW/UIC-5
Page 3 of 5
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) 571-
4700, 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 VII -PERMIT RENEW AL
The Permittee shall, at least three (3) months 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 .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 15A NCAC 2C .0214, including but not limited·to the following:
Permit No. WI0500030
ver.3/01 GW/UIC-5
Page 4 of 5
(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) The 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) Drilled wells 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, neat-cement shall be injected into the well completely
filling it from the bottom of the casing to the top.
(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 Abandonment Record (Form GW-30)
as specified in 15A NCAC 2C .0213(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:
Groundwater Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART IX -OPERATION AND USE SPECIAL CONDITIONS
None
Permit No. WI0500030
ver.3/01 GW/UIC-5
Page S of 5
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
June 18, 2002
Mr. Howard Moody
115 Carpathian Way
Raleigh. NC 27615
Dear Mr. Moody:
In accordance with your renewal application dated October 26, 2001, we are forwarding Permit
No. WI0500030 for the operation of a geothermal heat pump injection well at 115 Carpathian
Way, Raleigh, in Wake County, North Carolina. Copies of the laboratory test results of water
samples collected on December 6, 2001 and May 22, 2002 are also enclosed.
This permit shall be effective from the date of issuance until June 30, 2005, and shall be subject
to the conditions and limitations stated therein. In order to continue uninterrupted legal use of
this well for the stated purpose, you should submit an application to renew the permit three
months prior to its expiration date.
If you have any questions regarding your permit please contact me at [phone] or Mark
Pritzl at [phone].
ccCO-UIC Files
RRO-UIC Files
Enclosures
4A
1V�`DENR
Customer Service
1 800 623-7748
Sincerely,
Evan O. Kane
Hydrogeologist
UIC Program Manager
Division of Water Quality 1 Groundwater Section
1636 Mail Service Center Raleigh, NC 27699-1636
Phone: [phone] Fax: [phone] Internet: http:llgw,ehnr.state.nc.us

MEMORANDUM
GROUNDWATER SECTION
June 18, 2002
To: Debra Watts, Supervisor, Permits & Compliance Branch
From: Mark Pritzl, Hydrogeological Technician, UIC Program
Re: Howard Moody's SA 7 renewal for two geothermal injection wells
• Permit issued in 1999 for two years due to elevated lead in first round of samples. Second
round of samples showed no lead. See letter in file dated June 21, 1999.
• Samples taken on December 6, 2001 showed elevated Total Coliform, 18 colonies/lO0mL in
the water supply well and nothing above 2L in the two injection wells. Raleigh Regional
Office (RRO) asked Mr. Moody to correct the problem in January/2002. In May/2002 Mr.
Moody contacted the RRO and Jim Greer collected Total and Fecal Coliform samples on
May 22, 2002. Again, samples from the injection wells showed no Coliform but the Water
Supply Well showed slightly elevated Total Coliform, 3 colonies/l00mL. The RRO feels
the slightly elevated Total Coliform results are due to sample collection processes and not
from the well itself.
• Due to historically elevated sample results a three year injection well permit 1s
recommended.
COUNTY: WAKE')
QUAD NO:
REPORTTO
COLLECTOR(S) :
_R_R_O __________ Regional Office
JCREER
DATE:
TIME:
PURPOSE:
LABORATORY ANALYSIS
BOD310
CODHigh340
CODLow335
X Coliform: MF Fecal 31616 1 82
X Coliform: MF Total 31S04 1 82
TOC
Turbitity
Residue., Suspended S30
Total Suspended solids
pH
Alkalinity to pH 4.S
Alkalinity to pH 8.3
Carbonate
Bicarbonate
Carbon dioxide
Chloride
Chromium: Hex 1032
Color: True 80
Cyanide7Z0
COMMENTS:
m2/L
mg/L
m2/L.
/IOOml
/IOOml
ml!.11
NTU
m2/L
mg/L
units
mg/L
mJ!/L
mg/L
mg/L
mg/L
mg/L
ug/L
c.u.
mg/L
Owner:
Location or Site:
Description of sampling point
Sampling Method:
Remarks:
Diss. Solids 70300
Fluoride95I
Hardness: total 900
Hardness: (non:-carb) 902
Phenols 32730
Specific Cond. 95
Sulfate
Sulfide 745
MBAS
Oil and Grease
Silica
Boron
Formaldehyde
NH3asN610
TK.N asN 625
NO2 +NO3 as n 630
P: Total as P 665
P04
RFCEIVEO / OENR
OWO GiWUf{ ·wAT R SECTION
DIVISION OF WATER QUALITY /.~
Chemistry Laboratory Report/ Ground Water Quallty/0 3~,I A_~~""-ro_: 2 9
SAMPLE PRIORITY ~~~ '~ □ROUTINE □EMERGENCY :
4
_ • • • #~•-
~-' IJ?'',
Lab Number 2G0942
Date Received : 0S/.22/2002
Time Received : 10:15 AM
R-v,4 7; I ~ Ta;)
~-By: AR·
□ CHAIN OF CUSTODY □ ... c/ ~ SAMPLE TYPE ,, 0. ~ /;;' . -·,1:,.('¼i v <J '
MR HOWARD MOODY --::;w, ,; i.J.,01 lJe ti "~;~:~~ ~ -~t..!S:: }_/"=========='
Date reported : 6/3/2002
'~v~~, -~' y. '--~/
/
',/ "'\,,
ma/L Ag-Silver 46S66 ug/L Onranochlorine Pesticides
me/L Al-Aluminum 46557 ug/L Organoohosphorus Pesticides
m2/L As-Arsenic 46551 u2/L Nitro2cn Pesticides
mg/L Ba-Barium 46S58 ug/L
ug/L Ca-Calcium 465S2 mg/L Acid Herbicides
umhos/cm2 Cd-Cadium 46S59 ug/L
mg/L Cr-Chromium 46560 ug/L Semivolatiles
mg/L Cu-Copper 1042 u~/L TPH-Diesel Ranee
mg/L Fe-Iron 104S ug/L
mg/L Hg-Mercury 71900 ug/L Volatile Oritanics (VOA bottle)
ma/L K-Potassium 46555 mg/L
Mg-Magnesium 927 m2/L TPH-Gasoline Ranee
mg/L Mn-Manganese 10S5 ug/L TPH-BTEX Gasoline Ranae
mg/L Na-Sodium 929 mg/L
mg/L Ni-Nickel ug/L
mg/L Pb-Lead46S64 ug/L
me/L Se-Selenium u2/L
mg/L Zn Zinc 46S67 ug/L
2G0942.xls
GROUNDWATER FIELD/LAB FORM
County 6—
Quad No Serial No
Lat. Long.
Report To: ARO, FRO, MR r - R f aRO, NITRO,
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by: Bus Courier, Hand Del ,
Collector(s): t [.=- .-� Date i
FIELD ANALYSES
0140 4 • a Spec. Cond.94
Temp.io / 7. 3 °C Odor
Appearance
Field Analysis By:
at 25° C
Q,/•C •
SAMPLE TYPE SAMPLE PRIORITY
lEiWater ❑ Routine
❑ Soil ❑ Emergency
❑ Other
0 Chain of Custody
Purpose:
Time q Z L.> Baseline, Compl
Owner -7-1 fiz. P-r-
Location or site / /
Description of sampling point
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER DUALITY - GROUNDWATER SECTION
Lab Number
Date Received
Rec'd by: D,5
Other:
Data Entry By: Ck•
Date Reported:
omp anc. Ucao
ST, Pe hide Study, Federal Trust, Other:
7
Sampling Method Sample Interval
Remarks '"'"',er
LABORATORY ANALYSES
-ir-r7F
¢. ►- 4-".,f. # , - . - --
_ .
DOD, 310
mg/I
Diss. Solids 70300
mgil
Aq - Silver 46566
ugll
Organochlorine Pesticides
COD High 340
mgll
Flouride 951
mall
Al - Aluminum 45557
ug/1
Organophosphorus Pesticides
COD Low 335
m9/1
rdness: Total 900
mg/I
As - Arsenic 46551
u.
Nitrogen Pesticides
X.
Coliform: MF Fecal 31616
1100ml
Hardness (non-carb) 002
rng/t
8a - Barium 46558
ug/1
Acid Herbicides
7‹
Coliform: MF Total 31504
1100ml
Phenols 32730
argil
Ca - Calcium 46552
mg/I
PCB's
TOC 660
mgil
Specific Cond. 95
uMvlhoslcm2
Cd - Cadmium 46559
ugli
Turbidity 76
NTU
Sulfate 945
mgil
Cr- Chromium 46560
ug/I
Residue., Suspended 530
mg/1
Sulfide 745
mill
Cu - Copper 46562
ug/1
Fe - Iron 46563
ug/1
Semivolatite Organics
011 and Grease
mg/I
Hg - Mercury 71900
ug/1
TPH - Diesel Range
pH 403
units
K - Potassium 46555
mg/1
Alkalinity to pH 4.5 410
mg/1
Mg - Magnesium 46554
mg/1
Alkalinity to pH 8.3 415
mgA
Mn - Manganese 46565
ugA
Carbonate 445
mg/1
NH, as N 610
mg/1
Na - Sodium 46556
mg/I
Volatile Organics (VOA bottle)
Bicarbonate 440
mgll
TKN as N 625
mg/1_
Ni - Nick61
ugil
TPH - Gasoline Range
Carbon dioxide 405
mgA
NO, + NO, as N 630
mil
Pb - Lead 46564
ug/1
TPH - BTEX Gasollre Range
Chloride 940
P: Total as P 665
mgll
So - Seisnium
ugli
Chromium: Hex 1032
ug/1
Zn - Zinc 46567
ugll
Color: True 80
CU
Cyanide 720
mgll
_
J
Lab Comments:
0
GW-54 REV. 12/9
For Dissolved Analysis - submit filtered sample and write "DIS" In bl

DIVISION OF WATER QUALITY
clit NDWITIR S oar:
Chemistry Laboratory Report / Ground Wttcr Quality
COUNTY : WAKE 5AMP1,E PRIORITY
QUAD NO: - EKOUTiNE
REPORT TO : RRO Regional Office ❑ CI LAIN OF CUSTODY
COLLECTOR(S) : J GREER
DATE: =MON
TIME:
PURPOSE:
LABORATORY ANALYSIS
0OD 310
mg/L
COO High 340
rttg/L
COD Low 335
mg/L
X
Colifarm: MF Fecal 31616
1 02
/ 100m1
X
Colifmm: MF Total 31501
3 Ell
/ 100m1
TOC
mg/1
Turbitity
NTU
Residue., Suspended 530
mg/l.
Total Suspended solids
mR/1.
pH
units
AIkal{niry to pH 4-5
mg/L
Alkalinity toyH 8.3
mg/L
Carbonate
mg/L
Bicarbonate
mg/L
Carbon dioxide
mg/L
Chloride
mg/E.
Chromium: Hex 1032
ug/L
Color- True 80
c.u.
Cyanide 720
mg/L
COMMENTS :
SAMPLE-[YPE
Owner. 81,111141K6RIL8190.11.Y
Location or Site:
Description of sampling point
Sampling Method:
Remarks:
Dis!- Solids 70300
mg/L
Fluoride 951
mg/L
Hardness: total900
mg/L
Hardness: (pon•carb) 902 _
mg/L
Phenols 32730
ug/L
Specific Cond. 95
umhos/cm2
Sulfate
ruff,
Sulfide 745
mg/L
MBAS
mg/L
Oil and Grease
mg/L
Silica
mg/L
Boron
Formaldehyde
mg/ i-
NH3 as N 610
mg/L
TEN asN625
mg/L.
NO2 +NO3 as n 630
mg/L
P: Total as P 465
mg/L
PO4
mg/L
EMERGENCY
Ag Silvtr 46566
ug/L
Al -Aluminum 46557
ug/L
As -Arsenic 46551
ug/L
Ba-1330nm 46558
ug/L
Ca -Calcium 46552
mg/I.
Cd-Cadium 46559
ug/L
Cr-Chromium 46560
ug/L
Cu- Copper 1092
ug/L
Fe- iron 1045
ug/L
lig- Mercury 71900
ug/L
K-Potassium 46555
mg/L
Mg- Magnesium 927
mg/L,
Mn-Manganese 1055
tag/L
Na. Sodium 929
mg/l.
Ni-Nickel
ug/l.
Ph -Lead 96564
ug/1.
Se -Selenium
ug/L
Zn_Zinc46567
ui/L.
Lab Number : 2G0941
Dale Received : 5/22/2002
Time Received : 10:15 AM
Received By
tea;
ti Released By : AR
a(e reported : 611402
•
Organochionne Pesticides
Organophasehoma Pesticides
Nitroprn Pesticides
Add Herbicides
Se m vo 1 a ti 1es
TPH-Diesel Range
Volatile Organics VOA honk)
TPH•Gasoline Range
TPII.11 EX Gasoline Range

GROUNDWATER FIELD/LAB FORM
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
County 42 a 't_
quad No Serial No
Lat _ _ Long
SAMPLE TYPE SAMPLE PRIORITY
® Water ❑ Routine
❑ Soil ❑ Emergency
❑ Other
❑ Chain of Custody
Lab Number
Date Receiv
Rec'd by:
Other:
Report To: ARO,•FRO, MRO, WaRO, WiRO, Data Entry By: Ck-
WSRO, Kinston FO, Fed. Trust, Central Off., Other: Date Reported:
Shipped by: Bys, Courie�, Ha{id Del.,--h7 1�
Purpose:
Baseline, Comp! in Compliant LUST, Pesticide Study. Federal Trust Other Lit 4-
FIELD ANALYSES` c; '
pH400 .S ? S ec. Cond.94 �1 Tiex--,:ii?)
! � 1%_/le ' �ofTemp.10 Ili. oC Odor L.,�
Appearance C ) e—r4 '
Field Analysis By:;7
LABORATORY ANAL ES
Owner �''��- -
at 25° C Location or site / ' 5�
Description of sampling point
Sampling Method
Remarks
Sample Interval
. belle, eft.]
n Jun17L•
BODj 310
mgli
❑iss. Solids 70300
m '
Ag -Sliver 46566
ugJl
COD High 340
mg/1
Flouride 951
mgli
Al - Aluminum 413557
ugll
COD Low 335
mgll
Hardness: Total 900
mc/i_,
As - Arsenic 46551
ug/1
Coliform: MF Fecal 31616
1100m1
Hardness {non-carbt 902
mg/1
Ba - Barium 46558
ug/1
Coliform: MF Total 31504
1100m1
Phenols 32730
ug/1
Ca - Calcium 46552
mg/1
TOC 680
mg/1
Specific Cond. 95
uMhoslcm2
Cd - Cadmium 46559
ug/1
Turbidity 76
NTIJ
Sulfate 945
mg/1
Cr - Chromium 48560
ug/1
Residua., Suspended 530
mg/1
Sulfide 745
mg/1
Cu - Copper 46562
ugll
Fe - Iron 46563
ug/1
Oil and Grease
nigll
Hg - Mercury 71900
uglt
pH 403
units
K - Potassium 46555
mg/1
Alkalinity to pH 4.5 410
mgli
Mg - Magnesium 46554
mgli
Alkalinity to pH 8.3 415
mg/1
Mn - Manganese 46565
mill
Carbonate 445
rng/t
NH, as N 610
mgli
Na - Sodium 46556
rng/I
Bicarbonate 440
mqh
TKN as N 625
mGJL
Ni - Nickel
ugl1
Carbon dioxide 405
mgfl
NO2 + NO, as N 630
mn/1
Pb - Lead 46564
ugll
Chloride 940
nigh
P: Total as P 665
mg/1
Se - Selenium
ug/1
Chromium: Hex 1032
ug/1
Zn - Zinc 46567
uqh
Color: True 80
CU
Cyanide 720
mg/I
•
Lab Comments:
Organochlorine Pesticides
Organophospflorus Pesticides
Nitrogen Pesticides
Acid Herbicides
PCB's
Semivolalile Organics
TPH - Diesel Range
Volatile Organics (VOA bottle)
TPH - Gasoline Flange
TPH - BTEX Gasotlre Range
/)
GW-54 REV. 121F
For Dissolved Analysis - submit filtered sample and write "D1S" in bi

DATE:
•
t� P AL?S S
DIVISION O1 IVNI K QUALITY
Chemistry Laboratory Herat / Cvu un Il 1Ya to Quality
❑SinU'l•1NE
Regional Office I ! C 1 Lllu OP CLISMIn•
con High 340
COD Low 335
mg/L
mg/L
62 0 /100ml
ITCC
mg/1
Turbitity
NTtJ
mg/L
jpH
6.2 01
unib
'Mkt -Unity to pHi S
1
ICarnonate
mg/L
!Bicarbonate
11 mg/ L
mg/L
ug/L
Color. True SO
Gn.
Cyanide 720
SA A IPLE TYPE
Owner.
Location or Site: _
1S/ Ci -;-03 •^
4/ ;'-'/s
Remarks;
02 MR 22 t 1 !O: 27
EM IiRG I!NCY
1 WS
MR�HOWARDMOOD,/ ( %FFL, u
il.-r-►G U b..' "1k
X IDL.
31
mg/L
fluoride 951
mg/L
X
Hardness: total900
6
mg/L
X Hardness: (non-carb) 902
1 U
mg/L
Phenols 32730
ug/L
Specific Cond. 95
u mhos/cm2
Sulfate
mg/L
Sulfide 745
mg/L
I :..
au pit.
Oil and Grease
mg/L
Silica
mg/L
Boron
Formaldehyde
mg/L
X
NH3 as N 610
0.0623
mg/L
X
TRH asN625
0.20U
mg/L
X
NO2 +NO3 as u 630
1200
mg/L
P: Total as
0.02U
mg/L
POI
mg/L
AgSilver46566
ug/L
Al -Aluminum 46557
ug/L
As -Arsenic 96551
ug/L
Ba-Barium 41558
ug/L
Ca -Calcium 46552
mg/L
X
Cd-Cadium 96559
2.0U
u_g/L
X
Cr-Chromium 46560-
25U
ug/L
X
Cu- Copper1042
3.0
ug/L
X
Fe-Iron1045
50U
upji.
Hg- Mercury 71900
ug/L
K-Potassium 4.555
mg/L
Mg- Magnesium 927
mg/L
X
Mn-Manganese1055
10U
ug/L
Na- Sodium 929
mg/L
X
Ni-Nickel
10U
ug/L
X
Pb-Lead 46564
10U
ug/L
Se -Selenium
ug/L
X
Zn_Zinc 46567
29
ug/L
iahNumlx•r 1G1828
Date Received : 1 16/3001
Time Received : 11;45 AM
Received By HA AV
Released By : AR
Date reported ; 01/11/2002
0rgannchlarine Pesticides
Organophasphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
Semivalatiles
TPH-Diesel Range
Volatile Organics (VOA bottle)
TPFM- Gasoline Range
TPH-BTEX Gasoline Range

North Car,,..aa Department of Environment and i cural Resources
Division of Water Quality - Groundwater Section
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PERMIT NO. WI o .5-27»D
NAME OF OWNER .14%�-
ADDRESS OF OWNER
DATE !Z— /
(Street/ road or lot and subdivision, county, town)
LOCATION OF INJECTION WELL (and source well(s), if applicable) C cc jazz,
-ri,4-) Z n
(Street/road or lot and subdivision , county, town, if different t ran owner's ciStress, plus description of location on site)
Potential pollution source ` -- Distance from well
Potential pollution source
Distance from welt •- —
Potential pollution source Distance from well
Minimum distance of well from property boundary ,.S
Quality of drainage at site
dequate,poor)
GPS Data:
Latitude: 3 '
Flooding potential of site
(high,rnoderate,
Longitude: •: ;-
DRAW SKETCH OF SITE (Show property boundaries, buildings, wells, potential pollution sources, roads, approximate scale, a
- north arrow)
DESCRIBE INJECTION SYSTEM (vertical dosed loop, encased borehole or cased seater well; separate source well and
injection well; combination source and injection well; or other description as applicable)
r. 7 - S f '• '- -'�I Sc6,
'Llnv i 1(11

OUNTY
'UA❑ NO:
I3PORTTO : RRO
OLLECTOR(S : GEER
PATE:
1iv1E:
URPOSE:
ORY ...
'_YSIS
Regional Orrice
0UD 310
mp/L
COD High 340
rng/L
COD Low 335
rng/L
Calirorm: MF Fecal 31616
1 B2 Q
/ I00mI
Caliform_:.;. Total31504
1 Q
/100m1
TOC
ng/I
Turbility
NTU
Residue.. Sus' ended 530
mg/L
TotalSus. ended solids
rir./L
7.101
units
Tpit
Alkalinity to ,11.1.5
8.7
mg/ L
Allalinn.. to ,,:. 8.3
mVL
Carbonate
lU
mg/L
Bic to
8.7
mg/L
Carho a d ;oxide
mt;/ L
CI toridc
4
mg/L
Chromium: He 11132
ug/L
Color: True So
e.u.
C.,anide 720
mg/1.
•OMMEIYTS
Sri?
D1v1SIOI.1 Olz WATER QUAL1 I Yr „R 1 lI 1i 110: 33
Chemistry 1.mhor.tury Report (Ground W.tcr Qunllty
uattiv, PRIORITY
nRO1f iNE
E CHAIN OF CUSTODY
Wn SAMPLE TYPE
Owner; MR 11OWARD MOODY
Location or Site:
Description or sampling point
Sampling Method:
Remarks:
•
EMERGENCY
EFF2
jrAtl1
piss. Solids 70300
Fluoride 951
32 mLIL
mg/L
x
X
Hardness: total 900
Hardness: (non-carb) 402
6 mg/L
1 U mg/L
Phenols 32730
ug/L
Specific Cond. 95
15ulratc
umhos/cm2
mg/L
Sulfide 745
M BAS
Oil and Grease
Silica
mg/L
mg/L
to pet.
mg/I.
Boron
x
Formaldch do
NH3 asN610
mgIL
0.58 mg/L
x
x
TKN as N 625
NO2 +NO3 as n 630
2.2 mg/L
0.77 mg/L
Tidal as 1' 665
0,02 ml:IL
PO4
mg/L
Lab Number :
Date Received :
Time Received
Received 8v
1 G 1829
12/6/ZOt1
11:45AM
11W
eieasfd 1!v 1
Date reported : 1/14/200I
Ag•Silver 46566
AI -Aluminum 46557
As -Arsenic 46551
u1/IL
ug/LLi
ug/L
x
Ba-Barium 46558
tt L
Ca•Calciurn 46552
rnl /L
Cd-Caditm 46559
2.0U ug/L
Cr-Chromium 46560
25U ug/L
x
x
Cu- Co, Ter 1042
Pc• Iron 1045
1 IR- Mercury 71900
100 ug/L
50U ur,/i.
ug/L
It -Potassium 46555
m9IL
Mg- Magnesium 927
mg1I.
x
Mn•Mangancse 1055
Na-Sodium 929
IOU up/L
mg/1.
Ni-Nickel
IOU ug/L
x
Pb-Lead 46564
14 ug/L.
Sc•Scicnium
u#/ L
x
2n_2inc 46567
24 ug11.
..1
Organcrchlorine Pcslicidss
bilaisgph`os`pliorus Pesticides
Nitrogen Pesticides
Acid Herbicides
Scmivolatiles
TPH-Diesel Range
Volatile Organics [VOA bunk)
1'Pii-Gasoline Range
TP1 •BTEX Gasoline Range

GROUNDWATER FIELD/LAB FORM
County
Quad No Serial No
Lat Long. - -
Report To: ARO, FRO, MROWaRO, WiRO,
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by: Bus, Courier, Hand De! ,Q,g,,r.___&71---""
Collector -Cs): ,. re-71.- Date /Z G Tirne / b%ate
SAMPLE TYPO SAMPLE PRTO51TY
® Water ❑ Routine
❑ Soil ❑ Emergency
❑ Other -
❑ Chain of Custody
F. "_D ANALYSESL`
p} q00 . _ 0 Spec. Cond.94 5/4 at 25° C
Temp.10 • .7 °C Odor N'AJ ,
Appearance r°/v_.-:-r—
Field Analysis By:
LABORATORY ALYSES
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
Purpose:
Baseline, Compiainl-C mplianc t
Owner) • �l c�G�
Location or site
Description of sampling point
Lab Number 6'7$ c
❑ale Recei ed ( / / d1 06 Time f / c
Rec'd by: J From: Bus, Courier and Del
Other
Data Entry By:
Date. Reported: -- _
S T, Pesticide Study, Federal Trus )
�s.
Ck•
Sampling Method �� Sample Interval
w. etc.)
Remarks
(pumping lime. air Canc. Me.)
GOD, 310 m11i
Y
piss_ Solids 70300 moll
Aq - Silver 46566 uq/1
Drganochtorine Pesticides
GOD High 340 mg/I
FIouride 951 ' m Il
Al - Aluminum 46557 ugll
Drganophaspharus Pesticides
COD Low 335 mgll1
I
Hardness: Total 900 mRll
As - Arsenic 46551 ugli
Nitrogen Pesticides
1 }'
Coliform: MP Fecal 31616 1100m1,
Hardness (non-carb) 902 mall
Ba - Barium 46556 uo/1
Acid Herbicides
ti .'
Coliform: MF Total 31504 /100m1
I
Phenols 327"0 i
Ca - Calcium 46552 mg/l
PCB's
TOC 660 mg/I
, I , 1 u I . • rr2
h
Cd - Cadmium 46559 uq/1
Turbidity 76 NTt!
Sulfate 945 mall
4
Cr - Chromium 46560 uon
l
1 Residue., Suspended 530 rag/I
Sulfide 745 m, /1
_
Cu - Capper 46562 ug/1
Fe - Iron 46563 ugli
SemivoIalile Organics
011 and Grease m.lf
fig -Mercury 71900 ugll
TPH - Diesel Range
K - Potassium 46555 _ mg/1
pH 403 unit:
Mg - Magnesium 46554 mg/1
Alkalinity to pH 4,5 410 mgli
)'
Mn - Manganese 46565 uQ!1
Alkalinity to pH 8.3 415 mgll
Volatile Organics (VOA bottle)
Carbonate 445 mgli
NH, as N .610 m•/1
Na - Sodium 46556 rag/1
Bicarbonate 440 Mil 11
TKr,2 0 IL
Ni -Nickel u�t
�TPH -Gasoline Rance
_ _
Carbon dioxide 405 mgll
NO + NO as N 630 m./f
Pb - Lead 46564 ugll
TPH - BTEX Gasolire Range
P: Total as P 665 - m li
Se - Selenium ug/t
X
Chloride 940 mgll
V.
Zn - Zinc 46567 ugll
Chromium: Hex 1032 ugll
Color: True B0 Cl�
'
Cyanide 720 mg11
I
Lab Comments: -.� l�%,��� ,� J� S 1 v P) - z . $car
- -� Alp Jet (Pi -4 z• r .
GW-54 REV. '
For Dissolved Analysis - sub
.L filtered sample and write "MS" •

Analytical Area (check one):
WCH
0 NUT
it l: U11 I K W W %. t newasicy iiaUus awry
Sam 1 le Anomaly Re .art (SAR)
afrr•
O METALS
O MICRO
11 : following anomalies occurrecl (check all that apply):
Samples
0 Improper container used
O VOA vials with headspace
O Sulfide samples with headspace
Samples not received, but listed on fieldsheet
O Samples received, but not listed on fseldsheet
❑ Mislabeled as to tests, preservatives, etc.
O Holding time expired
Cl Prior to receipt in tab
0 . After receipt in lab
❑ Insufficient quantity for analysis
❑ Sample exhibits gross non -homogeneity
Sample not chemically preserved properly
0 pH out of range (record pli):
} j 0 Improper chemical
C3 J Residual chlorine present in sample
O Color interference .
❑ Heavy emulsion formed during extraction
O Sample bottle broken in lab - no reportable results
O VOA
O PEST
❑ SVOA
❑ Qusdity Control
❑ Instrument failure — no reportable results
❑ Analyyt error — no reportable results
❑ Surrogates
❑ None added
❑ Recovery outside acceptance limits
O Spike recovery
Ci None added
O Recovery outside acceptance Limits
Lt Failed to meet criteria for precision
❑ Internal standards
❑ Blank contamination
❑ QC data reported outside of controls (it QCS, LCS)
0 Incorrect procedure used
O SOP intentionally modified with QA and Branch Head
approval
O Invalid instrument calibration
❑ Elevated detection limits due to:
0 Insufficient sample volume
❑ Other (specify):
Comments:
0 ..94:7 Falb �/ Apr- /e s * (44,n ,— S€ rc d
-y1 l k(.4L[' ,nD O ^4 -1-,a�e.,. V) F7/1 nit /./r 1 ) F�
Corrective Action:
Nw
" -
Ati.; .4
Lead Chemist w
1 StMU:CM
J METALS
Branch Head Review (in' '
QA/QC Review (init
!S
Form completed by:
O PEST
O VOA
Ir�4: 4 f I.1 r i!l,l 11 1 1 .'i ! t
�AFf }i;R"3, _ yg
0 SVOA
Logged into .tni. hx9e by (initial):
QuliFonussuboroory&
lN2 41!db±

X HJN-I'1
)11AD NO:
WAKE
DIVISION 0 Ir WATER QUALIFY
Chemistry Laboratory stupors / Ground Water Quinsy
SAMPLE PRIORITY
ROUTINE
1.EPORTTO : RRO Regional Mice ❑ CILASN OF CUSTODY
X5LLECTOR(S) : CEER
]A'TE: 14161I001 E SAMPLE TYPE
"1ME:
RPOSE: Owner: J11&W)WA R11 610011V
,ABORATORY ANALYSTS
BO D 310
mg/ L
COD 1SiRh • •
mg/L
COD Low 335
mg/L
Coliform: MF Feca13 J 616
1 92 Q
/ 10prnl
CoIiIornt: NIP Total 31504
1 82 Q
/1110m1
TOC
mg/1
Turbitit
NTU
Residue.. Suspended 530
mir/L
TLnal S us n er,dcd sobids
mg/L.
p/I
7.3 Ql
units
Alkalinity to, ::4.5
11
sng/L
Alkalinity to 1 1 1 8.3
mg/J...
Carbonate
1 U
mg/L
Bic? :le
11
mg/L
Care - .:oxide
mg/L
Chloride
3
mg/L
Chromium: Hex 1032
ug/L
c-u-
Cyanide 720
mg/L
:OMMENTS
Location or Site:
Description of sampling point
Sampling Method:
Remarks:
El EMERGENCY
EFF3
X
Din. Solids 703110
34
mg/L
Fluoride 951 -
mk/L
X
Hardness: total 900
6
rng/L
X
Hardness: (non-carb1902
IU
mg/L.
Phenols 32730
ug/L
Specific Cond. 95
urnhos/cm2
Sulfate
-
mg/L
Sulfide 745
mg/L
MBAS
tng/L
Oil and Grease
mr/L
Silica
mg/L
Boron
Formaldehyde
mg/I,
X
NH3 as N 610
0.82
mg/L
X
TKN as N 625
0.89
mg/L
X
NO2 +NO3 as n 630
0.78
mg/L
P: "fatal as P 665
0.02
mgfL
PO4
mg/L.
Al•-5liver 46566
u 5/ L L 1
Al -Aluminum 46557
uR/L —As-Arsenic
46551
ug/L ,
Ba-Barium 46558
ug/1_
Ca -Calcium 46552
mg/L
X
Cd-Cadium 46559
2.0U
ug/1_
X
Cr-Chromium 46560
251J
ug/L
X
Cu- Copper 1042
68
ug/L
X.
Fr- [ion 1045
50U
ug/L
11g- lulerrun- 71900
uF/1.
IC -Potassium 46555
reglL
Mg- Magnesium 927
mg/L
X
Ildn-M a vieliese 1055
10U
ug/1.
Na- Sodium 929
mg/L
X
Ni-Nickel
SOU
up/L.
X
Pb-Lead 46564
1OU
ug/L
Se -Selenium
u g/ L
X
Zn_Zinc46567
29
ug/L
Lab Number : IG1830
Dale Received : 111612001
Time Received : 11:45 AM
Received By : UMW
R8J$°
AR
Date spoiled : 111 k/2002
Ono nochtorine.Eesticldesi'F ,C
Qrganol;hirspForus 1'esiicides
Nitrogen Pesticides
Acid herbicides
Semivolatiles
TPH-Diesel Range
Volatile Organics (VOA bottle)
TP11-Gasoline Range
TPII-lrfix Gasoline Rangc

GROUNDWATER FIELD/LAB FORM
County
Quad No Serial No
Lat. Long
Report To: ARO, FRO, MRO, [ti ice] �1faRO, WiRO,
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by: Bus, Courier, Hand Del., TIE?
SAMPLE TYPE SAMPLE PRIORITY
® Water ❑ Routine
❑ Soli ❑ Emergerioy
❑ Other
❑ Chain of Custody
•
Collector{s:. Date / Z Ci/
L -D ANALYSE
pH 00 C,- Spec. Cond.94 YR. at 25° C
Temp.10 -I °C Odor
Appearance "'—
Field Analysis By: .
LABC RATORY AN ..YSES
in, - Purpose:
Tiirne '' Baseline, C mplaint,
Owner ?7rc. •S�c.
Location or site
Description of sampling paint
Sampling Method
Remarks
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
Lab Number J / 3(7
Date Received 1 I d 6- Time ./I �i-r,
Reed by• f LM Lk/ From: Bus, Courier and De
Other:
Data Entry By: Ck:
Date Reported:
UST, Pesticide Study, Federal Trus QtlzerD - /" -
licks On0]
e[-'t2, fJ ` .4-1Go
\1
(Pump.t LIer, Wc.)
(pumping limo. a1r 10mp. etc)
Sample interval c'1=
k1'd
BCD, 310 mall
Diss. Solids 70300 moll
_
Ag - Silver 46566 ugll
COD High 340 mgll
Flourlde 951 mg/1
Al - Aluminum 46557 ug/I
CCD Low 335 m fI
X
Hardness: Total Boo moll
_As - Arsenic 46551 ug/I
Coiliorm: MF Fecal 31616 /l00m1
,'
Hardness (non-carb) 902 mg/1
8a - Barium 46558 ugll
Coliform: MF Total 31504 1100m1
Phenols 32730 unll
Ca - Calcium 46552 moll
TQC 680 m. ;11 j
.,
$n.,:n li • Cond, Qr.) .1Mtios[cm2
X
Cd - Cadmium 46559 ugll
Turbidity 76 NTU
Sulfate 945 moll
X
Cr - Chromium 46560 unit
Residue., Suspended 530 mg/I
j
Sulfide 745 malt
X
Cu - Copper 46562 ug/1
Fe - Iron 46563 u9II
Oil and Grease mg/I
Hg - Mercury 71900 ug/1 1
pH 403 units
K - Potassium 46555 mg/1
i
Alkalinity to pH 4.5 410 mg/1
Mg - Magnesium 46554 mg/I
Alkalinity to pH 3.3 415 mg/I
X
Mn - Manganese 46565 ug-II
NH_ as N 610 moll
Na - Sodium 46555 moll
Carbonate 445 mglf
X X.
TKN as N 625 mgLL
X_Ni
- Nickel ugll
r_
Bicarbonate 445 Mg/I
NO + NO. as N 63o moil
.�
Pb - Lead 46564 ug11
Carbon dioxide 405 mg!!
P: Tote! as P 665 moll
Se - Selenium ug/I
VtChloride 840 moll
2n-Zinc46567 ugll
Chromium: Hex 1032 ug/1
f___I Color: True 80 CU
Cyanide 720 _mglI
I- -
Lab Comments: 4vt,
�r
GW-54 REV. ' • ;,; •
Organochlorine Pesticides
-r
Organophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
PCB's
Semivolatile Organics
TPH - Diesel Range
A
Volatile Organics (VOA bottle)
TPH - Gasoline Range
TPH - RTEX Gasollre Range
For Dissolved Analysts-subtniit filtered sample and write "D1S"

lyUcal Ares (check one):
WCH
0 NUT
NC DENRIDWQ Chemistry Laboratory
Sample Anomaly Report (SAR)
r6��£f''3''_.C4'.f�:�%�`S' f2' i.23SL"':: £. F• i£:i'#.C' i«i:-=.i
❑ METALS
O MCRO
The fallowing anomalies occurred (check all that apply):
Samples
❑ Improper container used
VOA vials with headspare
Sulfide samples with headspace
Samples not received, but listed on fieldshee
Samples received, but not listed on fieldsheet
Mislabeled as to tests, preservatives, etc.
Holding time expired
❑ Prior to receipt in lab
O After receipt in lab
O Insufficient quantity for analysis
0 Sample exhibits gross non -homogeneity
Sample not chemically preserved properly
O pH out of range (record pH):
t%/p© Improper chemical
Residual chlorine present in sample
O Color interference
❑ Heavy emulsion formed during extraction
O Sample bottle broken in lab - no reportable results
0
0
La
a
0 VOA
0 PEST
7141
0 SVOA
❑ Quality Control
O Instrument failure — no reportable results
❑ Analyst error — no reportable results
❑ Surrogates
O None added
O Recovery outside acceptance limits
O Spike recovery
O None added
❑ Recovery outside acceptance limits
❑ Failed to meet criteria for precision
❑ Internal standards
O Blank contamination
❑ QC data reported outside of controls (i.e. QCS, LCS)
O Incorrect procedure used
❑ SOP intentionally modified with, QA and Branch Head
approval
O Invalid instrument calibration
❑ Elevated detection limits due to.
❑ Insufficient sample volume
❑ ❑ t her (specify):
Commen
ts:
,St. 0-›-v � )r— ..5-/ hip a
.-cr 5 /r x u I� ra . fir, $4 ++-7 ,, , trey? re"
__ fir t EN,1 VI '•�.) n r ( .A a r� .� c� (C2., �,'1 .'C • ,r- 7'1
Corrective Action:
Lead Chemist Review ( ' iai):
SIOC EM
1 METALS
Branch Head Review (initial):
QA/QC Review (initi
Q oeieo abwaurr, sMq
❑ PEST
O VOA
❑ SVOA
Logged into- deisba1e by (irtitia l}:
1N?3'01dbs

MEMORANDUM
DIVISION OF WATER QUALITY
GROUNDWATER SECTION
November 27, 2001
To: Jay Zimmerman, L.G., Regional Groundwater Supervisor
Groundwater Section
Raleigh Regional Office
From: Mark Pritzl '('/\JJ, [e-mail]
Hydrogeological Technician II
Underground Injection Control Group (UIC)
Central Office (CO)
Re: Permit renewal # WI0500030; request for inspection and routine sampling of Howard
Moody's geothermal injection well system. This system is located at 115 Carpathian
Way, Raleigh, NC 27615.
1. Please review the injection well permit renewal and submit any comments to the CO-UIC.
Retain the application for your UIC files.
2. Inspect the injection well site to verify that the location and construction plans submitted in
the application are accurate and the NCAC Title 15A 2C .0200 standards are being complied
with, using the _enclosed Injection Facility Inspection Report (form B) as appropriate.
3. Collect samples from the influent and effluent sampling ports and submit the results to
the CO-UIC.
You are requested to return the completed Injection Facility Inspection Report (form B) to the
CO-UIC by December 30, 2001. If the inspection can not.be accomplished by this date,
please inform the CO-UIC. The UIC group greatly appreciates Raleigh Regional Office's
assistance with this review. If you have any questions regarding this review or the UIC
program, please contact me at [phone].
cc: CO-UIC Files
Enclosures
Michael F. Easley, Governor
William G. Ross Jr„ Secretary
North Carolina Lo.,partment of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
November 27, 2001
Mr. Howard Moody
115 Carpathian Way
Raleigh, NC 27615
Dear Mr. Moody:
Your renewal application for a permit to use a well for the injection of geothermal heat
pump effluent has been received and is under review. The Groundwater Section appreciates your
timely response to our written inquiry regarding the status of your geothermal heat pump system.
A member of the Groundwater Section's Raleigh Regional Office staff will be contacting you to
arrange an inspection of the injection well and collect water samples as part of the review.
If you have any questions regarding the permit or injection well rules please contact me at
[phone] or Mark Pr-itzl at [phone].
cc: CO-UIC Files
RRO-CFTC Files
ATA
Ncb
Customer Service
t BOO 623-7748
Sincerely,
Evan Q. Kane
Hydrogeologist
Underground Injection Control Program
Division of Water Quality 1 Groundwater Section
1636 Mail Service Center Raleigh, NC 27699-1636
Phone: [phone] Fax: [phone] Internet: http:llgw.ehnr.state.nc.us

October 23, 2001
Mark Pritzl
UICProgram
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Dear Mr. Pritzl:
RECEIVED/ OENR
OV/0 GHOUtWWATER SECTION
OJ OCT 26 PH 2: 05
Pardon my oversight. I misunderstood what it was you wanted from me several years
ago. When we started this Geothermal Heating and AC, you said I might want to test the
wells occasionally on my own, after your test came back. I did have the wells both
egress and ingress and discharge in the street as well tested, they all came back fine.
Enclosed are the papers that you sent me and I signed. If there is anything I can do to
further assist you in getting this squared away, please let me know what I can do.
The wells are still in use for reinsertion, one of which, I also still pump out of for my
irrigation system. No modifications have ever been made since their inception several
years ago. If I need to have the samples done independently let me know. If I need to
have you come out again like you did when this began, please let me know. I hope this
oversight on my part has not caused you any trouble with your division. It was certainly
not my intent to deceive you about this.
Hope you do come out to see the wells, my yard has shaped up quite a bit and the bird
haven is coming full circle. Thanks again for the Stokes recommendation, it's been quite
helpful in identifying the multiple species that now come to feed.
Kind Regards,
w+17
owardMoody
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL :tESOURCES
DIVISION OF WATER QUALITY, GROUNDWATER SECTION
STATUS OF INJECTION WELL SYSTEM
Date: Permit Number: WI
Name:
�r�Rl�y f11�t ePy
Address: 1 S ciwitriA I ►,tom 6-GE i at k
Please check the selection which most closely describes the current status of your injection well.
In addition, please provide the requested information.
1) ei1 is still used for injection activities.
2) 'Well is used far water supply. ��foklGL 12. cu.)
3) Injection discontinued;
a) Well temporarily abandoned tb) _ Well permanently abandoned
Describe the method used to properly abandon the injection well, (Include a description of how the well
was sealed and the type of material used to fill the well if permanently abandoned): If you checked two
(2), report the pumping rate and what the water is used for.
Certification: (For well abandonment)
"I hereby certify, under penalty of law, that l am personalty responsible for the proper abandonment
of any injection well as required in Title 15A NCAC 2C .0214 Criteria and Standards Applicable to Injection
Wells."
qYi
(Signature)
Certification: (For information verification)
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the
information submitted in this document, and that to the best of my knowledge the information is true,
accurate, and complete."
(Signature)
ver,3l01 GW/UIC-68

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
APPLICATION FOR PERMIT RENEWAL TO USE A WELL(S) FOR INJECTION WITH
A HEAT PUMP SYSTEM
Type 5A7 and 5QM Wells
In accordance with the provisions of NCAC Title 15A: 02C.0200
complete application and mail to address on the back page.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE; / — 2 , 20 O L_
tV
CJ'f
A. SYSTEM CLASSIFICATION: Does the system re -circulate only potable water without any additives such as
corrosion inhibitors or antifreezes in continuous piping which isolates the fluid from the environment?
7
YES If yes, do not complete this form. A form GW-57 CL, (Notification Of Intent To Construct A
Closed -Loop Geothermal -Water -Only Injection Well System), should be completed.
NO If no, then continue completing this form.
B. PERMIT APPLICANT
Address: L (5 LLP [ 61) Lt)
Name:
City: t LC 1 f - State: e--, • Zip code: Z(o 15
County: V) ory Telephone: 9 — 0-I 7--
C. PROPERTY OWNER (if different from applicant)
Name:
Address:
City: State: Zip code:
County: Telephone:
D. STATUS OF APPLICANT
Private: �Federai: Commercial: State: Public:
Native American Lands:
E. FACILITY (SITE) DATA (Fill out ONLY if the Status of Owner is Federal, State, Public or Commercial).
Name of Business or Facility:. _
Address:
City: State: Zip code:
County: Telephone: Contact Person:
Standard Industrial Code(s) which describe commercial facility:
ver.3/O1 GWIUIC-57 HPR Page 1 of 3

F. INJECTION PROCEDURE (specify any modifications to the injection procedure since the issuance of the
previous injection permit)
G. WELL USE Is(are) the injection wells) also used as the supply well(s) for either of the following?
(1) The injection operation? YES NO y�
(2) Your personal consumption? YES NO
H. CONSTRUCTION DATA
(i) Specify any and all modifications to the well casing, grout or screens since the issuance of the previous
injection permit.
NJ°t1/4-10{ frtleliE AS IX- (ti►-L.
(2) NC. State Regulations (ISA NCAC, 2C, Section .0200) require the permittee to make provisions for
monitoring well head processes. A faucet on both influent (groundwater entering beat pump) and
effluent (water being injected into the well) lines is required. Is there a faucet on
(a) the influent line? yes ono
(b) on the effluent line? yes 1------i-ao
I. CURRENT OPERATING DATA 7
(1) Injection rate: Average (daily) gallons per minute (gpm)
(2) Injection volume: Average (daily) gallons per day (gpd)
(3) Injection pressure: Average (daily) pounds per square inch (psi)
(4) Injection temperature: Annual Average degrees Fahrenheit (° F)
J. INJECTION -RELATED EQUIPMENT
Attach a diagram showing any modifications to injection equipment since the issuance of the previous injection
permit including the engineering layout of the (1) injection equipment, and (2) exterior pipingltubing associated
with the injection operation. The manufacturer's brochure, if detailed, should satisfy (1).
LOCATION OF WELL(S) Attach a map CA-1 CI
Include a site map (can be drawn) showing: the orientation of and distances between the injection well(s) and
any existing well(s) or waste disposal facilities such as septic tanks ar drain fields located within 1000 feet of the
ground -source heat pump well system; include buildings, property lines, surface water bodies, any other potential
sources of groundwater contamination. Label all features clearly and include a north arrow to indicate
orientation.
L. PERMIT LIST: Attach a list of all permits or construction approvals, received or applied for by the applicant
that are related to the site.
Examples include:
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non -Discharge permits
(3) Sewage Treatment and Disposal Permits
ver.3/01 GWIUIC-57 HPR Page 2 of 3

M. OTHER MODIFICATIONS: Indicate any other modifications to the injection well system
(equipment, fluid, operation, etc.) that have occurred since the issuance of the
previous injection permit and have not been noted elsewhere on this application,
ILA 71.6G e ~_3 -
N. CERTIFICATION
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment, for
submitting false information. I agree to 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."
� A/l.d f1/1
(Signa re of Well Owt'r'6r Aut
iz�'d Agent)
If authorized agent is acting on behalf of the well owner.
please supply a letter signed by the owner
authorizing the above agent.
O. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property rights in the
well(s). A well is real property and its construction on land rests ownership in the !and owner in the absence of
contrary agreement in writing.)
if the property is owned by someone other than the applicant, the property owner hereby consents to allow the
applicant to operate an injection well(s) as outlined in this application and that it shall be the responsibility of the
applicant to ensure that the injection well(s) conform to the Well Construction Standards (Title 15A NCAC
Subchapter 2C .0200)
(Signature of Property Owner if Different From Applicant)
Please return the completed Application package to:
UIC Program
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
(Telephone: [phone])
ver.3101 GWIUIC-57 HPR Page 3 of 3

GROUNDW.
MEMORANDUM
To: Jay Zimmerman
Groundwater Section
Raleigh Regional Office
From: Mark Pritzl 1/tP.
June
Hydrogeological Technician l;
UIC Group
Groundwater Section
Raleigh Central Office
,;.J, Lt
fer v, ~
~ it <\,
J<::1 f
~
6' ~ ' ~ ( ...... ~ (\ ~
~ ~ ~ ....J) ~
~~
~ s:
A G' ~
~ --~
~ <.. ~
-T f ~ to 1-i 0 (1)
~ X"' '< O'" c..
~ ~ (") tc
::i. ~ ~ ..... 0 (1) fg. v N = ~ -~ ~e1 ~ ~ -. n
~ (" (
S) ~ ~ ~; f
\,,_\ ~ N ~~ ~ '-"~ \
'--' ---a .....a ---....0
..:
~""'
Re: Issuance of injection well permit type 5A7 Geothermal Heat Pump:
Permit Number WI0500030 to construct and operate a well for the injection of ground-source
heat pump effluent has been issued to Howard Moody, in Raleigh, North Carolina. This is a new
permit and the Underground Injection Control Group appreciates Jimmy Greer's assistance with
the injection well inspection tasks. Please retain the application and paper work for the
RRO-UIC files. If you have any questions regarding this permit or the UIC program, please
contact me at [phone] or Amy Axon at [phone].
cc: UIC Files
Enclosures
NA
NCDENR
JAMES B. HUNT JR.
GOVERNOR
WAYNE MCDEVITT
SECRETARY
KER~_T. STEVENS
DiRECTOR:
Mr. Howard Moody
115 Carpathian Way
Raleigh, NC 27615
Dear Mr. Moody:
NORTJ. :AROLINA DEPARTMENT·OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
June 21, 1999
In accordance with your new application dated· August 26, 1998, we are forwarding
'Permit No. WI0500030 for the operation of a geothermal heat pump injection well at
115 Carpathian Way, Raleigh, NC, in Wake County. A copy of the laboratory test
results of water samples collected on February 22 and May 13, 1999 are also enclosed.
Please note due to slightly elevated Pb(lead) concentrations in the effluent water -"' -
sample the Groundwater Section is issuing a two year geothermal heat pump injection
well permit instead of the normal five year interval. This will allow a more frequent
monitor schedule to observe Pb(lead) concentrations .
. This p
1
ermit shall be effective from the date of issuance until June 30, 2001, 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 three m·onths prior to its expiration
date on June 30, 2001.
If you have any questions regarding your permit please contact me at [phone]
or Amy Axon at [phone].
cc: UIC Files
RRO Files
Enclosures
it:i'f)f
Mark Pritzl
Hydrogeological Technician II
Underground Injection Control Program
GROUNDWATER SECTION
P.O. Box 29578, RALEIGH, NORTH CAROLINA 27626-0578 • 2728 CAPITAL, BLVD., RALEIGH, NC 27604
PHONE [phone] FAX 9 I 9•7 I 5-0588
AN EQUAL OPPbRTUNITY / AFFIRMATIVE ACTION· EMPLOYER • 50% RECYCLED/IC% POST-CONSUMER PAPER
April 26, 1999
MEMORANDUM
To: Howard Moody
115 Carpathian Way
Raleigh, NC 27615
From: Mark Pritzl tel. [phone]
Re: Groundwater Sampling Results from February 22, 1999
Influent Water Sample
Coliform, total
pH
Chloride
Total Hardness
NH3 asN
TKNasN
NO2• + NQ3• as N
Cadium
Chromium, Cr
Copper, Cu
Iron,Fe
Manganese,Mn
Nickel, Ni
Lead, Pb
Zinc, Zn
cc UIC files
RRO files
<10/100 ml
6.0
3 mg/L
26 mg/L
<0.01 mg/L
0.1 mg/L
0.51 mg/L
<2.0 mg/L
<25 ug/L
<2.0 ug/L
<50 ug/L
<10 ug/L
<10 ug/L
<10 ug/L
29 ug/L
Effluent Water Samp le
Coliform, total
pH
Chloride
Total Hardness
NH3 asN
TKNasN
NO2• + NQ3• as N
Cadium
Chromium, Cr
Copper, Cu
Iron,Fe
Manganese, Mn
Nickel, Ni
Lead,Pb
Zinc, Zn
<10/100 ml
6.1
2mg/L
24 mg/L
<0.01 mg/L
0.1 mg/L
0.50 mg/L
<2.0 mg/L
<25 ug/L
51 ug/L
<50 ug/L
<10 ug/L
17 ug/L
19 ug/L
27 ug/L
I
MEMORANDUM
To: Howard Moody
115 Carpathian Way
Raleigh, NC 27615
From: Mark Pritzl tel. [phone]
Re: Groundwater Sampling Results from May 13, 1999
Effluent Water Samo le # 1
Lead, Pb
cc UIC files
RRO files
<10 ug/L Lead,Pb
Effluent Water Sam o le # 2
10 ug/L
.,
7
:i
State Groundwater Quality Standards:
Classifications and Water Quality Standards Applicable To The Groundwater's of North
Carolina
(North Carolina Administrative Code Title 15A: 02L.200)
Coliform, total 1/100 ml
Chloride 250 mg/L
Total Dissolved Solids 500 mg/L
NO2 +NO3 asN 10 mg/L
Chromium, Cr 50 ug/L
Copper, Cu 1000 ug/L
Iron,Fe 300 ug/L
Manganese,Mn 50 ug/L
Nickel, Ni 100 ug/L
Lead, Pb 15 ug/L
Zinc, Zn 2100 ug/L
mg/L = milligrams per liter = parts per million
ug/L = micrograms per liter = parts per billion
1000 ug/L = 1 mg/L
ns = not sampled
cc UIC files
RRO files
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 ?,_Chapter 87; Article 21, Chapter 143, and
other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Howard Moody
FOR THE CONSTRUCTION AND OPERATION OF AN INJECTION WELL for the purpese
of injecting heat pump effluent. This system is located at 115 Carpathian Way, Raleigh, North
Carolina, in Wake County, and will be constmcted and operated in accordance with the
application dated August 26, 1998, 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 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 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 June 30, 2001,
and shall be subject to the specified conditions and limitations set forth in Parts I through X
hereof.
Permit issued this the ,2 / $1--day of~·~;:;:::,:· =c....,.:::·t/2/4-=----""-"c.._, ___ , 1999.
~ --------
i ' 6--:. ·, d 4-4 p
Ted L. Bush, Jr., Assistant Chief
Groundwater Section
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No. WI0500030 PAGE 1 OF 6
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 locking 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 each injection
well, to the Division of Water Quality (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 shall
notify the Groundwater Section-Underground Injection Control (UIC), Central Office staff,
telephone number [phone].
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
Permit No. WI0500030 PAGE20F6
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 Pennittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances which may be
imposed by other local, state, and federal agencies which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
PART IV -PERFORMANCE STANDARDS
I. 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 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.
PermitNo. WI0500030 PAGE3 OF 6
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place on
or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed
necessary by the Division of Water Quality to insure surface and ground water protection,
will be established and an acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first
knowledge of the occurrence, to the Raleigh Regional Office, telephone number (919) 571-
4700, 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.
Permit No. WI0500030 PAGE4 OF 6
PART VIII -PERMIT RENEW AL
The Permittee shall, at least three (3) months prior to the expiration of this permit,
request an extension.
PART IX-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 Pennittee 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 Pennittee shall abandon that injection well in accordance with the procedures
specified in 15A NCAC 2C .0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of
abandonment procedures if the Director finds such removal will not be
responsible for, or contribute to, the contamination of an underground
source of drinking water.
(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
Permit No. WI0500030 PAGE 5 OF 6
of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30)
as specified in 15A NCAC 2C .0213(h)(l) 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-VIC Staff
DENR-Division of Water Quality
P .0. Box 29578
Raleigh, NC 27626-0578
PART X-OPERATION AND USE SPECIAL CONDITIONS
NONE
Permit No. WI0500030 PAGE 6 OF 6
COHNIY : ►►'AI.E
QUAD NO:
99N 21 111•34
REPORT TO : CU
COLLECTOR(S) : PRIT].I.
DATE: 5113t90
Tfh1E:
PURPOSE:
LABORATORY ANALYSIS
Regional Office
BOD310
mg/L
COD I Iigh 340
mg/ I,
COD Low 335
mg/I,
Colifornt h1F Feral316L6
/100m1
Corium[ h1FTote/ 31501
/100nd
TOC
mS/1
Tittbilit•
N1 u
Residnc., Stisl,rndrd 530
m_/ L
Total Susl vi tiled solids
mg/L
pH
units
Alkaliniri• to p1I 45
mj/ L
Alkalinity to 1,11 8-3
mg/ L
Carbonate
mS/L.
8icarbonnle
mL / L
Carbon dioxide
mg/ L
Chloride
m g/ L
Chromium: 11ex 1032
uv,/L
Color; Tom 80
cm.
Cvartide 720
mL;/l-
COMM ENTS:
Owner
Location or Site:
Description of sampling point
Sampling Method:
Remodel:
DIVISION OF WATER QUALITY
Chemistry Laboratory Report / Craned Water Quality
SANM1'L.£ PRIORITY
�ROE]TINE
E CHAIN OF CUSrOL7Y
0 SAMPLE TYPE
[TOWARD MOODY F.FF 2
ElEMERGENCY
Diss. Solids 70300 mg/ L
Fluoride 9S1
mg/L
I Iunt i n'cs: t61a19011 ml! j L
I lerdnels' {non-earl+j 902 mg/ L
Phenols 32730 ug/L
Specific Cand. 95 umho /cm2
Sulfate mg/ L
Sulfide 745 mg/L
M8AS m1,/ L
Oil and Gmrase mg/L
Silica mg/L
Boron
Fomraldeht de mg/ L
NH3 os N 610 mg/L
TKNasN625 mg/L
NO2 +NO3 as n 630 ma L_
P: Total as P 665 mg/L
PO4 mrIL
A-SSi1ver 46566 ug/L
A I-Altemiiul m 46557 oaf.
As-Amenk 46551 ng/ I.
En -Barium 46558 uz/ L
Ca-C kium46552 mp/L
Cd-Cad ium 46559 ug/L
Cr-Ouamitt ii 465511
uS/ L
C a • C „l,s,t• r 1042 us/1.
iron I045 ur,/ L
Hg- hlercury 71900 ug/L
K-Potassitmi 41F.5I my/ 1.
Mg- Magnesium 927 roriL
hst-Mangan a 1055 uS/L
No- Sodium 929 mg(L
x
Ni-Nirl:e1 up,/L
Pb-Lend 46564 10 ug/L
Se. -Selenium ug/L
Zn_Zinr 46567 uS/ L
Lab Number : 9G11919
Dale Received : 5113f99
Time Received : 1045
Received By : jG
Released By : DS
Date reported - 61na199
Organocltlorine Pesticides
0reenorhosphorua Pesticides
Nilnigru Pealicidtrs
Acid Herbicides
Semivnlatiles
TPH-Diesel Bettye
Volatile Organics t1'OA bolI1e1
TPFI-Gasoline Range
TPH-13TEXGasalirre Range

GRO NDWATER FIELD/LAB FORM
punt
[ ua•. No Serial No MOE - 2.
La Long
t.c..)c4'Le
Report To: ARO, FRO, MRO, RRO WaFt9, WiRO,
WSRO, Kinston FO, Fed. Trusenlral 09, Other:
Shipped by: Bus, Couri r, Hand Del., Other
Collecto►(s): `I)i. } � Date 5/1'.2i t '
FIELD ANALYSES
pH4oe
Ternp_ ie
Appearance Sampling Method
Field Analysis By:
LABORATORY ANALYSES
Spec. Cond.94 at 25° C
°C Odor
BOD. au)
COD High 340
COD Low 335
Conform: ME Fecal 31616
Conform: MF Total 31504
TOC 680
Turbidity 76
Residue., Suspended 530
mg/1.
mg/1
mglt
/100m1
110C m1
rng/I
NTU
mg/1
pH 403
units
Alkalinity to pH 4.5 410
Alkalinity 10 pH 8.3 415
Carbonate 445
Bicarbonate 440
Carbon dioxide 405
Chloride 940
Chromium: Hex 1032
mg/1
mgll
mg/1
mq/l
mg/1
mgll
ug/1
Color: True 80
Cyanide 720
CU
mg/1
SAMPLE TYPE SAMPLE PRIORITY
® Water ['Routine
❑ Soil ® Emergency
❑ Other
❑ Chain of Custody
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
Lab Number �7Lr7 _
Date Received 5-13- 9' Timer /� - `f,�
Rec'd by: From: Bus, Couri ,Hand ❑eD
Other:
Data Entry By: Ck•
Date Reported:
l s1 4v. Purpose:
TimeBaseline, Comptaintjance, LUST, Pesticide Study, Federal Trust, Other:
Owner Mcuarct ill e, ,J,*,
Location or site RcAe I �1
Description of sampling point i/0. I I Plait
6,14'iCc.1-0,- [ !g l } (e=TY L
Remarks
I Puinl p, baior, BIG.)
tr.-wino limo. air Iorry7. etc.1
Sample Interval
Piss. Solids 70300
Flour€de 951
Hardness: Total 900
Hardness [non-carb) 902
Phenols 32730
Specific Cond. 95
Sulfate 945
Sulfide 745
mgll
myli
mgII
mg/1
ugll
LIMhosLrrf
mg/1
mg/1
011 and Grease
mg/I
NH, as N 610 mg/1
TKNasN 625 Ana
NOP + NO as N 630 m_gll
P: Total as P 665 mg/1
A[) - Sliver 46566
AI - Aluminum 46557
As - Arsenic 46551
Ba - Barium 46558
Ca - Calcium 46552
Cd - Cadmium 46559
Cr - Chromium 46560
Cu - Copper 46562
Fe - Iron 46563
Hg - Mercury 71900
K - Potassium 46555
u1111
ug/1
uq/1
ug/1
uq
ug/I
u911
ug/1
mg/I
w
Oroanochlorine Pesticides
Organophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
PCB's
Semivolatile Organics
TPH - Diesel Range
Mg - Magnesium 46554
Mn - Manganese 46565
Na - Sodium 46556
±11 - Nickel
Pb - Lead 46564
Se - Selenium
Zn - Zinc 46567
mg/I
ug/1
mall
li9Ll
ugll
ug/1
uq/1
Volatile Organics (VOA bottle)
TPH - Gasoline Range
TPH - BTEX Gasoline Range
Lab Comments:
GW-54 REV. 12/9
For Dissolved Analysis - submit filtered sample and write rDIS" in h

COUNIY = WAKE
QUAD NOt
g9 JU W ? 1 VI l l : 34
DIVISION OF WATER QUALITY
Chemistry Laboratory Report / Ground Water Quality
SAMPLE PRIORITY
❑RoUTENE
REPORT TO : CO Regional Office D CHAIN OF CUSTODY
COLLPCIOR(5j : PRITZL
DATE 5013/99
T1ME:
PURPOSE:
LABORATORY ANALYSIS
B00310
mg/L
COD High 340
mg/L
COQ_Low 335
mg/L
-
Conform: MF Fecal31616
J100m1
Coliform: AUTotal 31504
/100m1
TOC
mg/1
Turbilita
NT1A
Residue., 5i I51.•nded 530
trig/ L
TatalSuspended solids
mg/ L
pH
units
Alkalinity to pH 4.5
mg/L
Alt Iim y to pH 8.3
mg/L
Carbonate
mg/L
Bicarbonate
m6/L
Carbon dioxide
m g/ L
Chloride
mg/L
Chromium: Hex 1032
ul;/L
Color. True 80
c.u.
Cyanide 720
mg/ L
CUAtAlENTS:
n SAMPLE TYPE
Owner. I1UWARt1 MOOD EFT-1
Location or Site:
Description of sampling paint
Sampling Method!
Remarks;
x❑ EMERGENCY
Dits. Solids 70300
mg/L
Fluoride 951
mg/ L
Hardness. total 900
mg/L
Hardness: [noncarhj902
mg/L
Phenols 32730
ug/L
Specific Cond. 95
umhos/ran2
Sulfate
mg/L
Sulfide 745
mg/L
MBAS
met.
Oil and Crease
mg/L
Silica
mg/1.
Boron
Formaldehyde
mg/L
NH3 as N 610
mg/L
TKNasN625
mg/L
NO2 +NO3asn630
mg/L
P: Total as P 665
mg/L
PO4
mg/L
Ag-Silver 46566 ug/L
Al -Aluminum 46557
AB -Arsenic 46551
Bo -Barium 46558
ug/L
ug/L
/L
Ca -Calcium 46552 mgjL
Cd-Crdium 46559
ug/ L
Cr-Chromium 46560
ug/L
Cu-Copper 1012 ug/1.
Fe- Iron 1045
ug/L
I Ig- Alrrrun• 71900
ug/L
F.-Potassium 46555 mg/L
Mg -Magnesium 927 mg/L
Mrs -Manganese 1055 u5/ L
Na- Sodium 929
mg/ L
Ni-Nickel
ug/L
x
Pb-Lead 46564 <10 ug/L
Se -Selenium
ug/L
Zn_Zinc 46567 ug/L
Lab Number : 903918
Dale Received 5/13/99
Time Received
Received By : ]G
Released By : DS
Date reported : 6/14/99
Organochlorine Peshicidra
Ori a rrol'hosl'horus Pesticides
Nitrogen Pesticides
Acid Herbicides
Sem1voIafilea
T PH -Diesel Range
VolatlleOrganlrs [VOA bottle)
TPH-Gasoline Range
TPH-BTEX Gasoline Ranee
900918 MAY

G `r'UNDWATER FIELD/LAB FORM
Count Cx k-t
N ua► No Serial No IVIO a T' `" I
L- Long.
Report To: ARO, FRO, MRO, RRO RO, WIRO,
WSRO, Kinston FO, Fed. Trust, entral O Other:
Shipped by: BA Courie1r, Hand Del, Other
Collector(s): tr`Ll Date 6113/71
FIELD ANALYSES
Spec. Cond.94
°C Odor
pH400
Temp.10
Appearance
SAMPLE TYPE SAMPLE PRIORITY
gl Water ❑ Routine
❑ Soil ki Emergency
❑ Other
❑ Chain of Custody
at 25° C
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
Lab Number
Date Receiv
Rec'd From: Bus, Courie , and DeI.)
Other:
Data Entry By: Ck
Date Reported:
Purpose:
Time /O• AC a'"- Baseline, Complaint ,46;plianc LIJST, Pesticide Study, Federal Trust, Other
ode mei
Owner /4o t,..) are/�lan�:�`r..j-
Location or site e r
Description of sampling point I� )f.1 it ikaci « Ee ��-, uv. t i (C .0 mot,1f
Field Analysis By: Remarks (Puma baler
�` }
(pMrit"g lime, air Ieanp. etc.)
LABORATORY ANALYSES
Sampling Method
Sample Interval
BODt Sip
mgfl1
r
i
Diss. Solids 70300
minAi-
Silver 46566
urn/I
COD High 340
mg/I,
'
Flouride 951
mg/1
Al - Aluminum 46557 _
_ ugll
COD Low 335
mg/I
Hardness: Total 900
mall
As - Arsenic 46551
ugfl
Caliform: MF Fecal 31616
/100mi
Hardness (non-carb) 902
mg/I
Ba - Barium 46558
ugA
Coliform: MF Total 31504
1100m1
Phenols 32730
ugL
Ca - Calcium 46552
rnnjl
TOO 680
mg/I
Sveclfic Cond. 95
uMhosic m2
Cd - Cadmium 46559
ugA
Turbidity 76
NTU
Sulfate 945
mall
Cr - Chromium 46560
ugA
Residue., Suspended 530
mg/I
Sulfide 745
mg/1
Cu - Copper 46562
_ _ _ ugA
Fe - Iron 46563
ugll
Oil and Grease
mgfl
Hg - Mercury 719o01
ugA
pH 403
units'
K - Potassium 46555
mg/I
Alkalinity to pH 4.5 410
mg/1
Mg - Magnesium 46554
mg/I
Alkalinity to pH 8.3 415
mg/t
Mn - Manganese 46565
ugli
r
Carbonate 445
mg/1
NH, as N 610
mall
Na - Sodium 46556
mg/1
Bicarbonate 440
mg/I
TKN as N 625
trig_
Ni - Nickel _
_ _ug/l
Carbon dioxide 405
mgfl
NO + NO, as N 630
mclll
?
Pb - Lead 46564
ugll
Chloride 940
mg/I
P: Total as P 665
moll
Se - Selenium
ugll
Chromium: Hex 1032
ugA
Zn - Zinc 46567
ugll
Color: True 80
CU
Cyanide 720
mg/1
Lab Comments:
Organochtorine Pesticides
Organophosphorus Pesticides
Nitrogen Pesticides
Acld Herbicides
PCB's
Semivolatile Organics
TPH - Diesel Range
Volatile Organics (VOA bottle)
TPH - Gasoline Range
TPH - BTEX Gasollre Range
GW-54 REV.12/97
For Dissolved Analysis - submit filtered sample and write "DIS" in k'

;
COUNTY: WAKE
QUADNO:
DMSION OF WATER QUALITY
Chemistry Laboratory Report/ Ground Water Quality
SAMPLE PRIORITY
□ROUTINE (!]EMERGENCY
REPORT TO _C_O _________ Regional Office □ CHAIN OF CUSTODY
~ SAMPLE TYPE □ COLLECTOR(S) :_P_RITZ __ L _____ _
DA TE: 5/13/99
TIME:
DRPOSE: Owner: HOW ARD MOODY EFF-1
Location or Site:
Description of sampling point ______________________ _
Sampling Method:
Remarks:
LABORATORY ANALYSIS
BOD310 mg/L Diss. Solids 70300 mg/L Ag-Silver 46566
CODHigh340 mg/L Fluoride 951 mg/L Al-Aluminum 46551
CODLow335 mg/L Hardness: total 900 mg/L As-Arsenic 46551
Coliform: MF Fecal 31616 1100ml Hardness: (non-carb) 902 mg/L Ba-Barium 46558
Coliform: MF Total 31504 1100ml Phenols 32730 ug/L Ca-Calcium 46552
TOC mg/I Specific Cond. 95 umhos/cm2 Cd-Cadium 46559
Turbitity NTU Sulfate mg/L Cr-Chromium 46560
Residue., Suspended 530 mg/L Sulfide 745 mg/L Cu-Copper 1042
Total Suspended solids mg/L MBAS mg/L Fe-Iron 1045
Oil and Grease mg/L Hg-Mercury 71900
pH units Silica mg/L K-Potassium 46555
Alkalinity to pH 4.5 mg/L Boron Mg-Magnesium 927
Alkalinity to pH 8.3 mg/L Formaldehyde mg/L Mn-Manganese 1055
Carbonate mg/L NH3 asN610 mg/L Na-Sodium 929
Bicarbonate mg/L TKNasN625 mg/L Ni-Nickel
Carbon dioxide mg/L NO2 +NO3 as n 630 mg/L X Pb-Lead 46564
Chloride mg/L P : Total as P 665 mg/L Se-Selenium
Chromium: Hex 1032 ug/L PO4 mg/L Zn Zinc 46567
Color: True 80 ~c.u.
Cyanide720 mg/L
COMMENTS:
Lab Number 9G0918
Date Received : 5/13/99
Time Received : 10;45
Received By JG
Released By : DS
Date reported : 6/18/99
ug/L Organochlorine Pesticides
ug/L Organophosphorus Pesticides
ug/L Nitrogen Pesticides
ug/L
mg/L Acid Herbicides
ug/L
ug/L Semi volatiles
ug/L TPH-Diesel Range
ug/L
ug/L Volatile Organics (VOA bottle)
mg/L
mg/L TPH-Gasoline Range
ug/L TPH-BTEX Gasoline Range
mg/L
ug/L
<10 ug/L
ug/L
ug/L
COUNTY: WAKE
QUADNO:
DIVISION OF WATER QUALITY
Chemistry Laboratory Report/ Ground Water Quality
SAMPLE PRIORITY
□ROUTINE l!)EMERGENCY
REPORT TO _C_O ________ Regional Office □ CHAIN OF CUSTODY
~ SAMPLE TYPE □ COLLECTOR(S) : _P_RIT_Z_L _____ _
DATE: ~
TIME:
'TJRPOSE: Owner: HOW ARD MOODY EFF-2
Location or Site:
Description of sampling point ______________________ _
Sampling Method:
Remarks:
LABORATORY ANALYSIS
BOD310 mg/L Diss. Solids 70300 mg/L Ag-Silver 46566
CODHigh340 mg/L Fluoride 951 mg/L Al-Aluminum 46557
CODLow335 mg/L Hardness: total 900 mg/L As-Arsenic 46551
Coliform: MF Fecal 31616 1100ml Hardness: (non-carb) 902 mg/L Ba-Barium 46558
Coliform: MF Total 31504 /l00ml Phenols 32730 ug/L Ca-Calcium 46552
TOC mg/1 Specific Cond. 95 umhos/cm2 Cd-Cadium 46559
Turbitity NfU Sulfate mg/L Cr-Chromium 46560
Residue., Suspended 530 mg/L Sulfide 745 mg/L Cu-Copper 1042
Total Suspended solids mg/L MBAS mg/L Fe-Iron 1045
Oil and Grease mg/L Hg-Mercury 71900
pH units Silica mg/L K-Potassium 46555
Alkalinity to pH 4.5 mg/L Boron Mg-Magnesium 927
Alkalinity to pH 8.3 mg/L Formaldehyde mg/L Mn-Manganese 1055
Carbonate mg/L NH3 asN610 mg/L Na-Sodium 929
Bicarbonate mg/L TKNasN625 mg/L Ni-Nickel
Carbon dioxide mg/L NO2 +NO3 as n 630 mg/L X Pb-Lead 46564
Chloride mg/L P: Total as P 665 mg/L Se-Selenium
Chromium: Hex 1032 ug/L PO4 mg/L Zn Zinc 46567
Color: True 80 c.u.
Cyanide720 mg/L
COMMENTS:
LabNumber : 9G0919
Date Received : 5/13/99
Time Received : 10;45
Received By : JG
Released By : DS
Date reported : 6/18/99
ug/L Organochlorine Pesticides
ug/L Organophosphorus Pesticides
ug/L Nitrogen Pesticides
ug/L
mg/L Acid Herbicides
ug/L
ug/L Semivolatiles
ug/L TPH-Diesel Range
ug/L
ug/L Volatile Organics (VOA bottle)
mg/L
mg/L TPH-Gasoline Range
·ug/L TPH-BTEX Gasoline Range
mg/L
ug/L
10 ug/L
ug/L
ug/L
Mood 1.xls
99 APR 21 f'f 11: 55
fs
COUNTY : ►YAkE
QUAD Na:
REPORT TO : RICO
COLLtCTOR(S) : GREER
DATE: 2/12/99
tIME:
6URPOSE:
LAl[3RAtORi' ANALYSIS
Regional Olrrce
POD 310
mg&
COP High 340
COD Low 335
mg&
Colifrmn:) W Feeal 31616
1100m1
x
Co'lform: ALF Total 31504 <10 /I00nd
roc
mg4
Tashi. ly
Residue.. Suspended 530
NTU
mg/L
x
Total Suspended Solids
p1i BA an its
Alkalinity lu pH 4.5 mg/L
Alkalinity to 01111.i mg/L
Car ballade
mg/1.
Bicautonale
mg/L
Carbon dioxide
mgll.
x
Chloride 3 mg/L
Chromium; Hex 1032
irg/L
Color: True 60 c.0
Cyanide 720 mg/L
COMp1ENTS:
DIVISION OF WATER QUALITY
Ch emislry Labor Ivry Report l Ground %Vat er Qutrl:ey
SAMPLE PRIORITY
▪ ROUTINEEMERGENCY
• DRAIN OF CUSTODY
d SAMPLE TYPE
Owner. MR. 1HOWARD MOODY
Location es Site:
Description of sampling point
Sampling Method:
Remarks:
Dins. Solidi 703o0
mg/L.
fluoride 951
mg/L
X Hardness: total 900
20 mg&L
I'redness: (non-emb) 902
Phenols 32130
tnglL
ug/L
X Specific Cond. 95
74 tnnhos/cm2
Sulfite
mg/L
Sulfide 745
h1IAS
mg/L
Oil and Grease
Silica
mg/L.
Boron
Formaldehyde mg/L
X NH3 as N 610 e0.01 mpgL
x TkN as N 625 0.1 mg/L
X NO2 +NO3 as n 630
0.51 mg/L
P. Total as P 665
mg/L.
rO4
Ag-Silver 46566
up/L
AI -Aluminum 46557
u6'L
As-Anrnic 46551
uglL
Ba-Barium 465511
CA -Calcium 46552
mg&L
x
Cd-Cadium 46559
<2.0 ug/L
X
Cr-Chromium 46560
<25 ug/L
x
Cu- Copper 1042
<2.0 ug t.
x
Fe- Iron 1045
<50 ug/L
fig- Mercury 71900
ug/L,
K-Potassium 46555
mg/L
Mg- Magnesium 927
mg/L
x
/An -Manganese 1055
<10 ug/L
Na- Sodium 929
mg/L
x
Ni•Nickd
<10 ug/L
x
Pb-Lead46564
<10 ug/L
St -Selenium
ug/L
x
Zn_Zinc 46561
29 ug#3.
Lab Number : 9G0344'
Dare Received • 2/12199
Time Received : 10;20
Received Ely HMV/
Released By - DS
Dare repvrled ' 4/I5/99
Organuchlorine Pcitiddn
Organophnspherus Pesticides
Nitrogen Pesticides
Acid Herbicides
Semivolatilea
TPI I -Diesel Rmtge
Volatile Organics (VOA Soule)
TPH-Gasoline Range
TPIi-BTEX Gasoline Range
1

SAMPLE TYPE SAMPLE F IIORIIY
Water ❑ Routine
❑ soli ❑ Emergency
❑ Other
1•2
Report to: AHO, FRO, MRO, l WaRO, WIRO,
WSIIO, Kinston PO, Fed. trUst, Central Off., Other:
Shipped by: Btl§ Courier Hand Del GltIr2 77, 4
FILLd14NALYSS •
PKtoo Spec. Cond.e4
tempi° °C Odor
Appearance
at 25u C
Owner Y w- - , Ne.4s-yr _ 1-7 / A'ec y
Location or site I! s— L . . _!4
Description of sampling point >rsr/
Sampling Method --,
FUNDWATER FIELD/LAB FORM
Cot/nty G e4A 4
au d No Serial No.
Long.
0
❑ Chain of Custody
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
Lab Number T6--198
Date Receive 99i2 aR A Time /d 6Rec'd by: k From: Bus, Courier, nd
OtherData Entry By: Ck•
Date Reported:
Purpose
Coiir 'tor(s): k e.,•-e._.) r) Date 91 0' Time 7 Baselin , Complalntf•Com Ilan - saekLUSe oT, Pesticide Study, Federal Trust'z:Dlh
i
. ter L 4'--4/ .v .
Sample Interval
Field
LABORATORY
Analysis By:
Remarks
_/ :�•-----.
ANALYSES
°`�"1e 0 lamp.
,
BOO, 310
mg/I
Dlss. Solids 70300
moll
Aq - Silver 46566
uq/1
Organachlorine Pesticides
COI] High 340
hig/1
Flourfde 951
mg/1
AI - Aluminum 46557
ugll
Organophosphorus Pesticides
COD Low 335
mgll
)<
Hardne_gg: Total 900
ma/I
As - Arsenic 46551
Us/1
Nitrogen Pesticides
Collrorrn: MF Fecal 31616
1100m1
Hardness (non -carp) 902
mq/1
Ba - Barium 46558
Ugll
Acid Herbicides
X
Collform: MF Total 31504
1100m1
Phenols 32730 _
ugl1
j
Ca - Calcium 46552
moll
PCB's
TOG 880
mg(1
rK
Specific Cond. 95
uMfloslcm2
X ,
Cd - Cadmium 46559
uvii
Turbidity 76
NTU
-
Sulfate 945 _
mall
•?(
Cr - Chromium 46560
ugll
tteSldue., Suspended 530
mgll
Sulfide 745
mg/I
Cu - Copper 46562
ug11
>(
Fe - Iron 46563
ugli
Semivolatite Organics
011 and Grease
mgll
Hg - Mercury 71900
ugft
TPH - Diesel Range
X
pH 403
units
I( - Potassium 46555
mg/1
Alkalinity to pH 4.5 410
mgli
Mg - Magnesium 46554
moll
-
Alkalinity to pH 8.3 415
mg/1
Mn - Manganese 46565
ugl1
Carbonate 445
moll
)'
NH, as N 610
moll
Na - Sodium 46556
m.11
Volatile Organics (VOA bottle)
Bicarbonate 440
mgl!
'X
TKN as N 62s
moll
'
Ni - Nickel
uq/1
TPH - Gasoline Range
Carbon dioxide 405
mg/1
>'
NO, + NO, as N 630
mq/t
>
Pb - Lead 46564
will
TPH - BTEX Gasolire Range
x
Chloride 640
moll
P: Totat as P 665
mg/1
-
.
Se - Selenium
ug/1
Chromium, Hex 1032
uglt
,k!
Zn - Zinc 46567
u.
Color: TrUe 80
CU
Cyanide 720
mull
Lab Comments:
GW-54 13EV. 12tp'
For Dissolved Analysis - submit filtered sample and write "DIS" In I '

99 APR 21 Pit 1: 55
cnt1 flY ►TAke
QUAD NO:
DIVISION OF WATER QUALITY
Chemistry Laboralory RepaFl 1 Ground Water (bodily
SAMPLE PRIORITY
❑ROUTINE fEMEROENCY
REPORT TO ORO Regional OFTree CHAIN OF CUSTODY
COLLECTOR(S) : CHEER
17AtE: 7/2N9! W� SAMPLE TYPE
time:
PURPOSE;
LABORATORY ANALYSIS
BODiI0 mgA,
COP high 340 mgli.
COD Los. 335 mg/1.
Cotifo-r. MI. Fecal 31616 1100m1
x
CeliFcrm: MF Total 31504 <10 1100m1
TUC
mgl{
Turbitity NTH
Residue„ Suspended 530 n* /L
Total Suspended solids mg/L
x
pl{ 0.1 units
Alkiliniiy to pl I4.5 mgl7,
AlkrliniIy to p1I B.3 mg/L
Carbonate mg/L
$ictnrba • to
mglt,
Carton dioxide mg/L
X
Chloride 2 mg/L
Chromium. Iles 1032 ugli.
Csdoc True 80
Cyanide 720 mg11..
CO I M 1 NtS
ownerMR. HOWARD MOODY
Location or Site:
Descripl ion of sampling point
Sint pling Method:
Rcmoiks
Dias. Solids 70100 mg/L
Fluoride 95i mg&
X
1IR.dlless: Intel 900 24 mg/L
Iiuldness• (non- rrh)902 mg/L
Phenols 32730 ug/L
x
Specific Cond. 95 72 umhoalcm2
Sulfate mg/L
Sulfide 745 mg/L
MBAS
Oil and Grease mg/L
Silica mg/L
Boron
Formaldehyde mg1L
X
N173 as N 610 <0.01 mg/L
X
TRH msH625 - 0.1 mg/L
NO2 41403 as n 630 0.50 mg1L
P. Tom! 6s P 665 mg/L
i'04 mg/L
A g-Silver 46566
u8/L
AI -Aluminum 46557
ug/l.
A s-Arsenic 46551
ug/L
Bo -Barium 46558
uglf.
Ca -Calcium 46552
mat[..
X
Cd-Cudum 46559
<2.0 ug/L
X
Cr•Chsmnium 46560
<25 ugR.
X
Cu• Capper 1042
51 ug/L
X
Pe- Iron 1645
<50 ugly.
Flg- Mercury 7F900
ugly.
K-Pmmsium 46555
mg/L
Mg- Magnesium 927
mg/L
X
Mu -Manganese 1055
<10 ugly.
Na- Sodium 929
mg/L
X
Ni-Nickel
17 ug/L.
X
1'b-Lad 46564
19 ug i..
Se -Selenium
egfL
X
Zn_Zinc46567
27 ugly.
Lib Number : 903345
Date Received : 2/121911
Time Received : 10;20
Received By : HMV/
Released By : DS
Dale reported : 41I999
Organochlorine Pesticide'
0rganophosphorus Pesticides
Nitrogen Pesticides
Acid FFerbicidea
Seutivolaliles
TP11-Diesel Range
Volatile organics (VOA hauls)
TPII-G solineRange
TPI1-RTEX Gasoline Range
xtosls.FER

GgbUNBWATER FIELD/LAB FORM
County
qua• o Serial No
Lat Long.
Report To: AFIO, FRO, MR0(I1Q WaRO, WIRO,
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by: Bu , Courier, Hand Del., slag1' /77' r
(/ —, Purpose:
COliectnrWALL t f� Date 9 1) f0 w **Time f /ea Baseline, ompla€nQporrpllancoLWS ), Pesticide Study. Federal Trust. C .heat
SAMPLE TYPR SAMPLE PRIORITY
Water ❑ Routine
❑ Soli ❑ Emergency
❑ Other
❑ Chain of Custody
F1ELb ANALYSES`
pH4o0 Spec. Cond.94
Temp.lp aC Odor
Appearance
Field Analysis By:
LABORATORY ANALYSES
at 25° C
Owner .
Location or site IL,�
Description of sampling point 1.4 r`---s- � - —
Sampling Method
Remarks
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
Lab Number 9 �•�
Date Received 190R a Time / 2 f CD
Rec'd by: H1 1 lea From: Bus, Courier, and De
Other
Data Entry By: Ck.
Date Reported:
41/
(_ Imo, bolder. etc.)
/A%7
Sample Interval
(pumping limo. sir Miry. etc.)
BODs 310
mg/1
Dlss. Solids 70300
mgil
Ag - Silver 46566
uq/I
COD High 340
mg11
Flourlde 951
mg/1
Al - Aluminum 46557
ugfl
COD Law 335
mgll
X
Hardness: Total 900
mail_
As - Arsenic 46551
ugfl
Co#itorm: MIF Fecal 3106
Iiooml
Hardness (non-carb) 902
Moil
ea - Barium_46558
ugfl
Y.
Co6form: MP total 3i504
/l00ml
Phenols 32730
uati
Ca - Calcium 46552
mall
tOC 650
- ruglt
Specific Cond. 95
uMhoslcn
Cd - Cadmium 46559
uq/I
TUtbldlty 76
-- N L
SUllate 945
moilCr
- Chromiurri 46560
uq/1
FtesIdue., Suspended 530
mgll
Sulfide 745
nigh
AC
, Cu - Copper 46562 _
Ug/1
x
Fe - Iron 46563
ugfl
Olt and Grease
mg/I
Hg - Mercury 71900
ug/l
pH 403
units
K - Potassium 46555
mg/1
Alkalinity to pH 4.5 410
mg/1
Mg - Marc nesium 46554
mg/I
Alkalinity to pH 8.3 415
mg/1
)
Mn - Manganese 46565
ugfl
Carbonate 445
mgli
jX
NH, as N 610
mg/1
Na - Sodium 46556
mgll
Bicarbonate 440
mgll
A
TKN as N 625
mg/1
,rF
Ni - Nickel
QUA_
Carbah dioxide A05
mgll
-1
NO, + NO* as N 630
mgjl
,
X
Pb - Lead 46564
ug/1
V
Chloride 940
mgl1
P: Total as P 665
mg/l
Se - Selenium
ugfl
i.
Chromium: Hex lo32
ug
•-
Zn - Zinc 46567
ugfl
Color: True 80
CU
~
Cyanide 720
mgll
Organachlorine Pesticides
Organophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
PCS'S
Sem#volatile Otganics
TPH - Diesel Range
Volatile Organics (VOA bottle)
TPH - Gasoline Range
TPH - DTE][ Gasollre Range
Lab Comments:
GW-54 Fi1=V. 121°'
rot Dissolved Analysis - submit llllered sample and write "D€S" In I-

... _
:,, \i_ ...
~! :_
~
~ -~> -'"", -1
-h~
~...;~ ~ ~ ,,, ~ ...... ·" 1~) ~
r -, .. ';_
,,,-I.·
-~ ~
-r~ -.
~
l , .. :','
• • : ~ \ I ..., ~ / ,
; ' ;..,.v.·
~:,,
~.... ;_.l,
,(/Yi/'~1"~'-t
• I' (._
I -! •, ,' I ---~.
~o~-/ \ ~<r>~~\
~t::i
-;:;"t
,_
~,, y
~
�Grr�rr�

Page 1 of 2
North Carolina Department of Environment and Natural Resources
Division of Water Quality -Groundwater Section
PRECONSTRUCTION INJECTION FACILITY INSPECTION
REPORT -FORM A
INJECTION WELL PERMIT NO. WI DATE 9 9 n /d
NAME OF OWNER a t) Pr—r C f7 ca
ADDRESS OF OWNER / /
wlcr A
(Street/ road or lot and suddiv lion, county, towr7J
LOCATION OF PROPOSED INJECTION WELL (and source wells), if applicable) (...2-)
�1/
t L 7 2.1-2 t t]. T r -'
(Street road or ! and suddrwsion , county, town, if di t than owner's address, plus description of locations on site)
Potential pollution source
Potential pollution source Distance from well
Potential pollution source
Distance from well
/2�
Distance from well
Minimum distance of proposed well from property boundary
Quality of drainage at site
Flooding potential of site 6v47
adequate.poc r) {lriglr,moderate, lowj
DRAW SKETCH OF SITE
(Show property boundaries, buildings, wells, potential pollution sources, roads, approximate scale, and north arrow.)
March 98

Page 2 of 2
PRECONSTRUCTION INJECTION FACILITY
INSPECTION REPORT - FORM A (cont.)
COMMENTS
WITNESS. r_.aakr--d ock4.
Address
/) 0-40.0r--714
WITNESS
Address

4Gy �so� a. �
North Caroliu.� Department of Environment and Na....ral Resources
Division of Water Quality - Groundwater Section
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PERMIT NO. WI
NAME OF OWNER Als-.
•
ADDRESS OF OWNER /1.� �' .�� ge.r -'4 /A , 4 A/144.7 K► .fie Aye, . 6 ♦�
DATE a L /to
/i,
(Street) road or lot and subdivision, county, town)
LOCATION OF INJECTION WELL (and source wells), if applicable) 6J
l� e fry L' _41 - Fr ta. e'' r-�-� .1 v n -' t -ate Air tees t-e::?1 .4`7—
(Street/ road or lot and subdivision , county, town, if different than a r'er's address, plus description of location on site)
Potential pollution source
5 �-: -) Distance from well
D
Potential pollution source Distance from well
Potential pollution source Distance from well ------
Minimum distance of well from property boundary Ia
Quality of drainage at site
• adequate, poor)
Flooding potential of site G 1
(high, moderate, w
DRAW SKETCH OF SITE (Show property boundaries, buildings, wells, potential pollution sources, roads, -approximate scale, and
north arrow)
rL - �C-• 4/ A S.7 hie -di
„rri rC1L
DESCRIBE INJECTIONSYSTEM (vertical closed loop, uncased borehole or cased water well; separate source well and
injection well; combination source and injection well; or other description as applicable)
eC7L£ - -€

INJECTION FACILI`-'Y INSPECTION REPO: T -FORM B (CONTINUED)
WELL CONSTRUCTION
Date constructed /4 - 2-3 - 9
Drilling contractor: Name
Address _r—c; , g
/
177:Lf'-r .// ( l
-17 1- /-D Z & b - )
Registration number 7 L
Total d ith ofwel� qua Total depth of source well 75'
Q -Leo'
(f applicable)
Inspection point Measurement Meets minimum standards
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
G$-' -- - f
r/, I s'
740, i
Yes
t/ .f
No
Comments
Functioning of heat pump sysz (Determine from the owner if heat pump functions properly.)
INSPECTOR i
WITNESS
WITNESS
Office
�b r
Address
Address March 1998

GRADY POGLE WELL CO. TEL:[phone] Feb 23'99 16=47 N0.0C4 P.01
North Carolina - Departmont of Envtronmanta ialtsrai Reeournes - D'ii on 01 Ware, Qualk!' - Grot" 4watar Suction
P.Q. Boa 29678 • Rvaiph.N.C. 27O26-1G7B.PI.. s (1e`1 7334221
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
DRILLER REGISTRATION II:
STATE WELL CONSTRUCTION PERMTI: t
9-7\
1. WELL IJU dwN rink Aoptioseas ResldtLC�gr►tlal Municipal CI Industrial ❑ Agrlouttu►AI Q Monitoring❑
Ft coVRY [Haat Pump Water Injection Other If Other, Liiat Use:
2• WELL LOCATION: (Slew *each of** location beivw) L1Ill yy
Nearest Town: rt 1�k County: 1 G k e.
1[s fa Mt; tn/s�
mind. ar satrdvisisn +ed Ng�
OWNER C r toc►u� (4-i .- e 5/I i (
ADDRESS 11 3- f-1 r - Orlvt.
gloom or Pow Ho.)
et' itI
Cky or Town Slats
dA Cod. Slats
4. DATE DRILLED L I -l:i�'
5, TOTAL DEPTH 4 9 ft•
a. CUTE N►1GG COLLECTED YES ICIINGTS
7. DOES WELL REPLACE EXISTING WELL? YES In NO[i
a STATIC WATER LEVEL Baiow Toped Casing: FT.
�/� 1Ut " r" if &tows Too al Camino
9. TOP OF CASING IS _L`„s�_ FT. Above Lend Surface'
• Dosing Torah n a Einar Wow farol Wrlaoo M *NNW unloom a rarisnos is lamed
MI &deem 1M raft ISA *OAP a0 MIS
1D. YIELD (gpm): MET OD OF TEST R to
11. WATER ZONES (depth) • b f` .
12. CHLORINATION: 'type _ Amount
13. CASING:
W III! Tom&{
Dspih Oiami sr Of magma'. 14MOrW
From T n ^ R.
From To Ft._ -
from To F1.
14. GROUT:
Depth Material Matnod
Prom D . To FI.
From . To Ft.
15. SCREEN:
Depth Dismally Slat -Size Material
From -To- Ft ih in
From To Ft.. in in
From To Fl In. _ in
14. SANDIGRAVEL PACK:
Depth Sits Material
From To FL
From To Ft,
17. REMARKS.
I DO HEREBY C!RTIFYTHAT THIS WELL WAS CONS
CONSTRUCTION STANDARDS. AND THAT A COPY
DEPTH 1311ILLINro LOG
i'mrrl To POemrlion
t_7 Q- nor fv r
rgilw
i rap./ft lloct
9
if Wiliam' 'Pew o naa4s0 use beak of form
(Show •dirmction and diatom* from at Waal two Biota
Roads, or outer map ralsrenvs points) .
t.
r/, �a• PG Knott&
5iGRATURE OF GONTRAGTOR OR AGEN r ( _, DATE
&thaw ogonfl Ip ❑ivirion of WnI ,i Outility and ppylo ~or.
QW.1 REV. 144

GRADY POOLE WELL CO. TEL:[phone]
myth covalent - 04p)In IW 1O1 Erwin M. Health. end WWII waI Resource*
+7twtiion of Environmental Gtcvrx1waum Section
P.o.los2157$ - i+l.C. 27626457S
Phone use) 7224221
WELL OOM/TRUCT1ON REGORD
DRILLING OONTRACTORe GRADY rwrz WELL COMPANY
STAVE WELL
D L.LEII M6GIITRAIIDN MUMU* 479 IPERW1T Iiif,I1��
Feb 10'99 13:42 NIo.001 P.02
1. WELL LOCATION: (Show Woe* d the location below)
Newel _Osor _ RALSIGH Cowe MAKE
115 Carpathian Way
Pool Ooroy.o0r. rr Winoolows ar4 lag tlal
2. OWNW
_ •. 1:...•f R-.
ADORa63A 16- Strew(
QFa. a #Tree.
Ral.Jah. NC 27603
oat * Tem awe
DPTH
Fwn+ To
3. DATE DAIUID gplog WE OF YAS.L.Rft4.114etZtiOD
4. TOTAL DEPTH 400
S. C.UTTW13s COLUCTED � NO
II. COESWELLRErLAC1ii ELL? YRS DI No0
T. STATIC WATER LEVEL below Top of Cu:ingFT.
Noose aiwto Top of Cm*
S. TOP OF CASING 18 - - 1_ PT. Above Lard a it ce'
' !1AMr114r li�d
- ware lend
aMA// ill/ is rel mints i variorum
is Ld
S. YIELD 3 - '2 — METHOD OF TEST bi
10. WAR 20NE'5 00490 and 350'
O1t1LLP L.O{i
FMnttr w Doiort m
it. CHLORINATION: nips Amount If atIckaid • 4 needed mob** of fon
12. CA111 G
weTiMdrwn
Depth Calornolor orWsIgM(Pt Atwr.r Mho* *tre ilon and - rrara 4d IMM Iwo 8414
From To —GIG_ Pt. " (salvo P1oad.. or • .• reference Kemal
prom-.., Ta-•�.. I
MON SKETCH
PfOIR To Ft,
13. GROUT:
From 0 o ...20—R. mural
From TO Ft.
14.k
17ece Dhrnelsr Sint Se:* •Material
• &con To ___ Ft
Fiarn To In.
i +or n In.
15. SAND/GRAVEL PACK
Wei Sin SAstsrlSi
Rom 7b .Mi..,. P .
Rom 70 . Ft.
1S. REMARK&
1 Oo I-IWIwY CERTIFY MAT T14115 weu WAS
coNirrRucnow iTANOARDB, AI+IO THAT A'COPY
aw-! RIM Wee
CTEDIN#
IS RE P IiA5
)474-Jib/Li *.
1 NCAC 3C. WELL
D TOIHE WELL
IIKIN411.04f OF OR Ammon' DATE
..rprrk originolio >yob n ar ttn.iertmonnr Morogootont am copy a rrd parr.

GRRDY POOLE WELL CO. TEL:[phone]
WM Omar* - Deperlmenl a II,wV ant, Moth, and N turtl knout aka
•➢wile, d Edw3,ertmaMai PMi mwt - Gro ndata r Section
P.D. Sox MTh • Nil" N.C. 87edt4•O67e
Mona (4T81733,3211
Wf Lt. COMITRUCOON REOQRD
DRILLING OONTRACTOR4JRADY POOLS MIX COMPANY
STATE wall.
MILLAR RIOSTRATION M11MEA: 479 MINT NUWSE :
Feb 10'99 13:43 No.001 P.03
POOP IsTICeaOS tiNLY -
e9flate . + F ,
•
Kaw� • P ri ' Anti ea
i. gyp.
298
1. WELL LOCATION: (8haw sloth a the iocrt on botow)
wer.aeTakdn: MIME County WAKE
10 Carpathian Way, Wall *2
[lsol,Clo eisisky.0 ilkiblvisial end Lai Ho.)
2. commit Cea.
ADOAEU .LN• BMW St.
IIISsol Di Flows WO
Snlei�. NC 27503
011p o► taw Odra Zip Orris
S. DATE DiRIL.LED10/23/98 Uec OF WELT.-ilSgtoton
4. TOTAL DEPTH
f. OUTT1Nail COUSCTED YES E] NO
S. DOES WlI.L REPLACE EXISTING WSW Y S D N°®T. STATIC WATER LEVEL Below Top of Codling: 3n FT -
(Liss ' i t Abeam Tap of Cee6nW
i. TOP OF CASINQ.1d,. 1�- FF. Atom Land Lidice
• raa • ie i110A0 swims la a+ei imam a %silence is issued
011111
I. Yap METFNOO OF TEST —MAC. .
t 0. WATER ZONE4 (deSepI) 180 ft.
DEPTH
Prom •T
11.OHLORWATIOtt Type Amount
1E. DAMN
oral Trra.+.,a
Depth iw+a or wip.►rt.ua+dsd
From—{L.-TO P1.
Rom— Tom_ Ft
from —To—.
13. GROUT:
Depth Mideripi
From 0 To 20 Ft5 Ceae t
F+�om To —Ft.
14. Sit:
Mottled
Poured
L1rr+lh derneier 91o1 Stu Medina'
From Ta _
• From To..— in.
Pmrn To P1. in. In.
16. SANI VOf AV . PACK.:
Dapel
from Ta�� FI,
Rum To, . Ft.
IS, REi&_
Meterde
MILLOSIlsga—
r r.adk oaeorpum
spore ie nWad Lea beat d loan
Acrid*, Cr
and drama Iron at Meet tiro Moto
j;" imV411
1 DO MAY DUMPY 111ATTHIS WELL WAS OON
DONSTIVJCI1ON STANDARDS. AMP THAT A COY 1
AVM Are. MS
AUCTED 1N OM
aute+k arid%+ is •
I$ FOE
•.
IM NCAC,2C, WELL
'T° THE iNSLL
C4.77t-cl 41/
cA socier DATI
sit ermecnivientai Ar.c.1240..nI ensalp, la%s%.rr.

Yahoo! Maps and Driving Directions
http://raaps.yahoo.com/py/pinap.py?Pyt—DrAp...35.9 I 47itsin--78.6402&zip27615&mag=9&es�9
19L11.001 MAPS
Yahoo! Maps
Maps - Yellow Pages - Address Book - Helo
115 Carpathian dr., Raleigh, NC 27615
New Location
Need Help? Sec the FAO Or report map problems.
Copyright © 1994-98 Yahoo! All Rights Reserved

Yahoo! Maps and Driving Direcbams http:llmaps.yahoo.cam/pyipmap.py7Pyt=To.no...35.91478za1n=78.b4026txip-275I5&mag=7ot s=9
witioof MApti Mais - Yellow Pages - Address Book • Help
Yahoo! Maps
--«:.. prjngda9e
" r----Est Etas LaIke
f.
;-r
•
F-'Rc4wicSc YjlLi�e':dl
01007 Gao5y5iegm. GbbalCorp.,..
card
Jo
CASH=ACv
?�'l AF.• !!'EPA IrtL7:F rrT�3e=Y.7aisl<CNAPI`8
115 carpathian dr., Raleigh, NC 27615
Now!
New Location
„
P
I4� .6 uss
i
1kuae CrosStd
'" Uz:...
.ores i.a s`,X . .tI:,
efkh'Ha-ven'• i� "� .S Po?ld r--
�'atieview ,
.�r.,v3. rE:a liS rw ' tr'3'.. i"= i. r' ..... .......,,,,;.e Y
Need Help? See the FAO Or report map problems.
Copyright © 1994-98 Yahoo! All Rights Reserved

GROUNDWATER SECTION
October 7, 1998
:MEMORANDUM
To: Jay Zimmerman
Groundwater Section
Raleigh Regional Office
From: Mark Pritzl fl.f mark [e-mail]
Hydrogeological Technician II
UIC Group
Groundwater Section, Central Office
Re: Request for review of new injection well permit application for operation.
The CO-UIC has received an application by Howard Moody for a new permit for the construction
and operation of an injection well located at 115 Carpathian Way, Raleigh, NC. The proposed
injection well will be part of an open loop geothermal heat pump system, therefore a type 5A7 well.
A copy of the permit application was sent to Jim Greer on October 2, 1998.
1. Please review the application and submit any comments to CO-me. Retain the application
for your me file.
2. Please inspect the proposed injection well site to verify that the location and construction
plans submitted in the application are accurate and that the NCAC Title ISA 2C.0200
standards are being complied with, using the enclosed Preconstruction Injection Facility
Inspection Report-Form (A) as appropriate.
Please return any comments immediately upon application review. You are requested to return the
completed Preconstruction Injection Facility Inspection Report-Form (A) to the CO-UIC by
October 30, 1998. If the inspection can not be accomplished by this date, please inform the CO-
mc. The me Group appreciates your assistance in the review and evaluation of this permit
application. Please contact me if you have any questions or comments at [phone].
cc: me Files
Enclosures C:\wordocs\shells\Pennit\ASKRWHP.doc
MEMORANDUM
To: Jim Greer
GROUNDWATER SECTION
October 2, 1998
Groundwater Section
Raleigh Regional Office
From: -Mark Pritz! ·-/IIP [e-mail]
Hydrogeological Technician II
UIC Group
Groundwater Section, Central Office
Re: Request for review of new injection well permit application for operation.
The CO-UIC has received an application by Howard Moody for a new permit for the construction
and operation of injection well at 115 Carpathian Way, Raleigh NC, 27615. The proposed injection
well will be part of an open loop geothermal heat pump system, therefore a type 5A 7 well. A copy
of the permit application is enclosed.
1. Please review the application and submit any comments to CO-UIC. Retain the
application for your UIC file.
2. Please inspect the proposed injection well site to verify that the location and construction
plans submitted in the application are accurate and that the NCAC Title 15A 2C.0200
standards are being complied with, using the enclosed Injection Facility Inspection Report
(form B) as appropriate.
Please return any comments immediately upon application review. You are requested to return the
completed Injection Facility Inspection Report (form B) to the CO-UIC by October 30, 1998. If
the inspection can not be accomplished by this date, please inform the CO-UIC. The UIC Group
appreciates your assistance in the review and evaluation of this permit application. Please contact
me if you have any questions or comments at [phone].
cc: UIC Files
Enclosures
, \rlMEs s. HUNT . .i~~
.•'.:::;;~!~-~~~~
.WA~E McOEVITT.
SECRETARY
. -A. PRl!!CSTON HOWARD,
.. ;: .JR.;.P.E.
-DIRECTOR
S\i~ ... I! ➔• PMMIIME:liRr
Howard Moody
115 Carpathian Way
Raleigh, NC 27615
Dear Mr. Moody:
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
October 1, 1998
Your application for a permit to use a well for the injection of geothermal heat
pump effluent has been received and is under review. A member of the Groundwater
Section's Raleigh Regional Office staff will be contacting you to arrange an inspection
of the injection well and collect water samples as part of the review.
If you have any questions regarding the permit or injection well rules please
contact me at [phone] or Amy Axon at [phone].
cc: UIC Files
RRO Files
Mark Pritz!
Hydrogeological Technician II
Underground Injection Control Program
GROUNDWATER SECTION
P.O Box 29578, RALEIGH, NC 27626-0578 -2728 CAPITAL BLVD., RALEIGH, NC, 27604
PHONE [phone] FAX [phone]
AN EQUAL OPPORTUNITY I AFFIRMATIVE ACTION EMPLOYER· 50% RECYCLED/10% POST-CONSUMER PAPER
NORTH CAROLINA M,(
40/ °1'6
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A
WELL(S) FOR INJECTION WITH A HEAT PUMP SYSTEM
Type 5A7 and 5QM Wells
In Accordance with the provisions of NCAC Title 15A: 02C.0200
Complete application and mail to address on the back page..
TO:
DATE: k- ZCv . t9(?)
DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
A. SYSTEM CLASSIFICATION Please check column which matches proposed system.
(1) Type 5A7 wells inject water used to provide heating or cooling for structures.
(2) _ Type 5QM wells contain a subsurface system of continuous piping, that is
isolated from the environment and circulates a fluid other than potable water.
This includes systems that circulate additives such as antifreezes and/or corrosion
inhibitors.
(3)
Type 5QW wells contain a subsurface system of continuous piping, that is
isolated from the environment and only circulates potable water. If you selected
this well type, then complete form GW-57 CL, Notification Of Intent To
Construct A Closed -Loop Geothermal -Water Only Injection Well System.
PERMIT APPLICANT �y
NName:I�t/.] A 1p M OGI
Address: 115 (' A 1)J N`(
City: 1-F._.,41.,L�1 e",14 State: f\i FL Zip Code: Z76, !,'Z County: W A fC G
Telephone: -I 1 R - gifts - iv 24
PROPERTY OWNER (if different from applicant)
Name: T)A41r1t-
Address:
City: Sate: Zip Code: County:
Telephone:
STATUS OF APPLICANT
Private: Federal: Commercial:
State: Municipal: Native American Lands:
GW-57 HP (May 1998)
Page 1 of 4

E. FACILITY (SITE) DA TA
(Fill out ONLY if the Status of Owner is Federal, State, Municipal or Commercial).
Name of Business or Facility: __________________ _
Address: _________________________ _
City: _________ Zip Code: ____ County: ______ _
Telephone: _________ Contact Person: _________ _
F. HEAT PUMP CONTRACTOR DATA
Name: -~prz.JC.0JJ GLEql?IC< Co,
Address: +is 61t1ZDIJG!2-Ee/,
City: /J t,/G, I e;n_. Zip Code: ~75·'D / County: H1f----:t::;_GJT
Teleph~ne: tJ/t::!f-(e!;C/-{)'J?t) Contact Person: 6,§/..l; L
G. INJECTION PROCEDURE (Briefly describe how the injection well(s) will be used.)
bLElAJ w, t-L w, LL t1:>~ us50 m PG:-, kl J E?~r w.+rtm.,
E~t:-1\ Gee-TZ::fr~AL l::\-e-A-T BJ IYJ {)
H. WELL USE Will the injection weU(s) also be used as the supply well(s) for the following?
(I) The injection operation? YES ____ NO _v __ _
(2) Personal consumption? YES____ NO _v __ _
I. CONSTRUCTION DATA (check one)
EXISTING WELL being proposed for use as an injection well. Provide the data in
(I) through (7) below to the best of your knowledge. Attach a copy of Fonn GW-
1 (Well Construction Record) if available.
✓ PROPOSED WELL to be constructed for use ·as an injection well. Provide the
data in (1) through (7) below as PROPOSED construction specifications. Submit
Form GW-1 after construction.
(1) Well Drilling Contractor's Name: TD BG lti":?Tl£CZM 1>-.le=O
NC Driller Registration number:
(2) Date to be constructed: _______ Number of borings: _ ___.__ __
Approximate depth of each boring (feet): I D O
(3) Well casing: Is the well(s) cased?
(a) YES ..£__ If yes, then provide the casing infonnation below.
Type: Galvanized steel __ Black steel __ Plastic ✓ Other (specify) _______ _
Casing depth: From ___ to_.....-_ ft. (reference to land surface)
Casing extends above ground inches
(b) NO __
GW-57 HP (May 1998) Page 2 of 4
(4) Grout (material surrounding well casing and/or piping):
(a)
(b)
Grout type: Cement ✓ Bentonite __ Other (specify) ______ _
Grouted surface and grout depth (reference to land surface):
__ around closed loop piping; from ___ to ___ (feet).
__ around well casing; from __ to __ (feet).
(5) Screens (for Type SA7 wells)
(a) Depth: From __ to __ feet below ground surface.
(6) N.C. State Regulations (Title ISA NCAC 2C .0200) require the permittee to make provisions
for monitoring wellhead processes. A faucet on both influent (fluid entering heat pump) and
effluent (fluid being injected into the well) lines is required. Will there be a faucet on:
(a) the influent line? yes v no__ (b) the effluent line? yes ✓ no __
(7) SOURCE WELL CONSTRUCTION INFORMATION (if different from injection well).·
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-1 is not available,
provide the data in part K (1) of this application fonn to the best of your kn_owledge.
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
J. PROPOSED OPERA TING DATA (for Type SA 7 wells)
(1)
(2)
(3)
(4)
Injection rate:
Injection Volume:
Average ( daily) I -:, · gallons per minute (gpm). /5 fYI JJJ rf fL
Average (daily) M_ gallons per day (gpd).
Injection Pressure: Average (daily) '2Q pounds/square inch (psi).
Injection Temperature: Average (January) 50 ° F, Average (July) 'J5.. ° F.
K INJECTION FLUID DATA
(1) Fluid source (for Type 5A7 wells) If underground, from what depth, formation and type of
rock/sediment unit will the fluid be drawn (e.g., granite, limestone, sand, etc.).
Depth: [5 1
Formation: 14/tt Rock/sediment unit:~JJ_/_Jt ___ _
(2) Chemical Analysis of Source Fluid (for Type SQM wells)
Provide a complete listing of all chemicals added to the circulating heat transfer fluid:
"1o~e
L. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the injection equipment and exterior piping/tubing
associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
GW-57 HP (May 1998) Page 3 of 4
M. LOCATION OF WELL(S) Attach two maps.
(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 include a north atrow.
(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.
N. PERMIT LIST: Attach a list of all permits or construction approvals that are related to the site.
Examples include: •
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non -Discharge permits
(3) Sewage Treatment and Disposal Permits
f O. CERTIFICATION
"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."
L
(Signature of Well Owner or Authorized Agent)
!f authorized agent is acting on behalf of the well owner.
please supply a letter signed by the owner authorizing the above agent
P. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property
rights in the well being constructed. A well is real property and its construction on land rests
ownership in the landowner in the absence of contrary agreement in writing.)
If the properly is owned by someone other than the applicant, the property owner hereby consents to
allow the applicant to construct each injection well as outlined in this application and that it shall be
the responsibility of the applicant to ensure that the injection well(s) conforms to the Well
Construction Standards (Title 15A NCAC 2C .0200)
(Signature Of Property Owner If Different From Applicant)
Please return two copies of the completed Application package to:
UIC Program
Groundwater Section
North Carolina DENR-DWQ
P.O. Box 29578
Raleigh, NC 27626-0578
Telephone [phone]
GW-57 HP (May 1998) Page 4 of

)
Y
\'‘, ,,
J , 1
J ! :
�] IGITWAY
�e r' �f c S GH REC
-- I at.
Cal
•
or .,yi i
.
c
•t+
SOLI
1
►
I !iG .em
1�
+R�4DtM'Ra
111F24":.
.. ikkh.
,
'�
—0
• I(O.Otr. �° -
�r k� •-
- r
IIIIIII ( C ` @+Mrri
Li'y fjg;' rn r a
(\•.'i i k:\- -
_~
4
1
-�►..1
f
...,
%'
I�
r SA
'�
i i
L
:t3Zl�
' rt r,
-_
_ i
a xa
`�. r _ � TAR ALL'.A DC
g r • ,. nrr
l+,F04c, - 1,- 4,1, • -
-- f-r,
N p� -r Pik add
�.
r;
*g' i
1-\-7 0
I r
• , •
!
1
-....----.
rWyatt
ti% .f_�
i ti =
U` ,��, ,
Ferwtville �i
1
- 4'
t.r.
o. •
...;'.
owit
milli
Woke iar
r
'
`r M
mkt
glii% 1 ‘*
y Y �•1
) F -
7111111111N1111111,
i
. .....
f ''
b.
eV To
•
-rr NFUfFr "`$
woo 71
grun�rHyy10.� �°
-�
r
r 4r0.I 114
- a'o a auwCE��€
Las
,�
1
ZI
Gow..
- Gb I 0 %IBA. 1
r �, - ' ? r 1 i
+ �G�
71 r
'
I �,_ �.7 ' d+ .w i. •'�L` l
7 ' ram•
J r _ r� 40
I 3 ,/ L.; Lc'
-
, ---�,sy... b �—� ' 1
,k{ I` , •'- `y{ ��,- ��-�.GL'�'
.,., r--,--.7.-_-;z • -, - . -daa.
-
•,� , Loki.
r•-
Y ? FZ-
�r .• p' • ,� rNw
-4-
�p I r
I ',+ t
Crled �-
_ __ _,c
�, $ �-._��
,__
'
�` s
\
,;
c s
Anne # �--� t ;
- -
.-
\,(
�' L i r•p
I -.
\-:1 ,
r�
, ,
'• a.,
V tiB.au. yn rt r' l-
r_'_
7�
�` 1„_ •i
. Pr` n•y.�.
1
'F� r=- �-- t,i1•
'
� l .. i r,
L ��+�A:Pi61-
r .. `� �� -ERR
—, ' �` -�� - C"ir
- ./
i �% r.,y"
" may. f " '='
•A�'• ['
r r O
1 to
. J
ice. r''�. ' •
:,,,, _
r {i . rt
tea`
ar
'N
:-. '
``i
yp�,•
. •, i - -4
,
- '7CId
•
�`- _
r'*
^ .".- - •
- 1L Grove,
,
-7
Lor.
th
+ 1 Y*'I
r ,• r 116l lr i
, ati y
,�,g T .�u
4- kfAY!' � 1 "--
�_
A.las
AA L— a
f'
t c- 4wi
7._+
Iliesetreer
L��`,ERI I0'1V �Y•-•_
�j t.
m I
$ . I L..
k
' , 'i 2" +1 } e
4�I ;il ,..r.,
- r
1 •,4: , •L 7
tr .
�a
1t 1
',] 1 ',A'
_ r' _ I r
Y R�
L- =
—. -- L �. ] +la /
��*rr_ \ir�a'
} r. a 4•
rj ■■. ---- - ,lll% iM
f ii��rra,arr.. .t'z ,
f eQ �
■•s -- - - — ehp?-•
.A -

pre542Pe11i
,s=of_eLm_tez.L
4•4-1NED rAt-0,Zyl
5 cAdezPAT-.1,-kirtk)
t-674e;(14-_7
L_LOLE:_--LIL..)4A-910.&;
• :CPsaziPbse-D

0

(
C
,,1.:;v.,_;/:-:_f?i) A rrt"'A.1-!c.,~ MooD,
Operating Ternperatures & PressL1res, GT042-054
OPERATING DATA
COOLING HEATING
Entering Water Suction Discharge Water Air Suction Discharge Water Air
Model Water· Flow Pressure Pressure Temp. Temp. Pressure Pressure Temp. Temp.
Temp.,°F GPM PSIG . PSIG Rise,°F Drop,°F PSIG PSIG Drop,°F Rise,°F
30° 6.0 ·• 36-42 172-180 5-6 16-20
9.0 40-45 182-190 3-4 17-22
40° 6.0 68-74 133-141 23-25 19-23 45-50 192-200 6-7 18-23
9.Q ~.-67-73 108-126 10-11 19-23 50-55 202-210 4-5 19-24
50° 6.0 69-75 153-161 23-25 19-23 '. 54-58 212-220 8-9 20-25
9.0 68-74 130-135 10-11 19-23 58-68 200-230 5-6 22-27
60° 6.0 74-79 178-186 22-24 19-23 62-70 226-234 , 11-12 23-28
GT042 9.0 73-78 152-160 10-11 18-22 70-74 234-242 6-7 25-30
70° 6.0 76-81 192-202 21-25 18-22 74-77 242-248 11-12 28-32
9.0 75-80 176-186 9-10 18-22 77-82 251-261 7-8 30-34
80° 6.0 77-81 218-230 21-23 17-21 82-88 262-268 12-13 31-36
9.0 76-80 198-210 9-10 17-21 88-93 266-278 8-9 33-38
goo 6.0 78-82 242-254 21-23 17-21. 94-99 276-280 13-14 34-39
9.0 77-81 222-234 9-10 16-20 99-104 282-294 9-10 35-41
100° 6.0 78-82 266-278 21-23 15-19
9.0 77-81 246-258 9-10 14-18
30° 6.0 31..-38 175-214 3-4 14 .. 17
12.0 35-42 183-223 2-3 15-18
40° 6.0 66-80 117-143 17-21 20-24 39-48 193-236 6.:1 17-21
12.0 66-80 105-128 9-11 20-25 44-54 201-246 3-4 18-22
50° 6.0 68-83 136-167 18-21 19-23 48-58 211-258 8-10 20-24
12.0 68-83 122-149 9-11 19-24 '53-65 220-269 4-5 22-26
,..,,,.-·--'\
60° 6.0 69-84 161-196 17-21 18-22 56-68 225-275 9-11 23-28
e4~)
,. ·12 .0 69-84 · 144-176 9-11 '19-23 63-77 234-286 ' -5-6 25-31
70° 6.0 69-84 185-226 18-21 18-22 66-80 230-281 13-16 29-35 . .___,..,
12.0 69-84 166-203 9-11 18-22 74-90 240-293 7-9 31-38
80° 6.0 69-85 214-262 17-21 17-21 76-93 248-303 15-19 32-40
12.0 69-85 192-235 9-11 18-21 85-104 258-316 8-10 35-43
goo 6.0 71-87 243-297 17-20 16-20 87-106 264-322 17-21 36-44
12.0 71-87 219-267 8-10 17-21 97-119 275-336 9-11 39-48
100° 6.0 71-87 273-333 17-20 17-20
12.0 71-87 245-299 8-10 17-21 ..
30° 8.0 33-41 167-204 3-4 18-22
18.0 37-45 173-212 2-3 19-24
40° 8.0 66-80 117-143 13-16 21-26 42-52 184-225 5-6 22-27
18.0 66-80 107-131 7-9 22-27 47-57 191-233 3-4 24-29
50° 8.0 68-83 -137-167 13-16 20-25 51-63 201-246 7-9 27-32
18.0 68-83 125-152 7-9 21-25 57-69 209-255 4-5 28-35
60° 8.0 69-84 1-61-197 13-16 20-24 60-74 214-262 8-10 31-38
GT054 18.0 69-84 147-180 7-9 20-24 67-82 222-271 5-6 33-40
' 8.0 70-86 178-218 13-16 20-24 72-88 229-280 10-12 34-42 70° 18.0 70-86 162-198 7-9 20-24 79-97 238-290 6-7 37-45
80° 8.0 71-87 206-252 12-15 19-23 83-101 247-302 11-14 39-47
18.0 71-87 188-230 7-8 19-23 91-111 256-313 7-8 42-51
90° 8.0 73-89 235-287 12-15 18-22 94-115 263-321 12-15 43-53
18.0 73-89 214-261 7-8 18-23 104-127 272-333 7-9 46-56
100° 8.0 73-89 263-321 12-15 18-22
18.0 73-89 239-292 7-8 19-23
This chart shows approximate temperatures and pressures for a unit in good
repair. The values shown are meant as a guide only and s~ould not be used to
estimate system charge. This chart assumes rated air flow and ao• d.b./67° w.b.
entering air temperature in cooling, 70° d.b. entering air temperature in heating.
Heating data at entering fluid temperatures below 50° assumes the use of
antifreeze. • RP FHP MANUFACTURING
601 N.W. 65th Court • Fort Lauderdale, FL 33309
Phone: [phone] • Fax: [phone]
http://www.fhp-mfg.com
REV: 0
As a result of continuing research and development, specifications are subject to change w ithout notice.
GTPTCHRT.P65 3/4
CONTRACTOR
-0 ER iCArk fn ci-
tocATIoN 1 l C,(l T p FLU NI)/
I }�� -i+VAkE:COONT HCAlli • IbEI!AlttMAJT S PTIC TANK l.ktoit AND PERMIT :VII
TAX MAKNO. __.. 1 PARCEL NO 11-I PERMIT NO: 330 '
OrERAT10N FERMI 1:3
DATE
;r c
SUBDIVISION NAME !T ( k Z
REPAIR ❑ ORIGINAL PERMIT NO. t.
GARBAGE DISPOSAL UNIT YLSK' NO ❑
HOUSE ]t MOBILE HOME 0 BUSINESS 0
NO_
,,,,B►►IR`1"OOMS Li LOT AREA 0 art)
SITE OF;TANK • J 5/ (.) Sal.
NITRIFICATION LIKE (( r) b413) (,4() sq. (-
DEPTH Of STONE IN UNES: 12" K
RISER AND RAFFLE REQUIRED PUMP REQUIRED Cl
WATER SIJI"PY: INDIVIDUAL PUEUC ❑ OTHER 0
• PERMii. VOID JS MONTHS FROM k OF ISSUANCE.
* PERMIT VOID IF NOT IN CCMP[MNCE►WYTfi1 ZONING REGULATIONS
• PERMIT MAY 4E VOIDED 11' SITE ALTERATIONS MADE
S -
S R NO.
LOT NO SECTION DR BLOCK NO
.-
LAYOOI Tt SY_t'fi_1 �.c. _� _ �C�+a� s ••�
•-.
DATE
IMS1ALtED 1!I' .
3�+x3
02010 ktf
h . kit) fir e
ti , re it T 1.& ve.
API'1lOVtD R1' f f j 1
14 RC
�k
866T/bi/80
otermii1a3S n 43