WI0500033_GEOTHERMAL_20130220

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW REQUEST FORM
Date: March 18, 2020
To: Rick Bolich — Brion Byers
From: Shristi Shrestha, WQROS — Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E Mail. [e-mail]
Permit Number: W10500033
A. Applicant: Donnie R. & Emily Shelton
B. Facility Name:
C. Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal/Name Change
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 W ROS 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-WQROS Reviewer:
COMMENTS:
NOTES:
Date:
FORM: WQROS-ARR ver. 092614 Page 1 of 1

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
Donnie R. & Emily H. Shelton
2701 Weaver Hill Dr.
Apex NC 27502
NORTH CAROLINA
Environmental Quality
March 18, 2020
RE: Acknowledgement of Application No. WI0500033
Geothermal Heating/Cooling Water Return Well
Wake County
Dear Mr. & Mrs. Shelton:
The Water Quality Regional Operations Section (WQROS) acknowledges receipt
of your permit application and supporting documentation received on March 18, 2020.
Your application package has been assigned the number listed above, and the primary
reviewer is Shristi Shrestha
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 Shristi Shrestha at 919-707-3662 or email at [e-mail].
Sincerely,
For Rick Bolich, Chief
Ground Water Resources Section,
NCDEQ Division of Water Resources
cc: Raleigh Regional Office, WQROS
Permit File WI0500033
U
North Carolina Department of Environmental Quality I Division of Water Resources
D_E Q 512 North Salisbury Street 1 1636 Mail Service Center I Raleigh, North Carolina 27699-1636
NORTH CAROLMIA v
o9.naa 919.707.9000

North Carolina Department of Environmental Quality — Division of Water Resources
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELL(S)
In Accordance With the Provisions of 15A NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELL S
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 Sections A thru E. and M (signature page) only
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: "/U �{ 1 Z , 20_ZO_ PERMIT NO. [.tom 05100033 _(leave blank if New Application)
A. CURRENT WELL USE & OWNERS.HIP STATUS (Leave Blank if New WeliiPermit Application)
1. Current Use of Well
a. I wish to continue to use the well as L31beothermal. Well �rinking Water Supply Well
❑ Other Water Supply Use- Indicate use (i.e., irrigation, etc.)
b. Terminate Use: If the well is no longer being used as a geothermal injection well and you wish to
rescind the permit, check the box below. If abandoned, attach a copy of the Well Abandonment
Record (GW-30).
❑ Yes, I wish to rescind the permit
2. Current Ownership Status
Has there been a change of ownership since permit last issued? YES ❑ NO
If yes, indicate New Owner's contact information:
Name(s) 112AA) /Z -,, 6--^9 /GI/ Y � 7t,.,t.-
Mailing Address: CUCA
City: Pc k State:Zip Code: Z % �6 Z County:
l [lsi
Day,k6gft I l?I 9 2-6 d l SI Email Address.: ,Cbuul
B. STATWAR3t J,IRMMANT (choose one)
Non-Governor�x�GUuWR Individual Residence ✓ Business/Organization
NC DE
Governftntral O fW 5ta�e Municipal County Federal
C. WELL OWNER(S)/PERMIT APPLICANT - For single family residences, list all persons listed on the
property deed. For all others, list name of business/agency and name of person and title with delegated authority
to sign:&A)6^F_ Lf CM/L.1 14 SWCZ70 /
Mailing Address: `Z D 4A^ O�
City: E >�- State: U_ Zip Code: 2 %j ®Z County: aC-
Day Tele No.: / U 19/ 5/ Cell No.: E
EMAIL Address: —&-AXIS, /2 ,eft Tom' 0 L A4I1-,� 0_11ax No.:
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 1

D. WELL OPERATOR (if different from well owner) — For single family residences, list all persons listed on
the property deed. For all others, list name business/agency and name of person and title with delegated authority
to sign: p 1A
Mailing Address:
City: _ State: Zip Code: County:
Day Tele No.: Email Address.:
E. PHYSICAL LOCATION OF WELL(S) SITE
(1) Parcel Identification Number (PIN) of well site: 07 Z t0Z County: kuC
(2) Physical Address (if different than mailing address):
City:
County
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name:
NC Well Drilling Contractor Certification No.:
Company Name:
Contact Person:
Address:
City: Zip Code:
Office Tele No.: Cell No.:
EMAIL Address:
State:
G. HVAC CONTRACTOR INFORMATION (if different than driller)
HVAC Contractor's Name:
NC HVAC Contractor License No.:
Company Name:
County:
Fax No.:
O
Contact Person: EMAIL Address:
Address:
City: Zip Code: _ _ State: County:
Office Tele No.: Cell No.:
Zip Code:
Fax No.:
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES r/ NO
(2) Personal consumption? YES -L.1__ NO
I. WELL CONSTRUCTION REQUIREMENTS — As specified in 15A NCAC 02C .0224Id]:
(1) The water supply well shall be constructed in accordance with the water supply well requirements of
15A NCAC 02C .0107.
(2) If a separate well is used to inject the heat pump effluent, then the injection well shall be constructed
in accordance with the water supply well requirements of 15A NCAC 02C .0107, except that:
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 2

J.
(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.
WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
1 *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:
Depth of each boring below land surface
Well casing and screen type, thickness, and diameter
Casing depth below land surface
Casing height "stickup" above land surface
Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited for sealing water -bearing zones with 1500
mg1L chloride or greater per 15A NCAC 02C .0107&8J
Length of well screen or open borehole and depth below land surface
Length of sand or gravel packing around well screen and depth below land surface
K. OPERATING DATA
(1)
Injection Rate:
Average (daily) gallons per minute (gpm).
(2)
Injection Volume:
Average (daily) gallons per day (gpd).
(3)
Injection Pressure:
Average (daily) pounds/square inch (psi).
(4)
Injection Temperature:
Average (January) " F, Average (July) ° F.
L. SITE 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 well(s). The site map shall
include the following:
(1) All water supply wells, surface water bodies, and septic systems including drainfield, waste
application area, and repair area located within 250 feet of the 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 located within 250 feet of the parcel on which the proposed injection well(s) are
to be located.
(4) An arrow orienting the site to one of the cardinal directions (north, south, west, or east)
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 3

NOTE. Inmost 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, eta 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 .0211 a requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer
or ranking publicly elected official;
4. for all others: by all the person(s) listed on the 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 with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of the
Permit."
Signature of Property Owner/Applicant
Aw'JOr-� Z
Print or Type Full Name and Title
4n�4 .4 4ekAJ"
Signature of Property Owner/Applicant
r-M ll-_,Y A51 A.) 56(-7&V
Pnnt or Type Full Name and Title
Signature of Authorized Agent, if any
Print or Type Full Name and Title
Submit two copies of the completed application package to:
Division of Water Resources - UIC
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 4

I.
North Carolina Department of Environmental Quality
Division of Water Resources
PERMIT NAME/OWNERSHIP CHANGE APPLICATION FORM
1. Complete this form in its entirety as follows:
(a) Change of Ownership - Provide the information in Parts II and III and submit legal documentation of the
transfer of ownership such as a contract, deed, article of incorporation, etc. The certifications in part IV
must be signed by both the current permit holder, if available, and the new applicant(s).
(b) Name Change Only - Provide the information in Parts II and III. Sign the certification for the new
applicant in part IV.2.
2. Submit the properly completed form to the address on bottom of Page 2.
II. CURRENT PERMIT INFORMATION
1. Permit Number:— (L)-j d j U 007 j 3
2. Permittee name(s): 'l L O ttG l N i A- Q T7-
3. For Business/Governmental Agency- Permit signing official's name and title:
(Person legally responsible for permit)
4. Mailing Address: 2- 7� ���U�I'L 11 LC Oi-
City: X- State: 0 L Zip: :z i S6
Telephone number: (___j Fax number: (___j
EMAIL Address:
5. Physical Address of Facility/Well(s) (if different than mailing address)
City: — _ County:
III. NEW OWNER / NAME INFORMATION
1. This request for a permit change is a result of:
_L_,4.-Change in ownership of property/company
b. Name change only
c. Other (please explain):
Zip:
Permit/Name Change of Ownership Form Rev. 2-18-2020 Page 1

New Owner's name(s) as listed on the property deed (Please Print/or Type):
C) N,y(C
3. If Business or Governmental Agency- Permit signing official's name and title:
(Person legally responsible for permit)
4. Mailing Address: 2 701 (, Z A !/Co2 1'�1GC D/L
City: State: A) L Zip: - 7 Sy ?
Day/Cell Phone No. '
I� Fax number: �)
EMAIL Address: 401,,JA 11C , a,- <YC? X,� O G A4,+/ L ,CO3j
IV. CERTIFICATION
1. Current Permittee's Certification (Please print or type):
I, , attest that this application for name/ownership change has been reviewed
and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included,
this application package will be returned as incomplete. I understand I will continue to be responsible for
compliance with the current permit until a new permit is issued.
2. New App 'cant(s)'s Certification (Please print or type):
I/We, AJ [[ E C M I_(�/ 7Z7:!{ , , attest that this application for
name/ownership change has been reviewed and is accurate and complete to the best of my knowledge. I
understand that if all required parts of this application are not completed and that if all required supporting
information and attachments are not included, this application package will be returned as incomplete. I further
certify tha pera e an ntain the permitted facility in accordance with the permit and related regulatory
Signature:
Signature: &4 6-j-t Date:
03l(Z�z a
SUBMIT THE COMPLETE APPLICATION PACKAGE VIA ONE OF THE FOLLOWING METHODS:
U.S. Postal Service:
Courier / Special Delivery / In Person:
Ground Water Resources Section Ground Water Resources Section
NC Division Of Water Resources NC Division Of Water Resources
1636 Mail Service Center 512 North Salisbury Street
Raleigh, NC 27699-1636 Raleigh, NC 27604
Telephone Number: [phone]
Permit/Name Change of Ownership Form Rev. 2-18-2020 Page 2

Permit Number WI0500033
Program Category
Ground Water
Permit Type ·
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael .rogers
Coastal SW Rule
Permitted Flow
Facility
Facility Name
William and Virginia Ott SFR
Location Address
2701 Weaver Hill Dr
Apex
Owner
Owner Name
William
Dates/Events
NC
B
27502
Ott
Scheduled
Orig Issue
12/08/99
App Received Draft Initiated Issuance
01/24/13
Re gulated Activities
Heat Pump Injection
Outfall NULL
Central Files: APS SWP_ ' --
Permit Tracking Slip
Status
Active
Project Type
Renewal
02/20/13
Version
3.00
Permit Classification
Individual
Permit Contact Affiliation
William B. Ott
Owner
2701 Weaver Hill Dr
Apex
Major/Minor
Minor
Region
Raleigh
County
Wake
Facility Contact Affiliation
Owner Type
Individual
Owner Afflllatlon
William B. Ott
Owner
2701 Weaver Hill Dr
Apex
NC
NC
Public Notice Issue
02/19/13
Effective
02/19/13
Re quested/Received Events
RO staff report requested
RO staff report received
27502
27502
Expiration
01/31/18
01/29/13
02/18/13
Waterbody Name Stream Index Number Current Class Subbasin
•
Permit Number WI0500033
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
William and Virginia Ott SFR
Location Address
2701 Weaver Hill Dr
Apex
Owner
Owner Name
William
Dates/Events
NC
B
27502
Ott
Scheduled
Orig Issue
12/08/99
App Received Draft Initiated Issuance
01/24/13
Regulated Activitie.s
Heat Pump Injection
Outfall N UL L
Central Files: APS_ SWP_
02/18/13
Permit Tracking Slip
Status
In review
Project Type
Renewal
Version Permit Classification
Individual
Permit Contact Affiliation
William B. Ott
Owner
2701 Weaver Hill Dr
Apex
Major/Minor
Minor
Region
Raleigh
County
Wake
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
William B. Ott
Owner
2701 Weaver Hill Dr
Apex
NC
NC
Public Notice Issue Effective
Re quested/Received Events
RO staff report requested
RO staff report received
27502
27502
Expiration
01/29/13
02/18/13
Waterbody Name Stream Index Number Current Class Subbasin
DENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
William and Virginia Ott
2701 Weaver Hill Dr,
Apex, NC 27502
Division of Water Quality
Charles Wakild, P. E.
Director
February 19, 2013
Re: Issuance of Injection Well Permit
Permit No. W10500033
Issued to William and Virginia Ott
Wake County
Dear Mr. and Mrs. Ott:
John E. Skvaria, III
Secretary
In accordance with your application received January 24, 2013, I am forwarding Permit No. WIG500033
for the operation of geothermal heating/cooling water return well(s) located at the above referenced
address. This hermit shall be effective from the date of issuance until January 31, 2018, and shall be
subject to the conditions and limitations stated therein.
The Raleigh Regional Office inspected your geothermal system on February 7, 2013, and collected water
samples. The Raleigh Regional Office will forward a copy of the laboratory analytical results to you
when they become available.
In order to continue uninterrupted legal use of this well for the stated. purpose, you should submit an
application to renew the permit 120 days prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water Quality. If you have any questions regarding your permit or the Underground Injection
Control Program please call me at [phone].
Best Regards,
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
cc: Rick Bolich, Raleigh Regional Office
Central Office File, W10500033
Wake County Environmental Health Department
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
I_ocatim 512 N. Salisbury 5t. Raleigh, North Carolina 27604
Phone: 91M07$4641 FAX; 919.807-64801FAX; 919-807-6496
Intemet: www.ncwuateroual4-gra
f]Ite
No hCarolina
utur"Iff
An Equal opponan4y 1 Affirmative A.don EmAyer

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
William and Virgini_a Ott
FOR THE OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER RETURN WELL(S),
·defined in Title 15A North Carolina Administrative Code 2C .0224, which will be used for the injection of heat
p:ump effluent. This injection well is located at 2701 Weaver Hill Dr., Apex~ Wake County, NC 27502, and will
be operated in accordance with the application received January 24, 2013, and 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 I SA North Carolina
Administrative Code ·2c .0100 and .0200, and any other Laws, Rules,-and Regulations pertaining to wen
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until January 31, 2018, and shall be
'subject tothespecified·conditions·and limitations set forth in Parts-I-through VIII hereof.
~ .
Permit issued this the \ q day of ~ .f ~ , 2013
,Jlrr.,-_), ~
«<"' Charles Wakild, P.E., Director
'\ Division of Water Quality
By Authority of the Environmental Management Commission.
Pennit #WI0500033 UIC/Return Well -RENEWAL
ver. 01/2013
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 Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen. ,
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be permanently labeled· with a warning that it is for injection purposes and the entrance to each well
must be sealed with a watertight cap or well seal, as defined in G.S. 87-85(16).
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.01070).
8. Copies of the Well Construction Records shall be retained on-site and available for inspection.
PART II -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect . to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
4. Continued operation of the injection system will be contingent upon . the effluent not impacting
groundwater quality. , The water quality of the effluent cannot be that of a lower quality than the influent,
which results in a degrading of water quality of the aquifer.
Permit #WI0500033 VIC/Return Well -RENEWAL
ver. 0l/2013
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 injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART IV -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or-activity not ·specifically authorized by
the permit
PART V -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation ofcredentials, 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 groundvv:ater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities· as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and_ appropriate samples associated with the
injection facility activities.
PART VI -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The' Perinittee · shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Raleigh Regional Office, telephone number 919-791-4200, any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
Permit #WI0500033 UIC/Return Well-RENEWAL
ver. 01/2013
Page 3 of 5
(B) Any failure due to known or unknown reasons that' renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VII -PERMIT RENEW AL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
PART VIII -CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injectio1:. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0240,
Abandonment and Change-of-Status of Wells.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0240, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
.. the Director finds s.ucl\ .x~moyal_ w:ill not pe responsible for, or contrihµte __ Jo.,. 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 1 0_ 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.
Permit #WI0500033 VIC/Return Well-RENEWAL
ver. 01/2013
Page 4 of 5
(G) The Permittee shall submit a Well Abandonment Record (Form · GW-30) as specified in
15A NCAC 2C .0224(f)( 4) within 30 days or completion of abandonment.
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
Permit #WI0500033
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
VIC/Return Well -RENEWAL
ver. 01/2013
Page 5 of5
AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: February 8, 2013
To: . Aquifer Protection Central Office
Central Office Reviewer: Michael Rogers
Regional Login No: __ _
County: Wake
Per111ittee: William Ott
Project Name: Geothermal Heating/Cooling
Water Return Well
Application No.: WIOS00033
l GENERAL INFORMATION
1. This application is (check all that apply): D New IZJ Renewal
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Recycle D High Rate Infiltration D Evaporation/Infiltration Lagoon
D Land Application of Residuals
D Distribution of Residuals
D Attachment B included
0 Surface Disposal
D .503 regulated O 503 exempt
D Closed-loop Groundwater Remediation IZJ 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: 02-07-2013
b. Person contacted and contact information: William Ott, 919-363-0031
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?
~ Yes or D No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions: . __
c. USGS Quadrangle Map name and number: __
d. Latitude: Longitude: _. __
e. Regulated Activities I Type of Wastes ( e.g., subdivision, food processing, municipal wastewater): __
For Disposal and lniection 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): 2701 Weaver Hill Drive, Apex NC 27502
b. Driving Directions:
c. USGS Quadrangle Map name and number: D23SW Raleigh
d. Latitude: 35.42.20 Longitude: 78.57~06
fl NEW AND MAJOR MODIFICATION APPLICATIONS (tl1is section not needed for renewals or minor
moliific11tions. 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: Ott
AQUIFER PROTECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description Of Well(S) And Facilities -New, Renewal, And Modification
1. Type of injection system:
~ Heating/cooling ~vater return flow (SA 7)
D Closed-loop heat pump system (SQM/SQW)
D In situ remediation ( 51)
D Closed-loop groundwater remediation effluent injection (SL/"Non-Discharge")
D Other (Specify: }
2. Does system use same well for water source and injection? ~ Yes .0 No
3. Are there any potential pollution sources that may affect injection?~ Yes D No
What is/are the pollution source(s)? The septic system is approximately 100 fe~t from the well.
4. What is the minimum distance of proposed injection wells from the property boundary? IOJL.
5. Quality of drainage at site: IZJ Good D Adequate D Poor
6. Flooding potential of site: 1ZJ 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: NI A
8. Does the map presented represent the actual site(property lines, wells, surface drainage)? IZI Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
Iniection Well Permit Renewal.And Modification Only:
l. 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 tvpe), will
continued/additional/modified injections have an adverse impact on mifrration of the plume or management of
the contamination incident? D Yes O No. If yes, explain:
4. Drilling contractor: Name: C. W . Bing Well Drilling
FORM: Ott 4
AQUIF.ER PROTECTION REGIONAL STA .FF REPORT
Address: 620 Industry Dr.
Henderson, NC 27536
Certification number: 1544
5. Complete and attach Well Construction Data Sheet.
V. EVALUATION AND RECOMMENDATIONS
l. Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet-if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? D Yes IZJ No. If yes, please explain
briefly. __ .
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
"
FORM: Ott 5
AQUIFER PROTECTION REGIONAL STAFF REPORT
7. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pend'srig review of draft permit by regional office ; ❑ issue upon receipt of needed additional information;
Issue; ❑ Deny. If deny, please state reasons:
7
8. Signature of report preparer(s):
r
Signature of APS regional supervisor:
Date:
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
Well inspection and well water sampling were conducted on February 7, 2013.
The following comments are highlighted as a result of the inspection.
1. The description of the well by visual inspection
■ The well identification plate was securely attached to the well casing. The engraved
description on the plate was fading and difficult to read
■ A sampling tap for feeding line and a sampling tap for returning Iine were operable
• There was no concrete base around the well head
■ The well head was in good condition to preclude surficial contaminants from entering the
well.
2. The information on the well tag
C Li — I
■ Total depth of the well: 900 feet'
J
■ Casing depth: 200 feet
/06� f
Casing diameter: 5.25 inches
• Grout depth: 20 feet
Z d
• Yield: 3.5 gpm
3'=
• Static water level: 30 feet
Drilling Contractor and registration number: C W Bing Well Drilling, No 1544
3. The location of the well was verified during the inspection
■ The septic tank (potential pollution source) is a distance of approximately 100 feet from
the well.
■ The minimum distance of the well from the property boundary is about 10 feet.
• The minimum distance of the well from the building is 50 feet.
Over all, this geothermal injection well is in compliance with well construction standards.
However, we are awaiting the tab results of the well water to complete this application process.
FORM: Ott 6

Permit: WI0500033
SOC:
County: Wake
Region: Raleigh
Compliance Inspection Report
Effective: 07/09/08 Expiration: 06/30/13 Owner: William B Ott
Effective: Expiration: Facility: WIiiiam and Virginia Ott SFR
2701 Weaver Hill Dr
Apex NC 27502
Contact Person: William B Ott Title: Phone: [phone]
Directions to Facility:
From US64/US1 intersection near Apex go W appx 9 miles. Turn Lon New Hill-Olive Chapel Hill Rd and go appx 2.5 miles. Then, A
Qn Weaver Crqssina/Weaver Hill Drive.
system c1ass1ficanons:
Primary ORC:
Secondary ORC(s):
On-Site Representatlve(s):
Related Permits:
Inspection Date: 02/07/2013
Primary Inspector: Lin McCartney
Secondary lnspector(s):
Certification:
Entry Time: 11 :00 AM Exit Time: 12:30 PM
Phone:
Phone: [phone]
Ext.4243
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Heating/Cooling Water Return Well
Facility Status: ■ Compliant O Not Compliant
Question Areas:
■Wells
(See attachment summary)
Page: 1
Permit: WI0500033
Inspection Date: 02/07/2013
Owner -Faclllty: William B Ott
Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Well inspection and well water sampling were conducted on February 7, 2013.
The following comments are highlighted as a result of the inspection.
1. The description of the well by visual inspection
· The well identification plate was securely attached to the well casing. The engraved description on the plate was
fading and difficult to read
A sampling tap for feeding line and a sampling tap· for returning line were operable
· There was no concrete base around the well head
· The well head was in good condition to preclude surficial contaminants from entering the well.
2. The information on the well tag
· Total depth of the well: 900 feet
Casing depth: 200 feet
· Casing diameter: 6.25 inches
· Grout depth: 20 feet ·
· Yield: 3.5 gpm .
· Static water level: 30 feet
· Drilling Contractor and registration number: CW Bing Well Drilling, No 1544
3. The location of the well was verified .during the inspection
The septic tank (potential pollution source) is a distance of approximately 100 feet from the well.
· The minimum distance of the well from the property boundary is about 1 O feet.
· The minimum distance of the well from the building is 50 feet.
Over all, this geothermal injectlori well is In compliance with well -construction standards.
However, we are awaiting the lab results of the well water to complete this application process.
Page: 2
Ro gers, Michael
From: Rogers, Michael
Sent:
To:
Monday, February 18, 2013 10:04 AM
Mccartney, Lin
Cc: Bolich, Rick
Subject: RE: WI 0500033
I haven't seen it yet. Can you email, thanks.
From: Mccartney, Lin
Sent: Tuesday, February 12, 2013 2:02 PM
To: Rogers, Michael
Cc: Bolich, Rick
Subject: RE: WI 0500033
Michael,
The staff report for the subject permit was sent to you on Monday. You should receive it before Friday.
Thanks,
From: Rogers, Michael
Sent: Tuesday, February 12, 2013 12:27 PM
To: Mccartney, Lin
Cc: Bolich, Rick
Subject: WI 0500033
Lin-
Would it be possible to get the staff report for the above to me by Friday? I am going to be out most of next week for
shoulder surgery and would like to get the permit out.
Thanks
1
AQUIFER_ PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: Januar, , 29. 2013
To: ❑ Landon Davidson, ARO-APS
❑ Art Barnhardt, FRO-APS
❑ Andrew Pitner, MRO-APS
® Eric Rice, RRO-APS
❑ David May, WaRO-APS
❑ Morelia Sanchez Ding, WiRO-APS
❑ Sherri Knight, W-SRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Afall.Michael.Rogers r ncdcjv-.gov
A. Permit Number: Wl 0500033
B. Owner: Ott
C. Facility/Operation:
❑ Proposed ® Existing ❑ Facility ❑ Operation
D. Application:
1. Permit Type: ❑ Animal ❑ SFR-Surface Irrigation❑ Reuse FJ H-R infiltration
❑ Recycle ❑ VE Lagoon ❑ GW Remediation (ND)
® U1C — Geothermal Heatinc-,/Cooling Water Return Well
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. Project Type: ❑ New ❑ Major Mod. ❑ Minor Mod. ® Renewal ❑ Renewal wl Mod.
E. Comments/Other Information:
NOTE: Please return a completed APSARR after completing the site inspection, and collecting water samples if
system operational. At a later date, after the laboratory results are received by your office, send us a copy of the
cover letter & laboratory analytical results, which you send to the Permittee. ALSO, please record all information on
the well tag, if present,. and.put_ on staffrel?oyt. Thanks-
® Return a completed APSARR after the site inspection. At a later date, after sampling & the lab
results are received, please send us a copy of the letter you send to the Permittee containing
laboratory analytical results.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request forth, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: Date -
FORM: APSARR 07106 Page t of t

AifflA
NCDEN R
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, P.E.
Governor Director
January 28, 2013
William B Ott — Owner
Virginia Ott
2701 Weaver Hill Dr.
Apex, NC 27502
Dear Mr. Ott:
John E. Skvarla, III
Secretary
Subject, Acknowledgement of
Application No. W10500033
William and Virginia Ott SFR
Injection Heating/Cooling
Water Return. Well System
Wake County
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on 0112412013. Your application package has been assigned the number listed
above, and the primary reviewer is Michael Rogers.
Central and Raleigh Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for. additional information. To ensure maximum
efficiency in processing permit applications, the Aquifer Protection Section requests your assistance in
providing a timely and complete response to any additional information requests.
Please note that processing standard review permit applications may take as tong as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Michael Rogers at [phone] or [e-mail].
Si erely,
Lo
far Debra J atts
Groundwater Protection Unit Supervisor
cc: Raleigh Regional Office, Aquifer Protection Section
Permit File WI0500033
AQUIFER PROTECTION SECTION
1636 Nkll Service Center, Raleigh, North Carolina 27699.1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604 One
Phone: 91M07-6464 l FAX: 9f M07-6496 'i C y�+.Qha
in}emet: www.ncrqpter��[fy.4� ��uL n��f
Arr Equal Qpporhrnity l AMrmadve Avion Employer i f Ly

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 .0200
OPEN -LOOP GEOTHERMAL INJECTION WELLS
These wells discharge groundwater directly into the subsurface as part of a geothermal beating and cooling system
(check one) New Application X Renewal * Modification
* For renewals complete Parts A-C and the signature page.
Print or 7 pe information and Mail to the Address on the Last Page Alegible Applications Will Be Returned As Incomplete
1
DATE: 1 { I I . 2013
PERMIT NO. t-'r 05 dpO 3 3 (leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Nan-Govemment: Individual Residence �-SusinesslOrganization
Government: State Municipal County
Federal
B. PERMIT APPLICANT -- For individual residences, list each owner on property deed For all others.
state name of entity and name of person delegated authority to sign on behalf of the
business or agency:
W I L. t. I1q, t% 6. D TT-
_ V1&(,1rfFY4, 0Tr
Mailing Address: ZL ] D 1- w ro.'« -CA 1414A- 7 )c
City: A f rL State: NC Zip Code: z 7 Sn 1—
County- W► V E
Day Tele No.: l ��� 0p 31 _ _Cell No.: l �+ `"
11-- 7S I �]
EMAIL Address: 'K; t Ly T T 0_ r 14-F v rrs , 04 6 Fax No.:
C. LOCATION OF WELL SITE - Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: d 7 111 0 3 Y z 4002'
County: `U A K f
(2) Physical Address (if different than mailing address):
City: State: NC Zip Code:
m�ry ppmm
►Gl�r�ENEWO
D. WELL DRILLER INFORMATION
I A N 2 4 2013
Well Drilling Contractor's Name:
NC Well Drilling Contractor Certification No.: _
! Ar prow a se to
Company Name:
Contact Person: EMAIL Address:
Address: "
City: Zip Code: _. State: County
Office Tele No.: Cell No.: Fax No.:
GPUIUIC 5A7 Perrnit Application (Revised 31tS1201 I)
Page t

I CERTMCATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .0211(b) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer,
2, for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner (which means all persons listed on the_property deed).
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"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 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"
f - CJ_V-0---
Signature of Property OwnerlApplicant
wlzI- A AV$- P. 0Tr
Print or Type Full Name
Signature of operty LfOwner/Applicant
Ur' Irtre' f(-
Print or Type Full Name
Signature of Authorirsd Agent, if any
Print or Type bill Name
Submit two copies of the completed application package to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone] RFCU M
NEWO
JANB42013
4 ►4gUWr Pru6M;60n Sty
GPUIUIC 5A7 Permit Application (Revised 3/18/201I) Peke 4

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATUS OF INJECTION WELL SYSTEM
Permit Number: w= 0 S 00 a 13
Pernuttee Name: W i"i ]tin.. R O T- 1/t n I-!vl A OTT`
Address: `1-7 U 1 (,V� Ail -en i4ii c.. P/L Rf ex Alt z 7 S o
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 islare used for water supply or other purposes.
3) ❑ Injection discontinued and: a) ❑ Well(s) temporarily abandoned
b) ❑ Well(s) permanently abandoned
c) ❑ Wel1(srn6t abandoned
4) ❑ Injection welI(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 ofhow the well
was sealed and the type of material used to fill the well if permanently abandoned):
Permit Rescission:
Ifyou 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:
"1 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 D to
RECBEDWOM
JAN 2 4 2013
Revised 5/05 GWIUIC-68 Aqu* PT wwn Sedw

U.S. Postal 5erviceTM
;CERTIFIED MAIU. RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
For delivery information visit our wehRlrP at awn.
-B
0.
r-7
r"i
Postage 3
4
Certlffed Fee
l7
Q
Return Recelpl Fee
(l ndorseman[ SM, Fed)
4
Restricted Defrvery Fee
p
(End —mom Requlrad)
II
M
Total PDSU
:CIAL- ulz:>i;
postmark
Here
,a sent Ta William and Virginia Ott
I3 2701 Weaver Hill Rd.
I3 9+:�+::�ai--1
r- aePOBoxA Apex, NC 27502
dC WW
■ Complete Items 1, 2, and 3. Also compiete
Item 4 If Reshicted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailplece,
or on the front if space permits.
1. Article Addressed to-,
William and Virginia Ott
2701 Weaver Hill Rd.
Apex, NC 27502
2. Article Number
(ltansfer from service label)
PS Farm 3811, February 2004
A. Signature
x t
� � � dresses
B. Recelved by (PHnted Name) C, pate 4f DelNery
ail- 6 o T i � lill3
D. Is delhrery address dliferent from Rem 17 0 1 W
If YES, enter delivery address below. 0 No
3. Service Type
❑ Certified Mail ❑ Express Mall
❑ Registered ❑ Return Receipt for Mer&ondlss
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (&trm Fee) ❑ Yes
7008 1300 0000 1106 6885
Domestic Return Receipt
1 D2595-02-M-154a

NCDENR
North Carolina Department of Environment and Natural Resource
Division of Water Quality
Pat McCrory Charles Wakild, P. E. John E. Skvarla,11)
Governor Director Secretary
January 16, 2013
CERTIFIED MAIL # 70081300 0000 1106 6885
RETURN RECEIPT REQUESTED
William and Virginia Ott
2701 Weaver Hill Road
Apex, NC 27502
Subject: Notice of Expiration (NOE)
5A7 Geothermal Injection Well
Permit No. WI0500033
Wake County
Dear Mr. & Mrs. Ott:
The Underground Injection Control (UiC) Program of the North Carolina Division of Water Quality
(DWQ) is entrusted to protect the groundwater quality and resources of the State of North Carolina,
and is responsible for the regulation of injection well construction and operation activities within the
state. Our records indicate that the above -referenced operating permit for the underground injection
well system located on your property at 2701 Weaver Hill Drive in Apex, NC, which was issued to
you on July 9, 2008, and expires on June 30, 2013, is soon due for renewal, If you wish to keep this
permit and operate the injection well system, the permit must be renewed and issued in your name.
If Your Injection Well is Currently Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C,
Section .02I 4. When each well is plugged and abandoned, the well abandonment record (Form GW-
30) must be submitted to our office to certify that the abandonment was properly conducted.
If there has been a change of ownership of the property, an Injection Well Permit Name/Ownership
Change Form must also be submitted. The GW-30 and Name/Ownership Change forms can be
found at http:llporW.nedenr.orpJweb/wglaps/&,wpro/reporting-forms.
If Your Injection Well is Currently Active:
If the in well system is still active and you wish to renew your permit, the renewal application
must be submitted within 120 calendar days of the expiration of your permit. According to our
--ecords, you must submit your permit renewal by March 2, 2013.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Camlina 27699-1636
Locabon, 512 N. Salisbury St., Raleigh, No,ih Carolina 27604 NorthCarolina
Phone: [phone] FAX: 91"07.6496 -�-}ry�������
Internet: www.ncn�atergualiJy,om ��1[i
An Equal 6pporlunity IAMrmalive Action Employer

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 enclosed
forms:
A. Application for Permit (Renewal) to Construct andlor Use a Wells) for Injection with
Geothermal Heat Pump System for Type 5A7 Well(s) if the injection well system on your
property is still active.
M
B. Status of Injection Well System if the injection well system is inactive or has been temporarily
or permanently abandoned.
Please submit the appropriate forms to:
Aquifer protection Section
Groundwater Protection Unit
U IC 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://12ortal.ticdenr.org/web/w /a s w orolperm it-apul i cations#Leothe nnA Ws.
Thank you in advance for your cooperation and timely response. If you have any questions, please
contact me by phone at [phone] or by email at eric.g.smithra-Inedenngov.
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: RtaTeig-hRegion—a] 0tfice - APS w/o enclosures
APS Central Files - Permit No. WI0500033 w/o enclosures
2

A
.� PA
MCDENR
North Carolina Department of Environment and Natura
Divislon of Water Quality
Pat McCrory Charles Wakild, P. E.
Governor Director
January 16, 2013
CERTIFIED MAIL # 7008 1300 00001106 6885
RETURN RECEIPT REQUESTED
William and Virginia Ott
2701 Weaver Hill Road
Apex, NC 27502
Subject: Notice of Expiration (NOE)
5A7 Geothermal Injection Well
Permit No. WI0500033
Wake County
Dear Mr_ & Mrs. Ott:
Resource
John f. Skvarla, IIl
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water Quality
(DWQ) is entrusted to protect the groundwater quality and resources of the State of North Carolina,
and is responsible for the regulation of injection well construction and operation activities within the
state. Our records indicate that the above -referenced operating permit for the underground injection
well system located on your property at 2701 Weaver Hill Drive in Apex, NC, which was issued to
you on July 9, 2008, and expires on June 30, 2013, is soon due for renewal. If you wish to keep this
permit and operate the injection well system, the permit must be renewed and issued in your name.
If Your Infection Well is Currently Inactive:
If the injection wet[ 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 there has been a change of ownership of the property, an Injection Well Permit Name/Ownership
Change Form must also be submitted. The GW-30 and Name/Ownership Change forms can be
found at http://portal.ncdenr.ora/web/wq/aps,/gwpro/re ortinL,-forms.
If) our_I 1ection Well is Currently Active:
If the injection well system is still active and you wish to renew your permit, the renewal application
must be submitted within 120 calendar days of the expiration of your permit. According to our
records, you must submit your permit renewal by March 2, 2013.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699.1636 One
Location: 512 N. Salisbury St, Raleigh, North Carolina 27504 NorthCarohna
Phone: 91M07-64641 FAX: 91"07-6496 � �}
Wemat mn.acwaterquality arg � a��
An Ejua3 Opporlunily 1 Affirmative Aclion Employer

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 enclosed
forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s) for Injection with
Geothermal Heat Pump System for Type 5A 7 Well(s) if the injection well system on your
property is still active.
;.QR-
B. Status of Injection Well System if the injection well system is inactive or has been temporarily
or permanently abandoned.
Please submit the appropriate forms to:
Aquifer Protection Section
Groundwater Protection Unit
UICProgram
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of 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
h ttp ://p ortal .ncdenr .org/web/wq/ap s/ gwp ro/permit-applications#geothermApps.
Thank you in advance for your cooperation and timely response. If you have any questions, please
contact me by phone at [phone] or by email at [e-mail].
Sincerely, /4jj~
Eric G. Smith, P.G.
Hydro geologist
Enclosures
cc: R a leigh Reg10nal Office -APS wlo enclosures · · ·· · ·
APS Central Files -Permit No. WI0500033 w/o enclosures
2
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, P. E. John E. 5kvarla, III
Governor Director Secretary
January 16, 2013
CERTIFIED MAIL # 70081300 0000 1106 6892
RETURN RECEIPT REQUESTED
Jeffrey Gray or Diana McElroy
1111 Monterey Valley Drive
Chapel Hill, NC 27516
Subject: Notice of Expiration (NOE)
5A7 Geothermal Injection Well
Permit No. W10500013
Orange County
Dear Mr. Gray or Ms. McElroy:
The Underground Injection Control (MC) 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 permit was issued to
Jeffrey and Joy Frelinger on May 23, 2008, and expires on April 30, 2013.
This permit was issued for the operation of a 5A7 (Heating/Cooling Water Return) Geothermal
Injection Well on your property located at I111 Monterey Valley Drive in Chapel Hill, North
Carolina. As the new property owners, you are responsible for maintaining this permit.
Therefore, it is important that you submit a Change of ownership form within thirty (30) days
of receipt of this letter.
Since the pemYit is set to expire shortly and in order to comply with the regulatory requirements
listed under North Carolina Administrative Code (NCAC) Title 15A, Subchapter 2C, Section
.0211, you must also 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 5A7Well(s) if the injection well
system on your property is still active.
-OR-
S. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned -
AQUIFER PROTECTION SECTION
1636 MaiI 5ervlce Center, Ralegh, North Carolina 27699.1636 Ae
Locatlon7 512 N. Salisbury St., Raleigh, North Carolina 27604 IVocorthGarolina
Phase: 91M47-64641 FAX; 919a7-6496 ����r���l�
lntemer www,nmaLerguali .om
An Equal 4pporiunity 1 Afirmalive Aal%i Ernployar

Please submit the forms 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 Change of
Ownership form, 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 h!tp:llportal.nedenr.orglweb/wg/apslgwpro/permit-applicati-ons#geothentiApps.
Thank you in advance for your cooperation and timely response. If you have any questions,
please contact me by phone at [phone] or by email at eric.g.smith&cdenr.gov_
Sincerely,
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Raleigh Regional Office - APS w/o enclosures
APS Central Files - Permit No. W10500013 w/o enclosures
2

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and NaIuraI Resources
Coleen H. Sullins, Director
Di Asian of Water Quality
May 4, 2008
William and Virginia Ott
2701 Weaver Hill Drive
Apex, NC 27502
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
7006 2150 0003 5466 6205
Subject: Notice of Expiration (NOE)
SA7 Geothermal Injection Well
Permit No. W10500033
Ott SFR
2701 Weaver Hill Drive, Apex, NC
Wake County
Dear Mr. and Mrs. Ott:
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 on September 5, 2003, and expires on
August 31, 2008, has not been renewed. In addition, 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.
W
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Aquifer Protecrion Section 1636 Mail service Center
Internet: www.n_cwaterquali?y.ore Location: 2728 Capital Boulevard
An Equal 4pportunitylAffirmative Action Employer- 50% Recycledl 10% post Consumer Paper
N 'W CaroIina
Naturally
Raleigh, NC 27 69 9- 1636 Tclephone: (919} 733-3221
Raleigh, NC 27604 Fax 1: [phone]
Fax Z: [phone]
Customer Service: [phone]

If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted.
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 abandonmentwas 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/ap s/gp u/forms.htm.
Thank you in advance for your cooperation and timely response. If you have any questions,
please call me at [phone]
Sincerely,
/~~
Michael Rogers
Environmental Specialist
Attachments
cc: Raleigh Regional Office -APS w/o enclosures
APS Central Files -Permit No. WI0500033 w/o enclosures
Page 2
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUeT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE S-A 7 WELL {S}
____ New Permit Application OR ____ Renewal (check one)
DATE: _______ _, 20_
PERMIT NO. ________ (leave blank if NEW permit application) ..
A. PROPERTY OWNER(S)/APPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative w/authority for'signature): _________________ _
(1) Mailing Address: _________________________ _
City: _________ State:_·_ Zip Code: ______ County: ____ _
Home/Office Tele No .: ------------=Ca..::;e=ll-=-N=.o=.: __________ _
EMAIL Address: _______________ _
(2) Physical Address of Site (if different than above): _______________ _
City: _________ State: __ · Zip Code: ______ County: ____ _
Home/Office Tele No.: ____________ C=e=ll=--=N:..:..o=."-: _________ _
EMAIL Address: _______________ _
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Co~panyName: ____________________________ _
Contact Person . .:...: ---------------=E=M=A-=IL=·--=-A=d=d=re=s=s: __________ _
Address: _______________________________ _
City: _________ State:_._ Zip Code: ______ County: _______ _
Office Tele No.: Cell No.:
Website Address of Company, if any: ______________ _
GPU/UIC 5A7 Well Permit Application (Revised 9/2007) Page 1
C. WELL DRILLER INFORMATION
Company Name: ________ ---.---_____________________ _
Well Drilling Contractor's Name: _________________________ _
NC Contractor Certification No.: _________________________ _
Contact Person~: _______________ E=M=A __ I __ L ___ A ___ d ___ d __ r=es __ s __ : __________ _
Address:----------------------------------
City: _________ Zip Code: _____ County: _____________ _
Office Tele No.: Cell No.: ----------
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: ______________________________ _
Contact Person.:...: ----------------'E=M=A=I=L...:.A=d=d=re=s=s-=--: __________ _
Address:----------------------------------
City: _________ Zip Code: _____ County: _____________ _
Office Tele No.: Cell No.: ----------
E. STATUS OF APPLICANT
Private: Federal: Commercial:
State: Municipal: __ Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
G. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES ___ _
YES __ _
NO __ _
NO __ _
H. WELL CONSTRUCTION DATA (Skip to Section I if this is a Permit RENEW AL)
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 ofyour knowledge. Attach a copy of Form GW-1 (Well Construction
Record) if available. ·
(I) Date to be constructed: _______ Number of borings: ___ _
Approximate depth of each boring (feet): _______ _
(2) Well casing. Is the well(s) cased? (check either (a.) YES Q!. (b.) NO below)
(a) YES ___ If yes, then provide the casing information below.
Type: Galvanized steel __ Black steel __ Plastic __ Other (specify) ______ _
Casing thickness: __ diameter (inches): ___ depth: from ___ to ___ ft. (reference to land surface)
Casing extends above ground ____ inches
GPU/UIC SA 7 Well Permit Application (Revised 9/2007) Page 2
I..
(b) NO
(3) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement__ Bentonite Other (specify) ______ _
(b) Grouted surface and grout depth (reference to land surface):
__ Around closed-loop piping; from ___ to ___ · (feet).
___ Around well casing; from ___ to ___ (feet) ..
(4) Well(s) Screen Information
Depth of Screen: From ____ to ___ feet below land surface
(S) N.C. State Regulations (Title lSA NCAC 2C .0200) require the Permittee to make provisions for
monitoring wellhead water quality and processes. A faucet on both Influent (groundwater entering heat
pump) and Effluent (water being injected back into the well) lines is required .. Will there be a faucet on:
(a) Influent line? Yes __ No__ (b) Effluent line? Yes __ No __
(6) Source Well Construction Information (if the water source well is a different well than the injection well)
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-1 is not available, provide the
following data: ·
Groundwater Source. From what depth, formation, and type of rock/sediment units will the groundwater
be withdrawn? (e.g. granite, limestone, sand, etc.)
Depth: · Formation: ______ Rock/sediment unit: ______ _
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR PROPOSED WELLS IF
THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
OPERATING DATA
(1) Injection rate:
(2) Injection Volume:
(3)
(4)
Injection Pressure:
Injection Temperature:
Average (daily) gallons per minute (gpm).
Average (daily) __ gallons per day (gpd).
Average ( daily) __ pounds/square inch (psi).
Average (January)_._._° F, Average (July)_·_° F.
J. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the· engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
K. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(l)
(2)
Include a site map ( can be drawn) showing: buildings, property lines, surface water bodies, potential sources
of groundwater contamination and the orientation of and distances between the proposed well(s) and any
existing well(s) or waste disposal facilities such as septic tanks or drain fields located with.in 1000 feet of the
geothermal heat pump well system. Label all features clearly and include a north arrow.
Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
GPU/UIC 5A7 Well Pennit Application (Revised 9/2007) Page 3
L. CERTIFICATION
Note: This Permit Application must be· signed by each person appearing on the
recorded legal property deed.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and complete.
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
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/UIC 5A7 Well Permit Application (Revised 9/2007) Page4
Permit Number WI0500033
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael. rogers
Permitted Flow
Facilit
Facility Name
William and Virginia Ott SFR
Location Address
2701 Weaver Hill Dr
Apex
Owner
Owner Name
William
Dates/Events
NC
B
27502
Ott
Orig Issue
12/08/99
App Received Draft Initiated
04/11/08
Scheduled
Issuance
Central Files: APS_ SWP_
07/28/08
Permit Tracking Slip
Status
Active
Project Type
Renewal
Version
2.00
Permit Classification
Individual
Permit Contact Affiliation
MaJor/Minor
Minor
Region
Raleigh
County
Wake
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
William Ott
2701 Weaver Hill Dr
Apex NC
Public Notice Issue
07/09./08
Effective
07/09/08
27502
Expiration
06/30/13
_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=--=Ec.:...ve=n=--=-t=s;..__ _________ _
Heat Pump Injection RO staff report requested
Outfall NULL
Waterbody Name
Additional information requested
RO staff report received
Additional information received
Stream Index Number Current Class
04/15/08
04/15/08
07/08/08
07/08/08
Subbasin
Central Files. APS SWP
❑71091i18
Perinit Number W10500033 Permit Tracking Slip
Program Category Status Project Type
Ground Water in review Renewal
Permit Type Version Permit Classification
Injection Heating/Cooling Water Return Well (5A7) Individual
Primary Reviewer Permit Contact AMIiation
michael.rogers
Permitted Flow
I-7, 11ty
Facility Name MajorlMinor Region
William and Virginia Ott SFR Minor Raleigh
Location Address County
2701 Weaver Hill Dr Wake
Apex NC 27502 Facility Contact Affiliation
owi ler
Owner Name Owner Type
Individual
William B Ott Owner Affiliation
William Ott
2701 Weaver Hill Dr
Apex NC 27502
Dates lEvents
Scheduled
orig Issue App Received Oran Initiated Issuance
Public Notice Issue Effective
Expiration
12/08/99 04/11/08
—I i cl �-U-g
U I 3L)
J
Keguiated Activities
Rf?oki(-FtP_i iRo6upeyt-d LVpntS
Heat Pump Injectlon
RO staff report requested
04/15/08
Additional information requested
04130108
Additional information received
07/08/08
RO staff report received
07/08/08
Outfall NULL
Waterbody Name Stream Index Number Current C[as s Subbasin

MichacI F. Easley, Governor
William G. Ross Jr- Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
July 9, 2008
William and Virginia Ott
2.701 Weaver Hill Drive
Apex, NC 27502
Re: Issuance of Injection Well Permit
Permit No. W10500033
Issued to William and Virginia Ott
Dear Mr. and Mrs. Ott:
In accordance with your signed and completed application received April 11, 2008, I am
forwarding Permit No, WI0500033 for the operation of a 5A7 geothermal underground injection
well (UIC) heat pump system located at 2701 Weaver Hill Drive, Apex, Wake County, North
Carolina 27502. This permit shall he effective from the date of issuance until June 30.2013, and
shall be subject to the conditions and limitations stated therein.
Please pay special attention to the bolded language in the permit. In order to continue
uninterrupted legal use of this well for the stated purpose, you should submit an application to
renew the permit four (4) months prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of
the Division of Water Quality,
The water samples collected from your UIC well on May 21, 2008, had exceedances in the
maximum contamination level (MCL) for the following parameters: total coliform, iron, and
manganese (copy attached). Accordingly, the Raleigh Regional Office recommends you
chlorinate your UIC well with the effluent discharged to the woods.
If you have any questions regarding your permit or the Underground injection Control (UIC)
Program please call Mr. Qu Qi at [phone] or me at [phone].
Best Regards,
. � J
Michael Rogers \
Environmental Specialist
OPU — UIC Control Program
CC" Jay Zimmerman -- Raleigh Regional Office,
Central Office File — W10500033
Wake County Health Department
Attachment(s) Noo�t
Carofina
;Naturally,
Aquifer Protectirm Section 1636 Mail Service Center Raleigh, NC 27699-1636 Telephone: [phone]
Internet: h{iP:llwww.ncwateraualit+•.orL 2728 Capital Boulevard Raleigh, NC 27644 Fax 1: (919)715-05$8
Fax 2: (9I9) 715-600
An Equal opportunitylAffrmaiive Action Employer— 50% Recyaled1l0% Post Con surner Pa per Customer Servicc: [phone]

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
l�al,����i�lii:i�rlr��likRilr� r�l Tr7i�1'7:�i�r7%�rT�T:�►► r : 1� ► ,
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
WILLIAM AND VIRGINIA OTT
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL, defined in Title 15A North
Carolina Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat
pump effluent. This injection well is located at 2701 Weaver Hill Drive, Apex; Wake County,
North Carolina, and will be operated in accordance with the application received April 11, 21008.
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, 2013,
and shall be subject to the specified conditions and limitations set forth in Parts I through VIII
hereof.
r�
Permit issued this the day of
lk�Iv �. ��
-1c Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
WI0500033 Page 2

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 Injectiqn 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
forin N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in.accordance with the
conditions of this perm.it, 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-r.easonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded-reasonable protection against damage during
construction and use.
7. Each geothermal well injection system shall have permanently affixed an
identification plate according to 2C .0213(g).
PART II -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and 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 Pemiittee, 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 Pennfttee·ofthe 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.
WI0500033 Page 3
PART III -PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater, which will render it unsatisfactory for normal use. In
the event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility. •
2. The Permittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART IV -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for
injection, the Permittee must notify by telephone the Aquifer Protection Section-
Underground Injection Control (UIC), Central Office staff, telephone number (919) 715-
6166. Notification is required so that Division staff can inspect or otherwise review the
injection facility and determine if it is in compliance with permit conditions.
PART V -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place
on or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
WI0500033 Page4
PART VI -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed
necessary by the Division of Water Quality to insure surface and ground water protection,
will be established and an acceptable sampling reporting schedul~ shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence-or first
knowledge of the occutrence, to the Raleigh Regional Office, telephone nuinber (919) 791-
4200, any of the following: ·
(A) Any occurrence at the injectfon 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 su}?mitted in said.application or in any report to
the Director, the relevant and correct facts or information shall be promptly submitted to
the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily~ the Pennittee shall
take such immediate action as may be required by the Director.
PART Vil-PERMIT RENEW AL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an
extension.
PART VITI -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 discontinuation of 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:
(A) All casing and materials may be removed prior to initiation of
abandonment procedures if the Director finds such removal wi~l not be
WI0500033 Page 5
responsible for, or contribute to, the contamination of an underground
source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could lead to the contamination of an
underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be
introduced into the well through a pipe, which extends to the bottom of the
well and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and screens have
not been removed, the casing shall be perforated opposite the gravel pack,
at intervals not exceeding 10 feet, and grout injected through the
perforations.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner
that will prevent the movement of fluids into or between underground
sources of drinking water and in accordance with the terms and conditions
of the permit.
(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:
Aquifer Protection Section-VIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART IX -OPERATION AND USE SPECIAL CONDITIONS
None.
WI0500033 Page 6
LABORATORY ANALYTICAL RESULTS
5A7 GEOTHERMAL UNDERGROUND INJECTION CONTROL (UIC) WELL
PERMIT NO.: WI 0500033
PERMITTEE: William and Virginia Ott
SAMPLE COLLECTED DATE: 5/21/2008
Coliform, total Coliform, fecal pH
1 CFU/100ml 1 CFU/100ml units
MCL=1 MCL.= 1 MCL = 6.5-8.5
Influent _: ... :.::-/ • :.23/· ·,·::_. .· 1 7.49
Effluent ,,:· :-,:<-:;_1_5::: :., ... 1 7.46
NO2-+ NO3-as N Phosphorus Nitrate
mg/L · mg/L mg/L
MCL= 10 lillCL= nss MCL=10
Influent <.02 <.02 <.02
Effluent <.02 <.02 <.02
Calcium.Ca Cadmium.Cd Chromium, Cr
mg/L . µg/L µg/L
MCL=nss MCL= 1.75 MCL=50
Influent 17 <1 <10
Effluent 16 <1 <10
Manganese, Mn Sodium, Na Nickel, Ni
ua/L mg/L µg/L
MCL=S0 MCL=nss MCL= 100
Influent -· .. ·:84 :· 74 <10
Effluent ; Bt. 72 <10
MCL = Maximum Contamination Level per NCAC 2L .0200 (GA Standards)
nss = no state standard
na = not analyzed
Total Dissolved Solids
mg/L
MCL=500
216
230
Nitrite
mg/L
MCL=1
<.01
<.01
Copper, Cu
µg/L
MCL= 1000
22
14
Lead,Pb
1.1a/L
MCL= 15
<10
<10
"The laboratory sample matrix interfered with the ability to to make any accurate determination; Estimated
Chloride, Cl
mg/L
MCL=250
99
93
Sllver,Ag
ua/L
MCL= 17.5
na
na
Iron, Fe
µg/L
MCL=300
.. :::.7.W_.·::-'··
::•: .. :;.:·590_ ,· ... ... ,·.
Selenium, Se
µg/L
MCL=S0
na
na
Flouride
mg/L
MCL=2
1
0.9
Aluminum; Al
µg/L
MCL= nss
<50
<50
Mercury, Hg
µg/L
MCL= 1.05
na
na
Zinc,Zn
µg/L
MCL =1050
160
130
Sulfate Ammonia, NH3 TKN*
mg/L mg/L mg/L
MCL=250 MCL=nss MCL=nss
4.1 <.02 <.2
3.9 <.02 <.2
Arsenic,As Barium, Ba
µg/L µg/L
MCL=50 MCL=2000
na na
na na
Potassium, K Magnesium, Mg
..
mg/L • mg/L
MCL= nss MCL=nss
na 1.5
na 1.5
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 05/21/2008
To: Aquifer Protection Section Central Office
Central Office Reviewer: Micheal Rogers
Regional Login No: 05
L GENERAL INFORMATION
County: Wake
Permittee: Mr. William Ott
Project Name: 5-A 7 UIC-Open Loop Well_
Application No.: WI0500033
1. This application is (check all that apply): D New ~ Renewal
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Recycle D High Rate Infiltration D Evaporation/Infiltration Lagoon
D Land Application of Residuals D Attachment B included D 503 regulated D ·503 exempt
D Distribution of Residuals O Surface Disposal
D Closed-loop Groundwater Remediation [gl Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? IZ! Yes or O No.
a. Date of site visit: 05/21/2008
b. Person contacted and contact information: Mr. William Ott Ph.# 919363-0031
c. Site visit conducted by: JGreer, RRO-APS
d. Inspection Report Attached: ~ Yes or O No.
2. Is the following information entered into the BIMS record for this application correct?
~ Yes or D No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions: __
c. USGS ,QQadrangle Map name and number: __
d. Latitu4e: Longitude: __
e. Regulated Activities/ Type of Wastes (e.g., subdivision, food processing, municipal wastewater): NIA
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): 2701 Weaver Hill Drive, Apex NC 27502
b. Driving Directions: See Map Quest:
c. USGS Quadrangle Map name and number: D24SW Raleigh
d. Latitude: 35.42.20 Longitude: 78.57.06
IL NEW AND MAJOR MODIFICATION APPUCATIONS fthis section not needed for renewals or minor
modifications, skip to next section)
Description OfWastelS} And Facilities
1. Please attach completed rating sheet. Facility Classification: _
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
2. Are the new treatment facilities adequate for the type of waste and disposal system?
D Yes D No D NIA. Ifno, please explain: _-_
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? D Yes D No D NIA. Ifno, please explain: __
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? D
Yes D No D NIA. Ifno, please explain: __
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. 0Yes0No0
NI A. If no, please explain: __
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
D Yes D No D NIA. Ifno, please explain: __
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
D Yes D No D NIA. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV: __
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? D Yes or D No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit: __
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No D NIA. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program: __
10. For residuals, will seasonal or other restrictions be required? D Yes D No D NIA If yes, attach list of sites
with restrictions (Certification B?)
/IL RENEWAL AND MODIFICATION APPLICATIONS fuse previous section for new or maior modification
svstemsJ
Description OfWaste(S) And Facilities
1. Are there appropriately certified ORCs for the facilities? D Yes or O No.
Operator in Charge: __ Certificate#: __
Backup-Operator in Charge: __ Certificate #: __
2. Is the design, maintenance and operation ( e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage, etc) of the treatment facilities adequate for the type of waste and disposal system? 0 Yes or D No.
If no, please explain: __
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? D Yes or D No. lfno, please explain: __ . _
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
4. Has the site changed in any way that may affect permit ( drainage added, new· wells inside the compliance
I •
boundary, new development, etc.)? If yes, please explain: __
5. Is the residuals management.plan for the facility adequate and/or acceptable to the Division?
D Yes or D No. If no, please explain: __
6. Are the ·existing application rates· (hydraulic or nutrient) still acceptable? D Yes or D No. If no, please
explain: __
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? D Yes D No, D N/A. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Will seasonal or other restrictions be required for added sites? D Yes D No D N/A If yes, attach list of sites
with restrictions (Certification B?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? D Yes or D No. If yes, please attach a
map showing conflict areas or attach any new maps you have received from the applicant to be incorporated
into the permit: __
10. Is the description of the facilities, type and/or volume ·ofwaste(s) as written in the existing permit correct? D
Yes or D No. Ifno, please explain: ___ _
11. Were monitoring wells properly constructed and located? D Yes or D No D N/A. If no, please explain:
12. Has a review of all self-monitoring data been conducted (GW, NDMR, and NDAR as applicable)? D Yes or
0 No D N/A. Please swnmarize any findings resulting from this review: __ _
13. Check all that apply: D No compliance issues; D Notice(s) of violation within the last permit cycle; D
Current enforcement action(s) D Currently under SOC; D Currently under JOC; D Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments (such as NOV, NOD etc): ___ _
14. Have all compliance dates/conditions in the existing permit, (SOC, J0C,. etc.) been complied with? D Yes
0 No O Not Determined ON/A .. Ifno~ please·explain: __
15. Are there any issues related to CQmpliance/enforcement that should be resolved before issuing this permit? D
Yes or D No D N/ A. If yes, please explain: __
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description Of Well(S) And Facilities -New, Renewal, And Modification
1. Type of injection system:
cg] Heating/cooling water return flow (5A 7)
D Closed-loop heat pwnp system (5QM/5QW)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (51/'Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? IZI Yes D No
3. Are there any potential pollution sources that may affect injection? D Yes IZI No
What is/are the pollution source(s )? __ _,_. ~Wh:..:..::=a=t:..::.i=-s -=th=e....;:di=· s=tan=c;.=.e....;:o __ f..::;:th=e;...;:in~ie __ cti. ___ · o=n;;:...w.:..:...;::;.;el=l(.._s)~fr~om:;;:;_,,,;:th=e;::;...,a:;.po=l=.::lu=ti.=· o=n
source(s)? ft.
4. What is the minimwn distance of proposed injection wells from the property boundmy? 50 ft.
5. Quality of drainage at site: IZI Good D Adequate D Poor
6. Flooding potential of site: f2J Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(nwnber 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: N/ A
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? cg] Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
Iniection Well Permit Renewal And Modification Only:
1. For heat pwnp 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 cg] 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: NIA
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 ~ No. Ifyes, explain:
4. Drilling contractor: Name: CW Bing Well Drilling
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address: 620 hidustry Dr . .
Henderson, NC 27536
Certification number: 1544
5. Complete and attach Well Construction Data Sheet.
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V EVALUATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet - if needed information is available
3_ Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yes, please explain
briefly.
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
S. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
7. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information;
Issue; ❑ Deny. If deny, please state reasons:
8. Signature of report prepa��s).
Signature of APS regi al s r:
Date: L7
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
CW Bing is out of the Business.

County:
Sample ID:
VIArF9Q
River Basin
�QF
PO Number !1
Report To RROAP
Date Received
1�
�-
Time Received.
Collector. J GREER
—1
Region s
Labworks LoginlO
Sample Matrix: GROUNDWATER
U
Date Reported
Loc. Type: WATER SUPPLY+i•
Report Generated'
Emergency YerfNo
Ysit10 {
COC Yes1NoU3
- - Loc. Deecr.: Y41WAiA S OTT
Locatiorr IM RROAPNLC Collect Date: 05121/2008 Collect Time:: 13:30 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwglab.org Lander Staff Access
A -Value reported is the average of two or more determinations
81-Countable membranes with e20 colonies; Estimated
B2- Counts from all fikers were zero.
$3- Countabte membranes with more than 50 or 80 colonies; Estimated
B4-1711ters have counts of both DSO or 80 and a 20, Estimated
135-Too many colonies were present; too numerous to count (TNTC)
J2- Reported value failed to meet OC criteria for either precision or accuracy; Estimated
J3-The sample matrrx interfered with the ability to make any accurate determination; Estimated
J6•The lab analysis was from an unpresenred or improperly chemically preserved sample; Estimated
N1-The component has been tentatively identified based on mass spectral library search and has an estimated value
tA1
AB30W
8GO522
051211200a
14:30
MMATHIS
614f08
0610412008
N3-Estimated concentration is c PQL and �-,MDL
NE -No established POL
P-Elevated POL due to mabix interference arWor sample dilution
Q1-Hold ing time exceeded prior to receipt at lab.
02- Ho6ding time exceeded following receipt by lab
PQL- Practical Quantitation Limit -subject to change due to instrument sensitivity
U- Samples analyzed for this [compound but not detected
X 1 - Sample not analyzed for this compound
7o4A/ d A7 4'/ rn _7L4-- A
Laboratory SecUona­ 1623 Mail Service Center, Raleigh, NC 77699-1023 [phone]
�w�ut•L 5 .
Page t of 3
to'p'q

:JvC (J)WQ £a6oratory Section <R§su{ts Sample ID AB30343 ..
.. ocation ID: RROAPNLC Collect Date: 05/21/2008
l Loe. Descr.: WILLIAM BOTT Collect Time:: 13:30
Visit ID
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
sample temperature at receipt by lab 8.7 ·c HPARKER MMATHIS
Method Reference 5/21/08 5/22/08
MIC
Collfonn, MF Fecal In Rquld 1 82 CFU/100ml PCOTTEN CGREEN
Method Reference APHA9222D-20th 5/21/08 5/23/08
Coliform, MF Total In llquld 23 CFU/100ml PCOTTEN CGREEN
Method Reference APHA9222B-20th 5/21/08 5/23/08
Alkalinity to pH 4.5 of liquid _TITLE_ mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 5/27/08 6/4/08
Alkallnlty4.5 110 mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 5127/08 6/4/08
Alkallnlty8.3 u mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 5/27/08 6/4/08
Bicarbonate 110 mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 5/27/08 6/4/08
Cart>onate 1 u mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 5/27/08 6/4/08
pH..,Alkallnlty 7.49 mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 5/27/08 6/4/08
WET
Ion Chromatography _TITLE_ mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 5/21/08 6/2108
Total Dissolved Sollds In Uquld 12 216 mg/L AWILLIAMS MOVERMAN
Method Reference APHA2540C-18TH 5/22/08 5/30/08
Chlortde 1.0 99 mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 5/21/08 6/2/08
Fluorlde 0.4 1.0 mgll MIBRAHIM MOVERMAN
Method Reference EPA300.0 5/21/08 6/2108
Sutfate 2.0 4.1 mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 5/21/08 6/2108
NUT
NH3 as N In liquid 0.02 0.02 u mg/LasN MOVERMAN CGREEN
Method Reference Lac10-107-06-1-J 5/28/08 6/4/08
Total Kjeldahl N as N In liquid 0.2 0.2 u mg/LasN GBELK CGREEN
Method Reference Lachat107-06-2-H 5/28/08 6/4/08
N02+NO3 as N In liquid 0.02 0.02 u mg/LasN MOVERMAN CGREEN
Method Reference Lac10-107-04-1-c 5/28/08 6/4/08
Laboratory Section» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of3
WC ©'WQ, La6oratory Section <R§sults Sample ID AB30343
~Locatfon ID: RROAPNLC Collect Date: 05/21/2008
Loc.Descr.: WILLIAM B OTT Collect Time:: 13:30
Visit ID
CAS# Analyte Name PQL Result Quallfler Units Analyst/Date Approved By /Date
Phosphorus_total as In llquld 0.02 0.02 u mg/1..asP MA.JAY! CGREEN
Method Reference Lac10-115-01-1EF 5/23/08 5128/08
Nitrate as N In llquld 0.02 0.02 u mg/LasN MOVERMAN CGREEN
Method Reference Lachat107-04-1-c 6/3/08 614/08
Nltrfle as N In llquld 0.01 0.01 u mg/LasN MAJAYI CGREEN
Method Reference Lachat107-04-1-c 5122/08 5128/08
MET
7429-90-5 AJ.bylCP 50 50 u uglL DSTANLEY EST AFFORD
Method Reference EPA200.7 5/23'08 5/28/08
7440-70-2 CabylCP 0.10 17 mglL DSTANLEY EST AFFORD
Method Reference EPA200.7 5/23/08 5128/08
7440-43-9 QibylCPMS 1.0 1.0 u uglL SGOSS EST AFFORD
Method Reference EPA200.8 5123'08 5/28/08
7440-47-3 CrbylCPMS 10 10 u uglL SGOSS EST AFFORD
Method Reference EPA200.8 5/23'08 5/28/08
7440-50-8 CubylCPMS 2.0 22 uglL $GOSS EST AFFORD
Method Reference EPA200.8 5/23/08 5/28/08
7440-48-4 FebylCP 50 770 uglL DSTANLEY EST AFFORD
Method Reference EPA200.7 5123/08 5/28/08
7439-95-4 MgbylCP 0.10 1.5 mglL DSTANLEY EST AFFORD
Method Reference EPA200.7 5/23/08 5/28/08
7439-96-5 MnbylCPMS 10 84 uglL DSTANLEY EST AFFORD
Method Reference EPA200.8 5123/08 5/28/08
7440-23-4 NabylCP 0.10 74. rng/L DSTANLEY EST AFFORD
Method Reference EPA200.7 5123/08 5/28/08
7440-02-0 NlbylCPMS 10 10 u uglL SGOSS EST AFFORD
Method Reference EPA200.8 5123/08 5/28/08
7439-92-1 PbbylCPMS 10 10 u uglL $GOSS EST AFFORD
Method Reference EPA200.8 5/23/08 5/28/08
7440-66-6 ZnbylCPMS 10 160 uglL SGOSS EST AFFORD
Method Reference EPA200.8 5/23/08 5/28/08
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 (919} 733-3908 Page 3 of3
North Carolina
GROUNDWATER FIELDILAB FORM department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
County
Quad No Serial No.
Lat.35 lam- Long. 7,5 0 ,�—
Report To: ARO, FRO, MR�.WaRO, WIRO,
SAMPLE TYPE
® Water
❑ Soli
❑ Other
Routine
■Emergency
111 ❑ Chain of Custody III
WSRO, Kinston FO, Fed. Tr tral Off., Other:
Shipped by: Bus, Courier, ther-
Coilector(s) : Date Time i' L)
FIELD ANALY LES Owner �,C:
pH4W6 Spec. Cond.94 �S at 250 C Location or site d
O
Purpose:
Baseline, Complaint,
Lab Number
Date Received _ `i - �1- � k r Time ! q D
Reed by:-4— From: Bus, Courier and el.,
Other:
Data Entry By: -
Date Reported:
190
Pesticide Study, Federal Trus he :M F�-4
-- Z�s-yC�'
Temp-10 V' \ .oC Odor =-t!� e. _ Description of sampling point We_11 �e.��' ---
Appearance . Sampling Method � Sample Interval P�
Field Analysis By: _ Remarks _ _ u ff' ate.)1 fir,
r� .,,,1„r, �k— Ao- 1— y, t
B RAT Y NALY5
SOD 310 m A
Di . 5 lid 7 MQ11
A - Silver 46566 u A
Or anochlarine Pesticides
COD High 34o mgA
Fleuride 951 M-qA
Al - Aluminum 46557 um
Organophosphorus Pesticides
COI] Low 335 m-Hardness:
Total 900 mg1l
As - Arsenic 46551 u
Nitrogen Pesticides
oliform: MF Fecal 31616 1100ml
Hardness non�arb 902 A
Ba - Barium 46558 u A
Acid Herbicides
Coliform: MF Total 31504 1100m1
Phenols 32730Ca
- Calcium 46552 m
PCB's
TOC 680 mg
Saocificn
Cd - Cadmium 46559 uqA
Turbidity 76 NTU
Sulfate 945 mco
Cr - Chromium 46560 UqA
Residue., Suspended 530 mgA
Sulfide 745 mqA
Cu - Copper 46562 u 11
L-rFe
- Iron 46563 ug1l
Sernivolatile Organics
Oil and Grease m 11
H - Mercury 7196p ugll
TRH -Diesel Mange
pH 403 unit,
K - Potassium 46555 m A
Alkalinityto pH 4.5 410
M - Magnesium 46654 m 11
Alkalinity to pH 8.3 415
K4n - Man anese 46565 ugA
Carbonate 446 mgA
NH as N 610 mcul
Na - Sodium 46556 m i
Volatile Organics (VOA bottle)
Bicarbonate 440 m I
TPH - Gasoline Range
Carbon dioxide 405 mgll
NO + NO as N 630 II
Pb - Lead 46564 u /I
TPH - BTEX Gasollre Range
Chloride W mgA
P: Total as P 665 m A
e - Selenium ugA
Chromium: Hex 1032 UgA
Zn - Zinc 46567 uqA
Color: True so Cu
, Lj
Cyanide 720 mgA
Lab Comments: L-7 L) 't'`Vr-M i e-""i" "$
,4o,
RI. j2M For Dissolved Analysis - submit filtered
and write "DIS" in blF I ,� 0, { z , [J

QB Laborato ection esu[ts
`
County:
WAKE
Sample IC:
A8301114
River Basin
RROAP
OF W A r \ Q
PO Number #
8GO523
Report To
*
Date Received:
0512112p08
Collector.
J GREER
;
1 _ 1
Time Reaaived:
1a:]0
1 Q
Labworks Logintp
MMATHIS
Region:
BQ
ffl.
Sample Matrix:
GROUNDWATER
Date Reported:
tiI4108
Loc- Type:
WATER SUPPLY
��
Report Generated:
06/04/2008
Emergency Yes1Na
CDC Yes/No
i Descr.: MLL18M t3 � JC �
�
%,.., p�j
&Y 42
oc. [,� .
U
Location ID:
RROAPNLC
Collect Date: 051211200E Called Time:: 13:45
Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwqlab.org under Staff Access
A -Value reported is the average of two or more determinations
N3-Estimated concentration is < PQL and >NtDL
Bi-Covntable membranes with <21) colonies; Estimated
NE -No established PQL
B2- Counts from all filters were --ero.
P-Elevated PqL due to matrix interference endlcr Semple dilution
83- Countabie membranes with more than 60 or 80 colonies; Estimated
❑#-Holding time exceeded prior to receipt at lab.
84-Filters have counts of both >60 or 80 and c 20: Estimated
02- Holding time exceeded following receipt by lab
05-Too many colonies were present; too numerous to count (MTC)
POL- Practical Ouantitation Limit -subject to change due to Instrument sensitivity
J2- Reporled value failed to meet OC criteria for either precision or accuracy; Estimated
U-Samples analyzed for this compound but not detected
J3-The sample matrix interfered with the abitity to make arty aocvrate determination; Estimated
Xi- Sample not analyzed for this compound
A -The lab analysis was from an unpreserved or improperly Chemically preserved sample: Estimated
N 1-The coamponent has been tentatively identified based on mass spectra$ library search and has an estimated value
LA13
laboratory S000n— 1623 Malt Se"Ice Cprrtar, RaWgh, NC M699-1623 (919) TE3-3900 Page 1 M 3

l.ocatLon 10:
"Loe. Descr.:
Visit ID
MIC
WET
NUT
RROAPNLC
WILLIAM B OTT
1vC cV'WQ £a6oratory Section <J?ssu[ts
CAS# Analyte Name
Sample temperature at receipt by lab
Method Reference
Coliform, MF Fecal In llquld
Method Reference APHA9222D-20th
Collform, MF Total In llcµd
Method Reference APHA9222B-20th
Alkalinity to pH 4.5 of llquk:I
Method Reference APHA2320B -20th
Alkallnlty4.5
Method Reference APHA2320B-20th
Alkallnlty8.3
Method Reference APHA2320B-20th
Bicarbonate
Method Reference APHA2320B-20th
Carbonate
Method Reference APHA2320B-20th
pH_Alkallnlty
Method Reference APHA2320B-20th
Ion Chromatography
Method Reference EPA300.0
Total Dissolved Sollds In llquld
Method Reference APHA2540C-18TH
Chlorlde
Method Reference EPA300.0
Fluoride
Method Reference EPA300 .0
Sulfate
Method Reference EPA300.0
NH3 as N In liquid
Method Reference Lac10-107-06-1-J
Total K)elclahl N as N In llquld
Method Reference
N02+N03 as N In llquld
Method Reference
Lachat107-06-2-H
Lac10-107-04-1-c
PQL Result Qualifier
8.7
1 B2
15
_TITLE_
110
u
110
u
7.46
_TITLE_
12 230
1.0 93
0.4 0.9
2.0 3.9
0.02 0.02 U
0.2 0.2 U
0.02 0.02 U
Laboratory Section» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone]
Sample ID
Collect Date:
Collect Time::
Units Analyst/Date
CFU/100ml
CFU/100ml
mg/Las CaC03
mgtL as caco3
mg/Las CaC03
mg/Las CaC03
mg/Las CaC03
mg/las CaC03
mg/L
mg/L
mg/L
mg/L
mg/L
mg/LasN
mg/LasN
mg/LasN
HPARKER
5121/08
PCOTTEN
5/21/08
PCOTTEN
5/21/08
NDEO
5/27/08
NDEO
5/27/08
NDEO
5/27/08
NDEO
5/27/08
NDEO
5/27/08
NDEO
5/27/08
MIBRAHIM
5/21/08
AWILLIAMS
5/22/08
MIBRAHIM
5/21/08
MIBRAHIM
5/21/08
MIBRAHIM
5/21/08
MOVERMAN
5/28/08
GBELK
5/28/08
MOVERMAN
5/28/08
Page 2of3
AB30344
05/21/2008
13:45
Approved By /Date
MMATHIS
5/22/08
CGREEN
5/23/08
CGREEN
5/23/08
MOVERMAN
6/4/08
MOVERMAN
6/4/08
MOVERMAN
6/4/08
MOVERMAN
6/4/08
MOVERMAN
6/4/08
MOVERMAN
6/4/08
MOVERMAN
6/2108
MOVERMAN
5/30/08
MOVERMAN
6/2/08
MOVERMAN
6/2108
MOVERMAN
6/2108
CGREEN
6/4/08
CGREEN
6/4/08
CGREEN
6/4/08
¾C <DWQ, La6oratory Section ~su{ts Sample ID AB30344
Loca~on tD: RROAPNLC Collect Date: 05/21/2008
' Loe. Descr.: WILLIAM B OTT Collect Time:: 13:45
Visit ID
CAS# Analyte Name PQL Result Quallfler Units Analyst/Date Approved By /Date
Phosphorus_total as P In llquld 0.02 .02 u mgllasP MA.JAY! CGREEN
Method Reference Lac10-115-01-1EF 5/23/08 5/28/08
Nitrate as N In liquid 0.02 0.02 u mgllasN MOVERMAN CGREEN
Method Reference Lachat107-04-1-c 6/3/08 614/08
Nltrfle as N In llquld 0.01 0.01 u mgll.asN MAJAYI CGREEN
Method Reference Lachat107-04-1-c 5/22108 5/28/08
MET
7429-90-5 AJbylCP 50 50 u ugll. DSTANLEY ESTAFFORD
Method Reference EPA200.7 5/23/08 5/28/08
7440-70-2 C8bylCP 0.10 16 mglL DSTANLEY ESTAFFORD
Method Reference EPA200.7 5/23/08 5/28/08
7440-43-9 QfbylCPMS 1.0 1.0 u ug/l. SGOSS EST AFFORD
~ethod Reference EPA200.8 5/23/08 5/28/08
7440-47-3 CrbylCPMS 10 10 u ugll. SGOSS EST AFFORD
Method Reference EPA200.8 5/23/08 5/28/08
7440-50-8 CubylCPMS 2.0 14 uglL SGOSS EST AFFORD
Method Reference EPA200.8 5/23108 5/28/08
.7440-48-4 FebylCP 50 590 uglL DSTANLEY ESTAFFORD • Method Reference EPA200.7 5/23108 5/28/08
7439-95-4 MgbylCP 0.10 1.5 mgll DSTANLEY ESTAFFORD
Method Reference EPA200.7 5/23108 5/28/08
7439-96-5 MnbylCPMS 10 81 uglL DSTANLEY ESTAFFORD
Method Reference EPA200.8 5/23/08 5/28/08
7440-23-4 NabylCP 0.10 72 mglL DSTANLEY ESTAFFORD
Method Reference EPA200.7 5/23/08 5/28/08
7440-02-0 NlbylCPMS 10 10 u uglL SGOSS EST AFFORD
Method Reference EPA200.8 5/23/08 5/28/08
7439-92-1 PbbylCPMS 10 10 u uglL SGOSS EST AFFORD
Method Reference EPA200.8 5123/08 5/28/08
7440-66-6 ZnbylCPMS 10 130 uglL SGOSS EST AFFORD
Method Reference EPA200.8 5/23/08 5/28/08
Laboratory Section» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone] Page 3 of3
North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
County _ /z" SAMPUYP
Quad No Serial No. waxer
LaC �2� `_� � Long. 7 25 S 7 426 soil
❑ other
SAMPLE PRIORITY
Routine
Emergency
Report To: ARO, FRO, MR0 2"aRO, WiRO, T ❑ Chain of Custody
(D
WSRO, Kinston FO, Fed. Tru entral Off., Other:
Shipped by: Bus, Courier, and_Del. 'Other- r purpose:
Collector(s): 4Date l �Tlme [ Baseline, Complaint,
I
Lab Number _6 LT V D d• , ) ly_.IQ !21 .L"7 -In
Date Received - 1- 12 —Time ' 3d
Rec'd by:� From: Bus, Courier, Cand Deli,
Other:
Data Entry By: -
Date Reported:
Ck:
Pesticide Study, Federal T►us #e �r'�"7rcr�
FIELD ANALYSES Owner / n- 0- Z-1
PH400 tc t 0 Spec. Cond.
94 at 250 C Location or sitedL—
Temp.}, ` ml • 3 IC Odor ni arm. Description of sampling point
Appearance C 2r_ - Sampling Method Sample interval
Field Analysis By:
Remarks IS`�
Upumping fte, aU temp, 96c.y
LRtiUi-iA i UHY MRLY � ��s
av '
$OD 310 m 11
i olids 70300 MEO
A - Silver 46566 u
Or anochlorine Pesticides
COD Nigh Sao mgll
Flouride 951 !l
AI - Aluminum 46557 u
Organophosphorus Pesticides
COD Low 335 m
• T
As - Arsenic 46551 u
Nit en Pesticides
Coliform: MF Fecal 31616 I1 DOml
Hardness non-carb 902
Ba - Barium 46568 u
Acid Herbicides
Coliform: MF Total 31504 1100mi
Phgn 1 27
Ca - Calcium 46W m
PCB's
TOC s8o
o - Cadmium 465W ugA
Turbidity 76 NTLJ
Sulfate 945
r - Chromium 46560 u I
Residue., Suspended 530 mgll
Sulfide 745 mqA
Cu - Co2per 46562 UPA
Fe - Iron 46563 u A
Semivolatile Organics
Oil and Grease m A
H - Mercury 71900 u
TPH - Diesel Range
pH 403 unit
-Potassium 46555 M911
Alkalinity to pH 4.5 410 mgA
M - Magnesium 46554 m /1
Alkalinity to pH 8.3 415 mgA
Mn - Manganese 46565 u A
Carbonate 445 m9A
NH. as N 610 mgA
Na - Sodium 46556 m
Volatile Organics (VOA bottle)
Bicarbonate 440 m
TPH - Gasoline Range
Carbon dioxide 405 mgA
+ NO as N 630 m n
Pb - Lead 46564 u A
TPH - BTEX Gasoline Range
Chloride 940 mgA
P: Total as P 665 m
Se -Selenium u A
Chromium: Hex 1032 u A
Zn - Zinc 46667 u A
Color: True 80 CB
1 i 7
Cyanide 720 mgA
L
L
Lab Comments:
Z'
.1 ) e"(
=V. 22/9 For Dissolved Analysis - submit filtered saf6pFe and write "DIS" in bi, Jq v 3
.z jo

XCOB1Q LadorataSection esul
County-
WAKE
Sample ID:
A830344
River 5asin
�a� '01A T
PO Number #
8GO523
45121120a5
Report To
RROAP
I i—
Q G�
Date Received:
If
10 r
14,.30
f
Time Received:
Collector
J GREER
�
�
�
Labworks Logintt7
MMATHIS
Region-
PRO
t }I
? 'Jul
Date Reported.
6126108
Sample Matrix:
GROUNDWATER
Loc. Type:
WATER SUPPLY
)f —
Report Generated'
OWWOOS
Emergency YesJNo
DENR Ri,LiEjcH
_Li.:,•,'..
Visi[lD
COC Yes/No
�'--
tAc. Descr.: W1LUAM B OTT
Location ,)
RRROAPNLC
Collect Date:
13.*5
Sampie Depth
Sample Qualifiers and Comments
A. r
REVISED
REPOZ
DATE: `(��, [,� --
Routine Qualifiers
For a more detailed descriptions of these qualifier codes refer to www-dwglab-org under Staff Access
A -Value reported is the average of two or more determinations
B1-Countab4 membranes with ,,:20 colonies: Estimated
02- Counts from all alters were zero.
83- Countable membranes with mere than 60 or 80 colomes: Estimaled
B4-Filters%ave counts of both >60 or 80 and < 20: Estimated
135-Too many colonies were present., too numerous to count (TNTC)
J2- Reported value failed to meet OC Criteria for either precision or accuracy. Estimated
J3-The sample matrix interfered with the ability to make any accurate determination; Estimated
J6-The lab analysis was from an unpreserved or improperly Chemically preserved sample; Estimated
NI -The component has been teolativety identified based on mass spectral library search and has an estimated value
LAB
143-Estimated concentration is c PQL and >MOL
NE -No established POL
P-Etevated POL due to matrix interference andror sample dilution
01-Holding time exceeded prior to receipt at lab.
Q2- Holding time exceeded following receipt by lab
POL- Practical ❑uantitation Limit -subject to change due to instrument sensitivity
U- Samples analyzed for this compound but not detected
X 1 - Sample not analyzed for this compound
�Ot
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 (9191733-3900 page l of 3

WC <DWQ La6oratory Section ~sufts Sample ID AB30344
Location ID: RROAPNLC Collect Date: 05/21/2008
Loe. Oescr.: WILLIAM B OTT Collect Time:: 13:45
Visit ID
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
Sample temperature at receipt by lab 8.7 ·c HPARKER MMATHIS
Method Reference 5/21/08 5/22/08
MIC
Collform, MF Fecal In llquld 1 B2 CFU/100ml PCOTTEN CGREEN
Method Reference APHA9222D-20th 5/21/08 5/23/08
Coliform, MF Total In llquld 15 CFU/100ml PCOTTEN CGREEN
Method Reference APHA9222B-20th 5/21/08 5/23/08
Alkalinity to pH 4.5 of llquld _TITLE_ mg/Las caco3 NDEO MOVERMAN
Method Reference APHA2320B-20th 5/27/08 6/4/06
Alkallnlty4.5 110 . mg/Las caco3 NDEO MOVERMAN
Method Reference APHA2320B-20th -~ 5/27/08 6/4/08
Alkallnlty8.3 u mg/Las caco3 NDEO MOVERMAN
Method Reference APHA2320B-20th 5127/08 6/4/08
Bicarbonate 110 mg/Las caco3 NDEO MOVERMAN
Method Reference APHA2320B-20th 5/27/08 6/4/08
carbonate u mg/Las caco3 NDEO MOVERMAN '~
Method Reference APHA2320B-20th 5/27/08 614108
pH_Alkallnlty 7.46 mg/Las caco3 NDEO MOVERMAN
Method Reference APHA2320B-20th 5/27/08 6/4/08
WET / ...
Ion Chromatography _TITLE_ mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 5121108 6/2/08
Total Dissolved Solids In llquld 12 230 mg/l. AWILLIAMS MOVERMAN
Method Reference APHA2540C-18TH 5/22/08 5/30/08
Chloride 1.0 93 mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 5/21/08 6/2/08
Fluoride 0.4 0.9 mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 5/21/08 6/2/08
Sulfate 2.0 3.9 rng/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 5/21/08 6/2/08
NUT
NH3 as N In liquid 0.02 0.02 u mg/lasN MOVERMAN CGREEN
Method Reference Lac10-107-06-1-J 5/28/08 6/4/08
Total K)eldahl N as N In liquid 0.2 0.2 u mg/LasN GBELK CGREEN
Method Reference Lachat107-06-2-H 5/28/08 6/4/08
N02+N03 as N In liquid 0.02 0.02 u mg/LasN MOVERMAN CGREEN
Method Reference Lacl0-107-04-1-c 5128108 6/4/08
Laboratory Section» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of 3
-,•;:,-:f~~i··
'NC ©WQ, La6oratory Section ~su£ts Sample ID AB30344
Location ID: RROAPNLC Collect Date: 05121/2008
Loe. Descr.: WILLIAM B OTT Collect Time:: 13:45
Visit IC'"
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date APP".')Yed By JOate
Phosphorus_total as p In llqud 0.02 0.02 u mgllasP MAJAYI CGREEN
Method Reference Lac10-115-0t-1EF 5123/08 5128/08
Nitrate as N In llquld 0.02 0.02 u mgflasN MOVERMAN CGREEN
Method Reference lachat107-04-1-c • 6l3I08 614/08
Nltrtle as N In llquld 0.01 0.01 u r mgllasN MAJAYI CGREEN
Method Reference lac:hat107-04-1-c 5/22/08 5128108
MET
7429-90-5 AlbylCP 1!• 50 50 u uglL DSTANLEY ESTAFFORD
Method Reference EPA200.7 5/23/08 5/28108
7440-70-2 CabylCP 0.10 16 mg/I.. DSTANLEY ESTAFFORD
Method Reference EPA200.7 -!'-5/2JI08 5128/08
7440-43-9 CdbylCPMS 1.0 1.0 u uglL SGOSS ESTAFFORD
Method Reference EPA200.8 5123/08 5/28108
7440-47-3 CrbylCPMS 10 10 u ug/L SGOSS EST AFFORD
Method Reference EPA200.8 5123'08 5/28108
7440-50-8 CubylCPMS 2.0 14 uglL SGOSS EST AFFORD '.,;,
Method Reference EPA200.8 5/23/08 5/28/08
7440-48-4 FebylCP 50 590 ugll DSTANLEY ESTAFFORD
Method Reference EPA200.7 5123/08 5/28108
74~9-95-4 MgbylCP 0.10 1.5 mglL DSTANLEY ESTAFFORD :I
• Method Reference EPA200.7 5123/08 5/28/08
7439-96-5 MnbylCPMS 10 81 uglL DSTANLEY EST AFFORD
Method Reference EPA200.8 5123'08 5128/08
7440-23-4 NabylCP 0.10 72 mgll. DSTANLEY ESTAFFORD
Method Reference EPA200.7 5123/08 5128/08
7440'52-0 NtbylCPMS 10 10 u uglL SGOSS ESTAFFORD
Method Reference EPA200.8 5123/08 5/28/08
74i9-92-1 PbbylCPMS 10 10 u uglL SGOSS ESTAFFORD
Method Reference "EPA200.8 5123'08 5/28/08
7440-66-6 ZnbylCPMS 10 130 ugll SGOSS ESTAFFORD
Method Reference EPA200.8 5/23/08 5128108
Laboratory Section» 1623 Mall Service Center, Ralelgh, NC 27699-1623 [phone] Page3of3
'GROUNDWATER FIELD/LAB FORM
County
Quad No Serial No.
Lat.•15 `f--), ;�;O Long. 2 rS S s
North Carolina
Department of Environment and Natural Resources
DiVISION OF WATER QUALITY - GROUNDWATER SECTION
Lab Numbers
Date Received �-a 1- 03 Time
Rec'd by: From: Bus, Courier, and De ,
Other:
Report To: ARO, FRO, MR04jE � VaRO, WiRO, JIL ❑ Chain of Custody II
WSRO, Kinston FO, Fed. Tru1sentral Off., Other: 1
Shipped by: Bus, Courier,`Hand ❑el. Other:
! Purpose:
Collectors): Date r ' Time [ Baseline, Complaint, Compliance
SAMPLE TYPE
19 Water
❑ soil
❑ Other
SAMPLE PRIORITY
�$ Routine
❑ Emergency
Data Entry By: Ck:
Date Reported:
Pesticide Study, Federal TwsGDzSf ��-/-
FIELD ANALYSES I Owner 6c--"l z�
pH o � Spec. Cond.94
H3 at 250 C Location or site40
p.10 oC Odor ri o►-g1 Description of sampling point �
Appearance Sampling Method 40rSample
Field Analysis By: a Remarks
0 2//.
LAtiUHA I UHY ANALY �
lgj� ay'
BOD 310 mg/1
Diss. Soli s 70300 1D.Wl
A - Silver 46566 uqjI
❑r anochlorine Pesticides
COD High 340 mgll
Flouride 951 mg
Ai - Aluminum 46557 UCO
Organophosphorus Pesticides
COD Low 335 mLV1
T rdne t l 9QQ maA
As - Arsenio 46551
Nitrogen Pesticides
Coliform: MF Fecal 3t618 1100m1
Hardness non -cart 902 mqA,
Be - Barium 46558 u 11
Acid Herbicides
Coliform: MF Total 31504 1100ml
Phencls 32730 U0
Ca - Calcium 46552 m 11
PCB's
TOC 680 m
; h
Cd - Cadmium 46559 u R
Turbidity 76 NTU
Sulfate 945
r - Chromium 465W u R
Residue., Suspended 530 mgA
Sulfide 745 m !
Cu - Copper 46562 u I
Fe - Iron 46563 tjgA
Semivolatile Organics
Oil and Grease mall
H - Mercury 71900 u I
TPH - Diesel Range
t✓
pH 403 unit
- Potassium 465M
t�
Alkalinity to pH 4.5 410 mgll
M - Ma neslum 46554 n
Alkalink to pH 8.3 415 mgll
Mn -Man anese 46565 ucyl
Carbonate 445 mgn
NH as N 610 mop
Na - Sodium 46556 m n
Volatile Organics (VOA bottle)
Bicarbonate 440 m
TPH - Gasoline Range
Carbon dioxide 405 mgA
NO + NO. as N 630 m n
Pb - Lead 46564 u n
TPH - BTEX Gasollre Range
Chloride 940 mgA
P: Total as P 665 MW
Ss - Selenium u A
Chromium: Hex 1032 u A
zn - Zinc 46567 u A
Color: True 80 Cu
1 + F1 a,(
Cyanide 720 mgll
Lab Comments: ��'�"►� ti Ct"dn
N, 1219 T For Dissolved Analysis - submit filtered
r l k� r- r 1 3e-rr:
and write "DIS" In bk, i �� y
r_

County
WAKE
River Basin
R-3port To
g,R�AP
Collector
j GGREER
Region:
Sample Matrix:
GRaUNDW4TER
LOC. Type:
WATER 5UPPLY
Emergency YeslNo
COC Yes/No
I Location ID: RRQAPNLC
_o�0� WA
," LG
�
i O 'C
0- 3
OFFICE YlsitlD
Lac. Uescr.: IIVIILLIAAA B OTT
Collect Date 0512112DOB i Collect Time:: 13:30
Sample Qualifiers and Comments
A. 1
Routine Qualifiers
Sample ID:
A830343
Po Number it
JIGO522
Date Received:
05nirma
Time Received:
14:30
Labworks LoginlD
MMATHIS
Date Reported:
Gnsm
Report Generated
Sample Depth
RRORl
DA INITIALS'
I
For a more detailed description of these qualifier codes refer to www.dwglab.org under Staff Access
A4alue reported is the average of two or more determinations
B1-Countabl%membranes with <20 colonies; Estimated
62- Counts from ail fitters were zero.
B3- Countable membranes with more than 60 or 80 colonies; Estimated
B4-1 ilterslave counts of both >60 or 80 and c 20; Estimated
85-Too many colonies were present, too numerous to count (TNTC)
J2- Reported value failed to meet QC criteria for erthei precision or accuracy; Estimated
J3-The sample matrix interfered with the ability to make any accurate determination; Estimated
J6-The lab analysis was from an unpreserved or improperty chemically preserved sample; Estimated
N1-The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
N3-Estimated concentration m a PQL and >MDL
NE -No estabtished PRL
P-Elevated PQL due to matrix interference andlar sample dilution
Q t-Holding lime exceeded prior to receipt at lab.
Q2- Holding time exceeded following receipt by lab
PQL- Practical Quariblation Limit -subject to Change due to instrument sensitivity
U- Samples analyzed for this compound but not deteded
X1 • Sample not analyzed for this compound
.t
i abaratory Section>> 1623 Nall service Center, Raleigh, NC 27599-IM t9191 T33-39M Page 1 of 3

JCVC CDWQ Laboratory Section Results Sample 10 AB30343
Location ID: RROAPNLC Coned Date: 05r211200B
Logy- Omr„ WILLIAM 0 DTT Coiled Tim&: 13:30
MSS ID
CAS A Analyte Name
PQL
Reauit
Qualifier
Units AnalystfDate
Appmred By Mate
Sample Wnperat m at receipt by lab
8,7
'C
HPARKER
MMATHtS
Method Reference
521108
sUMS
MIC
Co9fo m, MF Fecal In
1
1
132
M11100m1
PCOTTEN
CGREEN
McVwd Rderence APHA-92Z2D-20th
Sulu
sraw
CbWorrn, MF Trim In "
1
23
CFLV100mI
PCOTTEN
CGREEN
Method RederOua APi1A92228.2{M
si im
SR31n9
Aika WIy bd pH 4.5 of Ilqutd
TTrLE_
mWL as CaOM
NDEO
MOVERMAN
method RereflD a APHA232OB-2gh
Sr27108
6AM
Alkapnfty4.5
110
arotas09m
NDEO
MOVERMAN
Method Reference APHA2320B-20th
af27108
8mm
AOralir".3
1
U
mglL as CeCO3
NOW
MOVERMAN
Method Reference APHA23200-2D[h
SF27M
614M
Bkarhanafe
110
mgfL as CaCO3
NDEO
MOVERMAN
Method Retctenoe APHA23206-2ft
5R7W
814M
!r
Carbonate
1
U
mokasCaCO3
NDEO
MOVERMAN
Method Reference APRA2320B-2rM
S27me
814M
pHjllkalinIty
7.49
mg►LasCaCO3
NDEO
MOVERMAN
Method Reference APHA23NO-201Et
5I17ffls
fiHAa
WET
�r
IanCNarnalograptry
Tlil_E�_
man-
MiBRAHIM
MOVERMAN
Method Reference EPA 300.0
U21M
saw
ToW Dissolved Sdkis In nquld
12
216
TnA
AWIWAMS
MOVERMAN
Method Reference APHA254OC-18TH
5r22108
5riome
Ctftgkm
1.0
99
m9&
MIBFMIM
MOVERMAN
Method Reference EPA 300.0
Seim
am=
FkxxWe
OA
1.0
mok
MIBRAHIM
MOVERMAN
L Method Reference EPA 300.0
5/21M
Br21b8
SLOWA
2.0
4.1
nwL
MIBRAHIM
MOVERMAN
Method Reference EPA 300.0
521N8
62R18
HUT
NH3 as N In liquid
0.02
0.02
U
mgfL as N
MOVERMAN
CGREEN
Method Reference laC1(1-107-06-1J
6 LSR
B1401
Total 1geklatd N as N in lkttlld
0.2
0.2
U
mgfL as N
GSELK
CGREEN
Method Reference Ladte007.013J-2-H
5128M
6mm
W)2+NQ3 as N In iquld
0.02
0.02
U
mgfL as N
MOVERMAN
CGREFN
Method Reference Lacl4107-04-1-c
Sr=
emm
l aboratnry Section» 1623 Mail Service Center, Raleigh, NC 21699-1623 [phone] Page 2 of 3

Location ID-
Loc. Ehmr.:
visit ID
RROAPNLC
WILLIAM a OTT
XC CDWQ Laboratory Section Xesufts
Called pate.
CO$kCI ,rIMe7
M112ODS
13.30
GAS 0 Analyte Name PQL ReBuft QUallder Emits AnalySNDate Approved By iDats
r' wprl rus wi as P In lic lw
0.02
Om
tJ
mgfL as P
AMA.JAYI
CGREEN
MoU)od Reference
toc10.115-01.1EF
5W23%
&?8"
Nitrate w N h liquid
0.02
0.02
U
mq&as N
MOVERMAN
CGREEN
Method Reference
L chatIO7-04-1-c
6r3A8
614M
NNr1te as N In liquid
0.01
0.01
U
mg+L as N
MAJAYI
CGREEN
Method Reference
Ledw1107-04-1t
51n"
52aFN
MET
7429-90-5
Ai by ICP
50
50
lJ
ugfL
DSTANLEY
ESTAFFORD
Method Reference,
EPA 200-7
srr"
5281ae
7440-7D-2
Ca by ICP
0.40
17
mWL
DSTANLEY
ESTWORD
Method Reference
EPA 200.7
A.
5/2"
520109
7440-43-9
Cd by IMAS
1-0
1.0
U
LOWL
SGOSS
ESTAFFORD
Wooed Reference
EPA 200-9
S73M
SFA=
7440-47-3
Cr by ICPMS
10
10
IJ
VtgIL
SGOSS
ESTAFFORD
Method Referonce
EPA 200.8
WWII
50"
7440-50-8
Cu by ICPMS
2.0
22
VIOL
SGOSS
ESTAFFORD
Method Reference
EPA 200.9
5f13108
5r OM
7440-48-4
Fe by ICP
50
770
UWL
DSTANLEY
ESTAFFORD
Method Reference
EPA200.7
sa3m
52efge
7439-95.4
Mg by ICP
0-10
1.5
fnwL
DSTANLEY
ESTAFFORO
Method Reference
EPA 200-7
523ft
Sea=
7439-96-5
Mn by ICPMS
10
84
upR
DSTANLEY
ESTAFFORD
McNod Reference
EPA 20C-8
Seri-"
Si e=
7440.23-4
Na by ICP
0.10
74
MOIL
DSTANtEY
ESTAFFORD
Method Reference
EPA 200.7
523A6
528I06
7440- 2-0
M by ICPMS
10
10
u
upfL
SGOSS
ESTAFFORD
Meshed deference
EPA 200.8
523w
s4taw
741"2-1 Pb by ICPMS i0 10 U WL SGOSS ESTAFFORD
Method Reference EPA 200-8 5123w 5r28108
7440-66-6 Zn by ICPMS 10 lea WL SGOSS ESTAFFORD
McOwd Reference EPA 200.8 523AM rr28tl08
Laborattry Section— 1623 MRall Service Center, Raleigh, NC 27SWIG23 (919) 733-3M Page 3 of 3

�C
C
North Carolina
Gnoui DWATER FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER OUALMY - GROUNDWATER SECTION
County, 1.'�—.Iz-e SAMPLg TYPE AAMPLE PRIORITY Lab Number
Dual No Serial No. to Water RmAlne Date Received `� - �l - [� �f Time
Lat.3S ` a ZZ) �_ Long. 73 4S 3 D G ❑Soil ❑ lE;mergency
❑ Other Reed by: f From: Bus, Courier and el.,
Other.
Report To: ARO, FRO, MRC(jj6�WaRO, WiRO, ❑ Chain of Custody -10 Data Entry By: GIC
WSRO, Kinston FO, Fed. T tral Off., Other: Date Reported:
Shipped by: Bus, CourierSwaamdukW&6rbbtherPurpose:
Collectors}; Date 9-- Time 3 Baseline, CornpWnt, Compliances LUST. Pesticide Study, Federal Trus ,Qth ..��
FIELD - Owner i ��►'1 -
pH,(. Spec: Cond.. at 250 O Location or site 6k7c7
Temp.,, 1`l .1 °C Odor , Q':�'}m, Description of sampling point
Appearance r)fa Sampling Method Sample Interval j S0 PS
Field Analysis By: Remarks ba"_ .A
LABORATON.Y. &NALY_ 5EU ]�7=
�. -
BOD 310 m
Diss. Solids Tom MW
J,Aq-
Silver 46566 um
Or anochiorine Pesticides
COD High 340 m9A
Flouride 951 mqA
AI - Aluminum 46557 rum
Organophosphorus Pesticides
COD Law 335 m9A
Hardness:1
As - Arsenic 46551 uQA
Nitrogen Pesticides
olilorm: MF Fecal 31616 1100ml
Hardness non -cart 902 mqA
Be - Barium 4WM ugA
Add Herbicides
Colilo": MF Total 31504 1100m1
Phenols 32730Ca
- Calcium 465W maA
PCB's
TOC sea My
§pecificCd
- Cadrnium 46559 uqA
Turbldty 76 NTU
Sullale 945 mqA
Cr - Chromium 46W u
Residue., Suspended 530 mgA
Sulfide 745 mg
Cu - Copper 46562 ugA
Fe - iron 46563 ugA
Semivolattie Organlcs
Oil and Grease mgil
W - Mercury 719M UgA
TPH - Diesel Range
pti 403 unit
OF
K - Potassium 46555 mgA
M - Ma nesium 46554 mgA
W - Man anew 46%6 ugA
Alkalinityto pH 4.5 410 �.,;
AlkaJiniN to pH 8.3 416
Carbonate 445
NH as N 610 mcill
Na -. Sodium 465% MqA
Volatile ftanlcs (VOA bottle)
Bicarbonate 440 T9A
TPH - Gasoline Ran e
Carbon dioxide 405 m9A
NO * NO as N 6W MW
Pb - Lead 46564 u
TPH - BTEX Gasollre Range
CNori a 940 ffw
P: Total as P 665 m
Se - Selenium uaA
Chromium: Hex 1032 ugA
Zn - Zinc 46567 u A
CWar: Trite So CU
Cyanide 720 mgA
Lab Comments: r M 5
rt
R
a-
Wxs t v--
For Dlssotved Analysis - submit fllterad samolldind write "DIS" In bV,�
E AIW5, .,.,r .-..-, .
.,./, 71.47

AQUIFER PROTECTION SECTION RECEIVED � DENR 1 DWQ
rpteCtid� SodomR
APPLICATION REVIEW REQUEST FORM A�qulfer er JUL 8 200$
Date: ALI 15, 2008
To: ❑
Landon Davidson, ARO-APS
❑
Art Barnhardt, FRO-APS
❑
Andrew Pitner, MRO-APS
®
Jay Zimmerman, RRO-APS
❑ David May, WaRO-APS
❑ Charlie Stehman, WiRO-APS
❑ Sherri Knight, W-SRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
aE Mail: Michaei.Rogers( zernail.ri
A. Permit Number: WI O500033
B. Owner: William Ott
C. Facility/Operation:
❑ Proposed ® Existing ❑ Facility ❑ Operation
D. Application:
1. Permit Type: ❑
Animal ❑ SFR-Surface Irrigation❑
Reuse
❑ H-R infiltration
❑
Recycle ❑ I/E Lagoon ❑ GW Remediation
(ND)
®
UIC - (5A7) open loop geothermal
For Residuals' ❑ Land App. ❑ D&M
❑
Surface Disposal
❑ 503 ❑ 503 Exempt
❑
Animal
2. Project Type: ❑
New ❑ Major Mori. ❑ Minor Mod. ®
Renewal
❑ Renewal w/ Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
NOTES:
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 14 calendar days, please take the following actions:
® Return a Completed APSARR Form.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: ;< rc Date: -**L68—
FORM: APSARR 07/06 Page 1 of f

AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: April 15, 2008
To: □ Landon Davidson, ARO-APS
0 Art Barnhardt, FRO-APS
□ Andrew Pitner, MRO-APS
[8.1 Jay Zimmerman, RRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: [phone]
E-Mail: [e-mail]
A. Permit Number: WI 0500033
B. Owner: William Ott
C. Facility/Operation: __
D Proposed [8.1 Existing
D. Application:
□ David May, WaRO-APS
□ Charlie Stehman, WiRO-APS
0 Sherri Knight, W-SRO-APS
Fax: [phone]
D Facility D Operation
1. Permit Type: D Animal D SFR-Surface Irrigation □ Reuse D H-R Infiltration
D Recycle D I/E Lagoon D GW Remediation (ND)
[8,1 UIC -(5A7) open loop geothermal __
For Residuals: D Land App. D D&M
D 503 D 503 Exempt
D Surface Disposal
D Animal
2. Project Type: D New D Major Mod. D Minor Mod. [8.1 Renewal D Renewal w/ Mod.
E. Comments/Other Information: D I would like to ac·company you on a site .visit.
NOTES:
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 14 calendar days;please take the following actions:
[8.1 Return a Completed APSARR Form.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
D Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed .above.
RO-APS Reviewer: _________________ _ Date: ______ _
FORM: AP SARR 07 /06 Page 1 of 1
of INATF� Michael F Easley, Governor
� 0
PWilliam G. Ross Jr„ Secretary
tr North Carolina Department of Environment and Natural Resources
Coleen H. Sullins Director
7 �
❑iv+slop of Water Quality
April 14, 2008
William Ott
2701 Weaver Hill Drive
Apex, NC 27502
Subject: Acknowledgement of'Application No. WI0500033
Ott, William SFR
Surface Irrigation System - SFR
Wake
Dear Mr. Ott.
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit
application and supporting materials on April 11, 2008. This application package has been assigned the number
listed above and will be reviewed by Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary.
To ensure the maximum efficiency in processing permit applications, the Division requests your assistance in
providing a timely and complete response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to fugal
action by the Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days
after receipt of a complete application.
If you have any questions, please contact Michael Rogers at 919-715-6166, or via e-mail at
nuchael.rogers[ancmail.net. 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
hLrp://h2o.enr.state.nc.us/clocuments/dwq orgchart.pdf
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUHUES ON THIS
PROJECT.
Sincerely,
0 Ldk �
for Debra J. Watts
Supervis or
cc: Raleigh Regional Office, Aquifer Protection Section
Permit Application File W10500033
Aquifer Protection Section 1636 Mail Service Center
Internet: www:ncwaterguality.oro Location: 2728 Capital Boulevard
An Equal QpportunitylAf irmatiue Action Employer- 50% Recycled/10%Post Consumer Paper
K Carolina
Naturally
Raleigh, NC 27699-1636 Telephone: [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 5-A7 WELLS. )
New Permit Application OR Renewal (check one)
DATE: q . 20 7r0'5
PERMIT NO. UJ'r v 5 a o v 3 (leave blank if NEW permit application)
A.
B
PROPERTY OWNERS)/APPLICANT($)
Aquifer Proteciipn Section
APR 112008
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative w/authority for signatum): +J + LL I A th 13 Q Tr_
OTr
(1) Mailing Address: �7 D
City: if C State: Ilk Zip Cade: 17 5 d Z County: W r"
Home/Office Tele No.: 5' 4 " � G � - ° ° 3 S Cell No.:
EMAIL Address: �► t t_b ,T 0 TjJ_i"e o TT 5. D /C G
(2) Physical Address of Site (if different than above):
City:
Home/Office Tele No.:
EMAIL Address:
State: Zip Code:
County:
AUTHORIZED AGENT OR OWNER, IF ANY (if the Permit Applicant does _ not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate [AC well)
Company Name:
Contact Person: EMAIL Address:
Address:
City:
State: Zip Code:
County:
Office Tele No,: Cell No.:
Website Address of Company, if any:
GPUIUIC 5A7 Well Permit Application (Revised WNW) Page 1

C. WELL DRILLER INFORMATION
Company Name: , y r t w -(" 901 14 1 IV,
Well Drilling Contractor's Name: C. W 1 *V C
NC Contractor Certification No.: l ; V 11
Contact Person: C V%/ , , d ` EMAIL Address_
Address: 6+14 -J v D d`;7')1f T)A
City: r}ti�4 <n S�"� Zip Code: Z 75; 6 County: VIKIt
Office Tele No.: Cell No.:
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name:
Contact Person: EMAIL Address:
Address:
City: Zip Code: County:
Office Tele No.: Cell No.:
E. STATUS OF APPLICANT
Private: X Federal: Commercial -
State; Municipal: Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used.)
10 l4cA-T i�Vien i
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
A. WELL CONSTRUCTION DATA (Skit) to Section I if this is a Per t RE'VEWAL.
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 Weil(s) being proposed for use as an injection well. Provide the data in (1) through
(7) below to the best of your know]edge. Attach a copy of Form GW-1 (Well Construction
Record) if available.
(1) Date to be constructed: Number of borings:
Approximate depth of each boring (feet):
(2) Well casing, Is the well(s) cased? (check either (a.) YES or (b.) NO below)
(a) YES If yes, then provide the casing information below.
Type: Galvanized steel Black steel Plastic Other (specify)
Casing thickness: . diameter (inches): depth: from to ft. (reference to land surface)
Casing extends above ground inches
GsP1JIUIC 5A7 Well Permit Application (Revised 912007) Page 2

I.
(b) NO
(3) Grout (material surrounding well casing amiior piping):
(a) Grout type: Cement__ Bentonite Other (specify) _______ _
(b) Grouted surface and grout depth (reference to land surface):
__ Around closed-loop piping; from ___ to __ · (feet).
___ Around well casing; from ___ to ___ (feet).
(4) Well(s) Screen Information
Depth of Screen: From--~-to ___ feet below land surface
(5) N.C. State Regulations (Title I SA NCAC 2C .0200) require the Permittee to make provisions for
monitoring wellhead water quality and processes. A faucet on both Influent (groundwater entering heat
pump) and Effluent (water being injected back into the well) lines is required .. Will there be a faucet on:
(a) Influentline? Yes __ No__ {b) Effluentline? Yes __ No_· __
(6) Source Well Construction Information (if the water source well is a different well than the injection well)
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-1 is not available, provide the
following data:
Groundwater Source. From what depth, formation, and type of rock/sediment units will the groundwater
be withdrawn? (e.g. granite, limestone, sand, etc.)
Depth: _______ Formation: ______ Rock/sediment unit: ______ _
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR PROPOSED WELLS IF
THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
OPERATING DATA
(1) Injection rate:
(2) Injection Volume:
(3) Injection Pressure:
(4) Injection Temperature:
,
Average (daily) _!__gallons per minute (gpm).
Average (daily)~ gallons per day (gpd).
Average ( daily) 'S"o pounds/square inch (psi).
Average (January) $"'? ° F, Average (July) 'D. ° F.
J. INJECTION-RELATED EQUIPMENT -/JU ft'\ 0 01 f= I vA-T, 0"1
Attach a diagram showing the engineering layout or proposed modification of the injection ~quipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
K. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(1) Include a site map ( can be drawn) showing: buildings, property lines, surface water bodies, potential sources
of groundwater contamination and the orientation of and distances between the proposed well(s) and any
existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet of the
geothermal heat pump well system. Label all features clearly and include a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
GPU/UIC 5A7 Well Permit Application (Revised 9/2007) Page 3
L. CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the
retarded legal property deed.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on rmy inquiry of those indi►+iduais
immediately responsible for obtaining said information, I believe that the information is true, accurate and complete.
I am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the approved specifications and conditions of the Permit,"
Signature of Property Owner/Applicant
W1 Lt, 1 I+r-N ;0 T i
Print or Type Full Name
5ignatur Property Owner/Applicant
VI
Print or -Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/UIC SA7 Well Permit Application (Revised 912GO7) Page 4

moms
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W A TEp�
Michael F. Easley, Governor
May 4, 2008
William and Virginia Ott
2701 Weaver Hill Drive
Apex, NC 27502
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
7006 2150 0003 5466 6205
Subject' Notice of Expiration (NOE)
5A7 Geothermal Injection Well
Permit No. W10500033
Ott Sl~R
2701 Weaver Hill Drive, Apex, NC
Wake County
Dear Mr, and Mrs. Ott:
William G. Ross Jr'. Secretary
North Catalina T7eparimeni of F.nvironmenr and NaturaI Resources
Coleen H. Sullins, Director
division of Water Quality
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 on September 5, 2003, and expires on
August 31, 2008, has not been renewed. In addition, 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.
M
S. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Noy` Catalina
Nalumily
Aquifer Pro tecLion Section 1636 Mail Service Center
Internet: www.ncwatcrcuali :.ort i.oca6on: 2728 Capital Boulevard
An Equal opportunity/Affirmative Aeon Employer— 50%Recycledl10%Post Consumer Paper
Raleigh, NC 27699.1636 Telephone: [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer service: [phone]

If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted.
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory r_equirements listed under NCAC Title 1 SA, Subchapter
2C, Section .0214 .. When each well js 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/gpu/forms.htm ..
Thank you in advance for your cooperation and timely response. If you. have any questions,
please call me at [phone]
Sincerely,
~~
Michael Rogers
Environmental Specialist
Attachments
cc: Raleigh Regional Office -APS w/o enclosures
APS Central Files -Permit No. WI0500033 w/o enclosures
Page 2
s� Doc) 3
Page I of 2
WAKL Ct3UNI Y dNrio rt;E Ci*rY or AALeiGti
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Parcel Number: 0711424002
REID: 0231771
OWNERI: OTT, WILLIAM B &
VIRGINIA
ADDRZ: 2701 WEAVER
HILL DR
APEX NC 27502-
: pTT
AD D R3:
DEED BOOK:
DEED PAGE:
DEED DATE:
DEED ACRES:
BLDG VAL:
LAND VAL:
BILLING CLASS:
DESCRIPTION:
MAP NAME:
PIN NUM:
PIN EXT:
CITY:
TOWNSHIP:
YEAR BUILT:
SALEPRICE:
SALEDATE:
TYPE USE:
DESIGN STYLE;
UNITS:
xN0x'1W_&1
ZONING:
OLD PARCEL
NUMBER.
ADDRESS
ST NUM:
ST MISC:
DIR PREFIX:
ST NAME:
ST TYPE:
DIR SUFFIX:
6548
07447
0548
5/2/1997
4.09
484704
270000
INDIVIDUAL
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CROSSING PHI
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071103
0711424002
000
BUCKHORN
1999
0
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0
RESIDENCE•< 10
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SITE
R-80W
2701
WEAVER HILL
DR
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Page 1 of 2
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071 787215
Map created on 41112008 4:16:47 PM.
WAKE
OWN
Parcel Number: 0711424002
REID:
0231771
OWNERI:
OTT, WILLIAM B &
VIRGINIA
ADDR1:
2701 WEAVER
HILL DR
ADDR2:
APEX NC 27502-
6548
ADDR3:
DEED BOOTS:
07447
DEED PAGE:
0548
DEED DATE:
5/2/1997
DEED ACRES:
4.09
BLDG VAL:
484704
LAND VAL:
270000
BILLING CLASS:
INDIVIDUAL
L05 WEAVER
DESCRIPTION:
CROSSING PH1
BM1997-602&60
MAP NAME:
071103
PIN NUM:
0711424002
P IN EXT:
000
CITY:
TOWNSHIP;
BUCKHORN
YEAR BUILT:
1999
SALEPRICE:
0
SALEDATE:
TYPE USE:
Single Family
DESIGN STYLE:
Conventional
UNITS:
0
RESIDENCE-< 10
LAND CLASS:
ACRES -HOME
SITE
ZONING:
R-80W
OLD PARCEL
667-00000-0000
NUMBER:
ADDRESS
ST NUM:
2701
ST MiSC:
DIR PREFIX:
ST NAME:
WEAVER HILL
ST TYPE:
DR
P]l:I•-31190.11
http://imaps. co.wake. ne.us/imaps/printmap. asp?pin=0711424002 &pinext=&minX=2014110... 4/1/2008

■ Complete items 1, 2, and 3. Also complete
Item 4 it Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallpleee,
or on the front if space permits.
t . Article Addressed to:
William and Virginia Ott
2701 Weaver Hill Drive
Apex, NC 27502
I
L-5.-r V 33
7006 2150 0003 5g66 6205
A. Signabirs
x ❑ Agent
❑ Addressee
B. Rec`enlgva}� by (fWnW Name} C. pate of Delivery
l� f
D. Is d@WmV address different from Item t? 13 Yes
If YES, enter delivery address below: ❑ No
3. 5eMce Type
❑ Cortlfied Man 0 Express Mai!
0 Registered ❑ Return Receipt for Merchandise
Cl Insured Mail ❑ C.D.D.
a. Restricted Delivery? (Extra Fee) ❑ Yes
P5 Form 3811, August M Domestic Return Receipt 2ACPRI-G3-x-OM

F W A ] Michael F- Easley, Governor
�Q�0 RQ� William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P- E. Director
�_ sl Division of Water Quality
Q -t Coleen H. Sullins, Deputy Director
Division of Water Quality
September 8, 2003
Mr. Williarn Ott
2701 Weaver Hill Road
Apex, NC 27502-6548
Dear Mr. Ott.
In accordance with your renewal application received on October 1, 2002, we are forwarding
Permit No. W10500033 for the operation of a geothermal heat pump injection well at 2701
Weaver Hill Road, Apex, NC, in Wake County. A copy of the laboratory test results of water
samples collected on April 10, 2003 and June 7, 2003 are also enclosed.
This pennit shall be effective from the date of issuance until August 31, 2008, 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 Evan
Katie at [phone].
cc: CD-U[C Files
RRD-U!C Fi1cs
Enclosures
Sincerely,,
Mark Pritzl
Hydrogeological Technician
Underground Injection Control Program
24aA
Ntbrm
N. C. Dimion of Water Qualtry 1 Groundwater Sect ton
1636 Mail Service Center Raleigh, N.C- 27699-1636 Customer Service
Phone: [phone] Fax: [phone] Internet hrtp llg v.ehrrr.state,nc.us 1-877-623.6748

DIVISION OF WATER QUALITY
GROUNDWATER SECTION
September 8, 2003
MEMORANDUM
To: Jay Zimmerman, P.G., Regional Groundwater Supervisor
Groundwater Section
Raleigh Regional Office
From: Mark Pritzl (Ip. . [e-mail]
Hydrogeological Technician II
UIC Group
Groundwater Section
Raleigh Central Office
Re: Issuance of a Open-Loop Geothermal Injection Well System (Type 5A7.):
Permit Number WI0500033 to operate a well for the injection of an open-loop
ground-source heat pump system has been issued to Mr. William Ott, in Apex, North Carolina.
This is a renewal permit and the Underground Injection Control Group appreciates Mr.
Greer's assistance with the inspection and review tasks. Please retain the application and
paper work for the RRO-UIC files. Ifyou have any questions regarding this permit or the UIC
program, please contact me at [phone].
cc: CO-UIC Files
Enclosures
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
William B. Ott
FOR THE·OPERATION OF A TYPE 5A7 INJECTION .WELL(S), denned in Title 15A North
Carolina Administrative Cqde 2C .0209(e)(3)(A), which will be used for the injection of heat
pump effluent. This system is located at 2701 Weaver Hill Drive, Apex, in Wake County, North
Carolina, and will be operated in accordance with the application received on October 1, 2002,
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 .0_100 and .0200, and any
other Laws, Rules, and Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until August 31,
2008, and shall be subject to the specified conditions and limitations set forth in Parts I through
IX hereof.
Permit issued this the ~ day of ¥~ , 2003.
_C(fA c;.__j . ~
~ Ted L. Bush, Jr., Assistant Chief
~ Groundwater Section
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No. WI0500033
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 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.
PART II -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In the event there is a desire for the facility to
change ownership, or there is a name change of the Permittee, a formal permit amendment
request must be submitted to the Director, including any supporting materials as may be
appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances which may be
imposed by other local, state, and federal agencies which have jurisdiction. Furthermore,
the issuance of this permit does not imply that all regulatory requirements have been met.
Permit No. WI0500033
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 injecti(?n 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 permitte~ activity.
3. The issuance of this permit shall not relieve the Pennittee of the responsibility for damages
~o 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. WI0500033
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 RENEWAL
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 injecti_on 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. WI0500033
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 wen shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to 4o 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 Vill (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. WI0500033
ver.3/01 GW/UIC-5
Page 5 of 5
Date Initials ' Type
Mark Pritzl sf~,;{)~ ~f 511-1 l_
Debra Watts / S_,v3 &i w.
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R CEIVED /DENR
=' ICE, i '' ^� OWO GROUNDWATER SECTION
DIVISION OF WATER QUALITY
E i n 1 Ckemklsrrr laahorelory Repoli I Ground ►M PW 9 PM 21 5 8
COUNTY : WAKE 1 MAY — 5 ?-.53 �: 'J jj�] j'j�i f 7 L
SAAfI'I� l�Rl[]RIIY
QUAD NO, I .v.....`_ .YEROUIiNr 11I.MrRGENCY
DEER &g _rir-�gr_rIG, �,
RM'ORTTO RRO ! kcma f c DO IAIN OF CIAIVAW
COL1.rCTORISj : J GREEK -- l
L]AITt NIW2003 1V SpAll'Lli'fYl'1i
I IMC:
PURPOSE O+vnCr: H'It.l.1A 1J I Rlll I' _
I'matim nr Sllr:
Ilk a. ril+li•kn nl sampling ln,i nl
RrmarAr
LABORATORY AINALYMS
DOD310
m /L
COD High 340
m /L
COD Low 335
m /L
X
Colifomi: MF Fecal31,616
1 U
100mf
1
Colifomu MF Total 31504
1
100mi
TOC
m i
IT.Aritily
NiU
Residue., spended 530
m L
Total Susrended solids
m • L
x
•11
7.56
units
C
AlkAlWky to rH 45
100
m L
X
Alkalinity to 1,H 83
1U
Mg/ L
k
Carbonate
1u
rng/L
7[
nimbonate
JO0
mg/L
Carbon dlox I&
m L
r
Chloride
17
m / L
Chromium:l iex 1032
u L
Cn1nr. True !W
r.u.
Cyanide 720
m •/L
COMMENTS
X
Dist. Solids 70300
160 m •/ L
Flumide 951
m /L
x
IlarJe+ess:(at III 9W
46
X
Hai Jness: (non-carb) 902
1 u mF;/ L
PheimAs3273D
u p/L
,eAlk Cond_ 95
urr+has em2
X
Sulfate
5u mg/L
Su I I ide 745
mF;/ L
MBAS
mg/L
Di I .%nJ Grease
m 1;/ L
SiliL a
1lor+m
fo:nurldel+yJe
mg/L
X
N1I1asN610
0.02uern IL
X
TKi l as N 675
0.20u mg/L
X
N01 ►N01 as n 6.141
0.02 lit / I.
X
I':7nlalasP665
0.02 m;/L
POI
AS -Sliver 4G566
T
u6/ L
AI-Aluminum46557
ul./L
As- Arsenk 46551
_
ug/t_
Ba-Barium 46556
u •/L
X
Cm— Calcium 46552
16
err L
x
Cd-Cadlum4M
2.011
u •/L
X
Cr-Chromium465W
25U
u'/L
]t
cu- Copper1042
69
u /L
X
re. Iron 1045
610 u /L
I I . Mercury 71900
u /L
K-Polossium 46555
m •/1.
X
Ni - Ma nesium 927
1.4
m'/L
X
Mn-Manganese1055
90
ug/L
X
Na. Sodlum929
36
mpIL
X
Ni-Nkkei
10
u ,./L
X
1%4rad 465M
IOU
trl;/I.
Se -Selenium
up,1L
of
2n,_7inc 46%7
6,40
ug/L
Lab Number
3G0364
pate Received
4/1012003
T'rmr Received
11-00 AM
Received By
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Released By :
AR
We rel+nrted :
/41/20411
arw hos phorus Pesticides
Nitr en Pesticides
Acid Herbicides
7 PN•GasoIine Panre
1PH-13TU Gasoline Ranee

North Carolina '
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
County _ �e
Quad No Serial No. _
Lat.
Long.
SAMPLE TYPE SAMPLEEERLOR1TY
® Water ® Routine
❑ Soil ❑ Emergency
❑ Other
Lab Number -7�3/
Date Receiv�01=rnm_-
Time 1-/60
Reed lay: us, Courier nd De .,
Other:
Report To: ARO, FRO, MR0,0jNb WaRO, WiRO, �� ❑ Chain of Custody Data Entry By: Ck:
WSRO, Kinston FOP Fed. Trus nftz Qff.,.Olher: Date Reported: �
Shipped by: Bus, Courier, d Del. (then`
Purpose: 1
Co!lector[s]: Date Time % 0 C) E2 Baseline, Compialnt, m Ilanca ILUST, Peslicide Study, Federal Trust„ harp a L41 <_
EJELD ANALYSES Owner T .� •r C2 '
pH 4� L , � Spec. Cond. � at 25o C Location or site � r'2r
Temp-10 yL CZ y oC Odor Description of sampling point _ � r- , - `- �f+ F1 -
Appearance C- --- Sampling Method - Qr-_j 9 Sample Interval
Field Analysis By. Remarks _ °`�' "�' a�`'
LABORATORY ANALYSES bkw`h'° Iwo,
Or low, SO-.)
piss_ Solids 7e3ea _ _mall_
- Silver 4s5ss u
Or anochlarine Pesticides
Flourida 951 Mali
At - Aluminum 46557 w A
Organophosphorus Pesticides
r ines5: Total 90U ntM
As - Arsenic 46551 unit
Nitre en Pesticides
Hardness (non -cart?) 902
Ba - Barium 46559 w A
Add Herbicides
Phenols 32730 u9A
X
Ca - Calcium 46552 maA
PCB,s
Snecllic Cond. 95 umhus/ w
Cd - Cadmium 46559 will
_
Sulfate 945 T mall
Cr - Chromium 46560 0_0
Sulfide 745 mgfl
- Copper 46562 ugll
r
_Cu _
- Iron 46563 u911
Semlvolafile Organics
_Fe
Oil and Grease — mall
Hu—Mer'cury 719D4 u n
TPH - Diesel flange `
K - Potassium 46555 me A
_ — — -
NH as N 610 _ min
hill l..525_ _mgfL
NO.. i• NO, -ISM 630 mr�lt_
F�, Total as P 665 — — me
- — --
Mg_- Magnesium 46554m2A
Mn - Ma Aanese 46565 Ur !I
Na - Sodium 46556 mg/l
Volatile Organics (VOA bottle)
_iL- Nickel ug[i
TPH - Gasoline Range
_Ph - Lead 46564 rirrll
_Se= Selenium — ur 1
Zrl -Zinc 46567
TPH - STEX Gasollre Range
T
- — -
BOD. 310 m411 Ali
COD High 340
COD Low 335
Col'srorm: MF Fecal 3161e 11
Coliform; MF Total 31504 li
TOC 680
Turbidity 76
Residue., Suspended 530
PH 403
unit
Alkalinity to pH 4.5 410
mgA
Alkalinity to pH 8.3 415
mg/1
Carbonate 445
mgA
Bicarbonate 440
_ mall
Carbon dioxido 405 _ -
Chloride 940
A
mgA
Chromium: Flex 4032
Color: True so
Cyanlde 720
ur
CU
Mali
Lab Comments:
�� n� _, _.
GW-54 REV. 12le For Dissolved
f �
s -,submit filtered Sample and write "DIS" in bl
_.r

RECEIVED I OENH
OWQ GROUNDWATER StCTlON
03 HAY I 5 PH 4: 0 I
RECEIVED / DENR
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It� 01VISION t>'F WATIP"11 QUALITV DWG
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ChrmlHry 1.0mrsfarr Itrl,ntI I Goapnd Watrr t)na111) r
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r
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7-7R PAI-Vlrll RI
CI N AI 1
DR-1-1O RRO
1 ReglanaMin
Q C'11AINt11-t-1191ROY
LrCIVR[S] : ! GREER
Er LIW2003
ElSANHI ETVI'li
r_,
POSE:
BORATORY ANALYSIS
IRIENTS
vvner:
Lmc Iirn,yrSite 7
Drsctiplinn of saniplinR paint
S.inipling Method:
Rema1 ks:
ll'ILLIAM BUS-[
X
1]isa. Solids 7030U
170
m • L
Fluoride 951
n1b/L
7r
Hsrdresse total9W
46
mgj L
7r
IIardom: non-car6 902
lU
mrZL
I'ltrnols32730
u /L
5 i1-rc Cond. 95
unlhos ant
R
Sulfate
5U
m • L
Sulfide 745
m /L
MBAS
rng/L
CHI and Crease
rry;/L
Silica
mg/ /L
Baron
romaldehyde
%
N113ssN610
0.02U
m• L
3S
TKN as N 629
0.20U
m L
X
NO2 +NO3 m n 630
0.03
n, L
R
P: Tolal as 11665
0.02U
m •/L
I'O4
m L
A r -Silver 46566
u • L
AI -Aluminum 46557
u L
As -Arsenic 46551
u /L
Ba.parlum 46530
0 /L
R
Ca-Calcium46552
16
m /L
7C
Cd- adium46559
2.OU
v /L
X
Cr-Chrornlum46%0
25U
u /L
X
Cu• Ca • err 1042
71
v •/ L
R
Fe -]von 100
600 u •/L
II - Mrrcu 71900
u L
IC-I'utassiuln44555
m I L
R
Mg- Magnesium 927
1.4
/L
X
Mn-Man anrsc 105
93
u •/L
X
No- Sod turn 929
35
m • L
X
NI -Nickel
10
u L
X
r'b-Lead 46564
IOU
v /L
Se -Selenium
p /L
_
C
7.n_Zinc 4&%7
650
u /L
Lab Numtvr 3C0365
Dale Received 4(1012003
1 ime Received : l LOD AM
Received By 11 1W
IlyS)lp CICASL`d
Uate repotted : 511f2003
Pestkides
I I Arid Her6lcldes I

GROUNDWATER FIELDILAB FORM
County —
Quad No Serial No.
Lat. Long.
SAMPt E TYPE SAMPLE -PRIORITY
Water Routine
Soll Emergency
❑ other
Report To: ARO, FRO, MRO 9Q�IIVaAO, WiRO, L _ ❑ Chain of Custody
WSHO, Kinston FO, Fed. Trust, Central Off., Other:
j(1)E
hipped by: B s, Courier, and Del., O er•
llector(s):, r� Dale Purpose:
- U �tD_!±� � Time % � i �� Baseline, I
LD ANAL E Owner
Spec. Cond.94 2G 0..) at 250 C Location or sale �7 Z>/
Temp.,( )?.+- 2 oC Odor _ _ IJ ylV e _ ❑escriplion of sampling point
Appearance Sampling Method
Field Analysis By: Remarks
LABORATORY ANALY S
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
Lab Number r4-9
Date Received 0 — Time ZZOZ2_
Rec'd by: / From: Bus, Courier, and ❑el f
(D Other:
Data Entry By: `_- Ck:
Date Reported:
1 , omp"ance UST, Pesticide Study, Federal Tru- r (�e
refs one)
�Aa �s
Tom. Sample Interval tz '
_
BO❑ 310 InCIA
Diss. Solids 703U0 ma/i
Ag - Silver 46565 ugll
COD High 340 mgA
Flouride 951 m A
Al - Aluminum 46557 u A
COD Low 335 mgli
liardrless: Total 900 nlgf
As - Arsenic 46551 uuli
Collform: MF Fecal 31616 1100m1
Hardness (non-carb) 902 mg1l
_
Ba - Barium 46558 UqA
Conform: MF 'Total 31504 1100ml
�
nipnols 3213o Uali
�
Ca - Calcium 46552 mull
TOC 680 m A
_
Snegific Cond. 95 i uml1a [crn'
Cd - Cadmium 40659 uoll
Cr - Chromium 46560 ur1/1
Cu - Copper 46562 uqA
Turbidity 76 NTU
Sulfate 945 mull
Residue., Suspended 530 mg/t
Sulfide 745 mgA
_
Fe - Iron 46563 u A
Oil and Grease mg/1
li - Mercury 71900 o A
pH 403 unit.
K - Potassium 46555 mgll
Alkalinity to pH 4.5 410 mgA
- Magnesium 46554 myli
�(
Alkalinity to pH 8.3 415 m9A
_Mg _
Mn - Man anesa 46565 u A
Carbonate 445 mg/1
NH- as N 610 rngll
TKN as625 mull
Na - Sodium 46556 mgli
Bicarbonate 440 rng11
-N -Bickel uall
Carbon dioxide 405 mgA
-N
NOP + NO, as N 630 MQA
_
Pb - Lead 46564 ugA
Chloride 940 m9A
P: Total as P sss MqA
_Se - Selenium ugll
Chromium: Hex 1032 u A
zn - zinc 46567 _ ugll
Color: True 90 CU
_
Cyanide 720 mgA
Lab Comments: ❑ / /� / on
G I-F�IrI77 •� If7�`�'4'�[}�Y 115iz L-f
n&
Pesticides
rus Pesticides
Nitrogen Pesticides
Acid Herbicides
PCB's
Samivolatile Organics
TPH - Diesel Range
Volatile Organics (VOA bollle)
TPH - Gasoline Range
TPH - STEX Gasoilna Range
a -
GW-54 REV. 12111\, For Dissolved Analysis - submit t(Itered sample and write "LA" in bl

North Carolina Department of Environment and Natural Resources
Division of Water Quality - Groundwater Section
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PERNUT NO. W1
NAME OF OWNER . IZ. p„ :2 l] 7-7-
DATE r 2— G 4 G Z
ADDRESS OF OWNER
41r -_a 'E. c-)C) �1
(Streetl road or lot and subdivision, county, town)
LOCATION OF INJECTION WELL (and source well(s), if applicable)
6
(Streetl road or lot and subdivision, county, town, if different than owner's address, plus description oflocation on site)
Potential pollution source
Potential pollution source
0
n
Distance from well o
Distance from well Z"1
Potential pollution source E,, Distance from well cam, �
Minimum distance of well from property boundary kZ-,0
Quality of drainage at site Flooding potential of site
0o equate poor) (high,moderate4aD
DRAW SKETCH OF SITE (Show property boundaries, buildings, wells, poeenrial pollunan sources. roads, approximate scale, and
north arrow.)
C.
+ 1
.,3 I
DESCRIBE I TWN-SY T 1 I vertical closed loop, encased borehole or cased water well; separate source well and
injection well; combination source and injection well gar other description as applicable)

�P� ..................
Duration..». ..........................................
Frequency/Accuracy of measurements
Other ( y .
Disinkr2loIl ..............................
Chlorination ..........................................
Other [
Construction {GW-1).................
Abandonment (GW-30) ........................
Well Head Compietlan
Access port.............. .............................
Hosebib ...............................................
Pitiess Adaptor ....................................,
Pitless Adaptor Unit...., . ......................
Suction line ..........................................
TeeOet)...............................................
Valved flow ..........................................
Vent.....................................................
Water tight pipe entry ...................Y.....
Wellentry ............................................
Check Items
Measured
Meets Min. Standards
Yes No
Bemarks
lI
-
cf
x�=
Applies to wells constructed after December 1, 1992
Pump Installation
Pump Installation Contractor
Name Address Reg. #
Sr7-rs�c. ,ems c_.7� I�
Violations noted attributable to the pump Installation contractor are as follows:
(2)
(3)
INSPECTOR
Name
Witness(es)
(If Available) Name
C C-J
Office
Address Type
Name
Address Type

North Carollria
Department of Environment, Health, and Natural Resources
Division of Environmental Managem
3 G 3 r a❑ Groundwater Section c
Well Location:
(Town, Community, Subdivision and Lot No_)
Owner- �U L r. L,? t a -) P-,L, 0
Address: 17 00
2
�- Well Construction
Drilling Contractor
acne Address
it ? QNj
Location - Distance -From:
Water Tight Sewage/waste collection..
Waste disposal (septic tank drain field)
Other Poll. Source
Other Poll. Source {
Casing
Type.....................................................
Depth. ...................................................
Weight/thickness..................................
Height (A.LS.) ......................................
Other ( ] .
❑ngiL f rii -f dstAdditives
Type.... .................................................
Grau
Type.....................................................
Thickness.............................................
Depth....................................................
Other ( j
Screens
Screened interval .................................
Other ( 1 .
Development .......................................
Total Suspended solids ........................
Turbidity..-_.._........................................
Settleable Solids ...................................
I.D. Plate
Well Contractor .....................................
Abandonment .......................................
Temporary.............................................
Permanent ............................................
Date 'i g ° -!;�
WELL TYPE
County
Road/Street 1 2
Quad No. �
Serial No.
Lat. Lai
R—
a -T7 nl CI u el 4V--L�
A
Check Items Meets Min. Stanciarci5
Measured Yes No
..................
c�
Perrin
(Permit No.
}
(Circle one)
Plastic Carbon aiv. Stain. St.
Other
tf
o ❑ '
f
gOa'
`4
xM-
crf
Co
o
x
>l
t�
GW-36 Rev- io/Q9
Applies to wells constructed after December 1, 1992

1N1Y : WAKE
IU NO
ORTTO : RHO
1117120112
t?:
III r15ION U11 WA F11 QOAAW9 GROM WATER SEC ION
i fir mIse ry Labor ■lor3RepurI I Craumd lYster uglily
0 .BAN -7 AM I0= 27
_ SAh1L'LEPR(0.11,11Y
�ROU-1tNE 1:111MERGENCY
_ Rrgkmal UJIke C71A I N 0l! CUS-I0DY
BOO 310
m IL
COD Ili h 340
m IL
COD Low DS
m IL
Coliform: MF Fccal 31616
1 132 Q1
I100ml
Coliform: MF TuW 31504
1 92 Ql
Il00ml
7 OC
m I]
Futbilky
NW
Residue., Sus cndc i 539
_
m IL
Total 5vs +ended solids
m IL
1i
7.2
units
Alkalinity to pi14.5
110
n1 IL
Alkalinity to 1i 9.3
1 U
m IL
Carbonate
1 U
m IL
Bicarbonate
110
m IL
Carbon dioxide
rn IL
Chloride
14
m IL
Chromium:llca 1032
u L
Color: ?roc 80
C.u.
Cyanide 720
malL i
FSnnsr'1.l? TYrr
(1wiwr:
— I -oral ion In S 11r: -• ---
t)cscrilIlion n1 satnhl ifrg Ixwi Pit —
SamPling Method: _
Remarks:
X
Visa. Solids 70300 _
170
ing.l.
Fluoride 951
1n ■l,
%
Hardness: total900
46
m IL
X
Iiardness:(non carb)902
lU
n1 1L
Phenols 32730
u /L
Specific Cond. 95
umho3lrm2
X
Sulfate
50
m1 /L
Sulfide 745
m IL
WAS
m IL
Oil and Grease
m IL
Silica
m /L
Boron
Fturrsmaldrh de
m IL
X
INIV as N 600
❑.02U
m IL
%
JTKN as N 625
0.20U
m I I.
X
NO2 +NO3 as re 630
DMU
m IL
X
P: Total as P 665
U-021J
ni IL
1'04
n1 IL
Ag-Slrcr-06566 TT
uglL
AI -Aluminum 4 655 7
u /1.
As Arsenic 46551
u IL
Ba-Barium 4655E
u /L
_
%
Ca -Calcium 46552
16
m IL
X
Cd•C1ldivm 46559
2.0J
ug/L
X
Cr-Chromium 46560
25U
u ?L
X
Cu-Copper I042
76
u IL
X
F'c- lean 1045
450
u IL
1! • Wicurz 71900
a IL
K-Potassium 46555
m IL
_
%
Mg- Magnesium 921
1.5
m IL
X
Mn-hlangancse 1055
97
ugJL
%
Na. Sodium 929
34
m / L
X
Ni-Nickel
IOU
u IL
%
lFb-Lead 46564
IOU
us, L
Se -Selenium
vgtL
X
Zn Zinc 46567
71 ❑
u 1t,
Lab Number ;
2[;1663
Dam Received :
1 im2002
Time Recrivcd
11:10 AM
Received By
�CaC��
r
AR
Dale reported:
17/1711001
Orginucldvrine PcsWdcs
Orpnophosphnrus Pesticides
Ndragcn Pesticides
Acid Herbicides
Gasoline
2W663..1s

N a r I b Carolina
GROUNDWATER FIELDILAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
County &?
Quad No Serial No.
Lai,
Long.
5AMPLE TYPE
awater
❑ soil
❑ Other
SAMPLE PRIORITY
[NRoutine
❑ Emergency
Report To: ARO, FRO, MRO, Oi . WaRO, WiRO, � ❑ Chain of Custody
WSRO, Kinston FO, Fed. Trust, Central Olf., Other:
Shipped by. Bus Courier, Hand Del., _ i� ei_� �
Purpose:
Coliector(s): Date L%= 7 0P- Time ioc, a Baseline,
HELD ANAL E Owner L"D" C/legr3
0
Lab N
Date F
Rec'd
Other:
Data Entry By:_
Date Reported:
From:
Ck:
Pesticide Study, Federal Trust Other k� _
pH400_5, Spec. Cand.94 at 250 C Location or site —9 7 Cl/ 2- �!
Temp.,, oC Odor _ Description of sampling paint ZZ
Appearance - r _ Sampling Method _ Sample Interval � c->
�Field Analysis By: r �/ ` .� Remarks
LAORAIORY �tr °rt"• "� �` B'
B A L.. r Zf—ping tk-, sk Ismµ ate.)
BOD& 310 mgll
„ - - -- -
COD High 340 mgA
COD Low 335 MA
Colilorm: MF Fecal 31616 1100m1
Coliform: MF Total 31504 1100m1
TOC 68o mt A
Turbidity 76 NTU
Residue., Suspended 630 mgA
pH 403 1rnits
Alkalinity to pH 4.5 4 10 mgA
Alkalinily to pH 8.3 415 mgA
Carbonate 445 mgA
Bicarbonate 440 _ mg/l
Carbon dioxide 405 rngA
Chloride 940 mgA
Hex 1032 u A
_Chromium:
Color: True 80 CU
Cyanide 720 mrdl]
DiSs. Solids 70300 m
An - Silver 46566 uy/l
Flou►lde 951
At - Aluminum 46557 ugA
-Hardne= laal 9 maA
As - Arsenic 46551 LmA
Hardness non Carl 9U
Ba - BariUm 465586558 ugn
,�
Phenols32733 6Alio`I i m•tfq/
Ca - Calcium 46552 mall
sso-so-r', 4rld-95 uMhasNm'
Sulrale 945 mqA
Cd - Cadmium 46558 unA
Cr - Chromium 46560 UqA
Sulfide 745 mgA
^
Cu - Copper 46562 ugA
Fe - Iron 46563 UO
_
❑II and Grease mgfl
NH, as N 610 _ mrL.
IKN as N 625moll
NQ,+ Nq. - as N 630 _ M
P: Total as P 665 mg4
_
H1c - Merm y 71 00 ucg/l
K - Potassium 46555 mgll
Marjnesium 46554 rrrrll!
Mn Mananese 46565 ug11
Na - Sodium 46556 mill
_tAL- 611ckel T uq1;_
Pb - Lead 46564 urtA
Se - Selenium ug1l
Zn - zinc 46567 ugll
_y
_/N
J(
Lab Comments: -)0..� �N -C�� r-L' 7 a_S F fr'� 1 z
Pesticides
R Organophosphotus
Pesticides
Nilrooen Pesticides
Acid Herbicides _
PCB's
Semivolatile Organics
TPH - Diesel Range
Volatile Organics (VOA battle)
TPH - BTEX Gasotire Range
7�
z
GW54 REV. 12191,.—, For Dissolved Analysis; submit liltared sample and write "DIS" In bl, J

e
UN I Y ; WAKF_
AD Na
1'0111 1 ❑ RRO
LLLCI-OR(S); J GREER
TF: upwool
4 E:
RPQSE'
W01 ATORY ANALYSIS
UWO Gltf t1NDWA EReSECTION
DIVISION O WATEII Ql1Al.l V
L�a3 f LiJ L{ j�
03 FEB — r r M 10. 34
Chendstr5 Lahvrstory Report I I:raimd ►► rler Qua1lll
SANTL1:-EILIO I:I'Y
%❑ROUTINE L]CMLIZGL•NCY
Regional bR"xr
0 i11A1N OF CUSIUllY
Wl SAMPLETYPIE,
Owner:
11'II.I.I�TI I1 UI i
I'Masion or Situ
Desee ipe inn u9 sa mpl in it pol ut
Sampling McIhod;
Remarks:
BOD 310
mg/L.
COD Ili 1r 340
m /L
COD Low 335
m /L
Calirortn: MF Fecal 31616
X3
/ 100nd
Caliform: MFTotal 31SM
X3
/ 100rnI
TOC
rrr /I
Tuibiiiiy
NTU
Residue., Sus rndcd 531)
m /L
I ulaI Sus + nkd snl ids
m /L
pi
7.2
units
Alkalinity to r114.5
110
ins/1.
Alkalinity to •118.3
1 U
ns IL
Carbonate
1 U
m VL
Bicarbonate
110
mg -IL
Cathun dioxide
m ■L
Chloride
14
m /1_
Chrumiunt:IICX 1032
ug/L
Cohn: True 80
C.v.
C: arsidc 720
rn /L
-)NINIFN rs
Lab Number 2G1766
Date: Received I2147200Z
1'imc Received : 10:45 AM
Rmcivcd By 1IM
�f[ele y R
Date reposed - 112YJ2a03
X
Diss. Solids 70300 170 J4 nr /L
X
X
X
X
X
_
X
X
X
X
X
X
Ag,Silver 46566 ug/L
_
Or •anochlonne Pesticides
Fluoride 951 rri /L
AI-Alununum46557 ug/L
Or :Ina rhos rhorus Pesticides
X
Hardness: emal900 49 mg/L
AS -Arsenic 46551 ug/L
Nitre en Pesticides
R
Ilardrscss: (non-carb) 902 1 U m /L
lia•Barium 46558 ug/L
Phenols 32730 rI / L
Ca -Calcium 46552 17 mg/L
Acid Herbicides
Sperifve Cond- 95 u1111105/cn12
Cd-Cadium 46559 2.OU ug/L
X
Sulfate 5U m /L
Cr-ChTomiam 46560 25U ug/L
Semivolatiles
Sulfide 745 rn /L
Cu-CGpM I1M2 78 t /L
TPH-Diesel Rau c
MBAS ur •/L
Fc- lion 1045 460 ug/L_
Oil and Grcasc rrr /L
1[ •- Mcrcory 71900 ug/L
Volatile O: ini� (VQA hotdr)
Silica mg/L
K•I'uiTcsiuni46555 nr /L
Baron
Mg, Magrsesium 927 _ 1.6 m IL
TPII-Gasoline Range
Formaldeh •dc nr /L
Mn-Manganesc 1055 100 u /L
'TPH-BTEX Gasoline Ran e
X
NIi3 as N 610 0-020 m /i.
Na- Sodium 929 30 m /1-
X
j1KNasN625 0.20U.14 m /L
Ni-Nickel IOU u /L
X
NO2 4 NO3 as n 630 0.02U rn / I -
Pb-Lead 46564 IOU ug/L
X
P: Tolal as l' 665 0.02-14 rrs Il,
5e•Selerrium ug/L
PO4 m /I.
Zn_2inc 40567 680 uglL_
2G 1766..I s

North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
County ze2e, -
❑uad No Serial No. [XWater [21'Aautlne
❑ Soll ❑ Emergency
Lat. Long. ❑ Other
Report To: ARO, FRO, MRO, M WaRO, WiRQ, [I Chain of Custody
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by: Bt4s, Courier, Hand Del., titer
Purpose:
Collectors}: .' Date rU ` Time --Z!?v Baseline, Complai Compllaric?j�
FIELD ANALYSES 1. c3 Owner L��i /�� •�na
PH400 (, Y Spec. Cand.94 -� 7 . mat 250 C Location or site ..-2Z Z
Temp.19 8- 7 . °C Odor 'VnV6 Description of sampling point -
Appearance Sampling Method
Field Analysis By: -t- Remarks _ +� r ' !°`' sic
B A Y A AL E `°ur°
BOD 310 m li Diss, Solids 7030D - mall Art - Silver 46566
COD High 340 rrrgJl Flouride 951 m A At - Aluminum 4655i
_ _COD Law 335 nigh fdnessd Tolal 900 moll As d &senIC 46551
Cvliform: MF Fecal3ww 1100ml Hardness non-carbl_eo2 MW arium4655B_
Coliform: MF Total 315o4 1100m1 Phenols 3Z730 Vga Ca - Calcium 46552
TOC 600 m nd. g�_ uM1fos1c1112 Cd - Cadmium 4655
Turbidity 76 NTU Sullate 945 mqA Cr - ChromlUm 465E
Residue., Suspended 530 mgA Sulfide 745 MAA _Cu - Copper 46562_
Fa - rrnn dRgmR.4
pl-1 403 unitt
Alkalinity to pH 4.5 410 mgll
Alkalinity to pH 0,3 415 mg/1
Carbonate 445 moll
Carbon dioxide 405
Chloride 940
Chromium: Hex 1032
Color: True 80
Cyanide 720
.Lab Comments: ;4jp
i
Oil and Grease mgll H - !qrcury 71900
IUi 1 46555
- kf gnesium 46554
NH, as N 610 m[111 11�'_xt Na -
. . 1 n[v as rr[ n/n rilulL _'�K_ -y[ - 14itirttn1
mgn NO + NO as N 630 m QA Pb - Lead 46564
mg/1 P: Total as P 665 nic Se - Selenium
U } Zn - Zinc 46567
CU
mgfl
S -L T 6 Z. >
Lab Number
Date ReG i ed
Rec'd by-�
Other:
Data Entry By:_
Date Reported:
Pesticide Study, Federal
From: Sus, Courier, and Del.
Ck:
Trust, ther: ,L—�' L_
Sample interval_ �� c�
Organochlorine Pesticides
Organophospho►us Pesticides
Nitrogen Pesticides
Acid Herbiddes
PCS's
Sarnivolatile Organics
TPH - Diesel Range
Volatile Organics 1(M
TPH - Gasoline Hang
TPH - BTEX Gasoline
G -541+ R 2/e\�'
For Dissolved Analysis - submit filtered sample and write "DIS" In bt,

rtt: Dk;LNR1DWQ Lricrosstry• i-aboratory
Report to: Sample Anomaly Report (SAR)
Lab Nu rube r. _ Ci I 6 _ Sa,tstp le ID:
Station L=tion: 1.'� ; l L4 h.. ,3 . Q? Count r.. IL f - — Region: _ - 0 0
{—'ample Typc: Priority: VO ck44 � L - _ y Collector.
Date collected: , l 1 102, Date received: 1 :--���1, &'>Z Date analyzed: 2-2_l�2 �4 1 2
Affected Paramc(er(s}s,
Analytical Arta (check one):
❑ NVCH ❑ ciALS
❑ NUT Q, MICRO
The following anomalies occurred (check; all that apply).
❑ Santp(cs
❑ Ierpraper container used
❑ VOA vials ►vith headspace
❑ Sclt7dc ssnptcs with htadspact
❑ Simples not rt:eivcd, but Iistcd on frcldsh::t
❑ Sarnp(ts received, but not listed on fieldsheet
❑ NQ513beled a; to t:st3, preservatives, etc.
❑ Holdin- timt expired
❑ Prior to receipt in'lab
❑ After receipt is Iab
❑ Insurlicicnt quandry for an:lysis
❑ Samplc exhibits gross non -homogeneity
❑ Sanip t: nor chemically prest eved properly
❑ pH cw of range (record pH):
❑ 1.19coper chenical
❑ Residual chlorine prescat in swnpi=
❑ Color in;c: i.•rtrc�
❑ Mcavy crnuIsion iorred during extraetio❑
❑ Sanigh: bottle broken in tab - no reperab(e results
❑ Other (specify);
Cotnnlcnts;
Corrcc(IMAcCie n:
❑ VOA ❑ S VOA
❑ PEST
Q Qua ' • Control
izscm,rncnt failur:—co r:_artaulc resuIcs
❑ Analyst rrror— no r::o.—,: resins
❑ Surrogate;
❑ Norte added
❑ RtcoYcry ou:5:.1_ tance Iir.tits
❑ 5pic reco:•try
❑ No= added
Cl Recovery C_tii'_e
❑' Fai(cd to mc_: crit...z for pr:c:star.
❑ Integral standards
❑ $13:1": con:aninsda^
❑ QC data rtporttd a_uid: cfcorl:rals 0-a. QCS, LCS)
❑ Incorrect proccdu,_ :s:d
❑ SOP irtca.ioralfy r..c'dict:e' with QA :ad Branch Hczd
ep.roval
❑ Ir.:e1id ins:.•rn:-::;?:br_:::n
❑ El:vated dr.: tiort Ii.. its due to:
❑ Inst:Mcient s_-:t: vc'.urnc
I
❑ Sampies were rejected by DWQ Lab. Authorized by: D_:e; 1 I
Cl Accepted and analyzed after notifying the colitetor or contact person and der:raining that sa~alc could not be secured.
❑ �.Sarnple(s) on hold until:
5smpl;- reported with qualification. Data qualification code used:
❑ Other (explain):
Notification Required (circle
Person Contacted:
Lead Chemist Rcv(cw irtid I :
""ZCHE4(
-A L5
BrzlcIt Head Review (initist)
Q.VQC Rvescw (iniriai
QA1i4 MU,AbQ14NI)'SAx
Yes N
Form coma
❑ VOA
D_ c. r
Dz,::.
Lag;:: i:,:a e_-OS. sa by (initisI):
U7,
rrsdra.

NC DEiNRI WQ Chernistry L2bomrory
Repdr: to: Sample AnotnxIy Report (SAR)
Laic Number n a 1 -7 CC & Sample :D
St- 7 Location: „r 26/ 10<.; --`,Pr _1�.11 L�2Gounty. 0- Region: J�• ��
Sample Type: _— 04- r— Priority (4-'►v e—, Collector.
Date collected: 1�_I` Tate received: 0,—Z Date analyzed; _ A 1- 2�I��
Affected Parameter(s):.
An Iydcal Area (chccf: one):
%VCH ❑ METALS
❑ NUT ❑ MICRO
The following anomalies occurred (check: all that aopl►):
❑ Samples
❑ Improper container used
❑ VOA vials with hcadspacc
❑ Sul ride samples with hcadspacc
❑ Samples not received, but listed on i[cidshcet
❑ Samples received, but not fisted on iieldshcct
❑ Mislabeled as to tests, preservatives, ctc.
0 Holding time expired
❑ Friar to receipt in lab
❑ After receipt in lab
❑ Insafricicnt quantity for analysis
❑ Sample exhibits gross non homogeneity
❑ Sample not chemically preserved properly
❑ PH out of range (record pH):
❑ Improper chemical
Residual chlorine present in sample
_s Color intericrencc
❑ Heavy emulsion formed during extraction
❑ Sample bottle broken in lab • no reportable`r�esults
e�,fJther (specify): 1- A t,
Comments.
a VOA
❑ PEST
❑ SVOA
❑ Quaiirr Control
❑ Insirstrneru failure - no re.-onabi: results
❑ Analyst error - no reportable results
❑ Surrogates
❑ None added
❑ Recovery outside acc:panct lirniu
❑ Spike recovery
C None added
❑ Recovery outside ace:atanc: Iimits
❑ F=iced to meet crite-ia for pre=ision
❑ Internal standards
❑ Blank contamination
❑ QC data reported outside of controls (i.e. QCS. L CS)
❑ Incorrcc, procedure us.-d
❑ SOP intentionally modirted i ith QA and Branch H.-:d
aporovni
❑ Invalid instrument calibration
❑ Elevated dct=cdon limits due to:
❑ Insufficient sample volts: to
v
Co rrective Action:
❑ Samples were rejectcd by DWQ Lab. Authorized by: Date: !
❑ Accepted and analyzed after notifying the collector or ccnract person and de:e-minina that another sarnpie could nor be s==urcd-
p �Sample(s) an hold {trail:
� Sample reported with qualification. Data qualification code used:
❑ Other (explain):
Notification Required (circle one)? Yes NO
Person Contacted: Date: 1 1
Form completed by gate:
10
Lead•Chemis[ Rer w � isiJ:
p SIOCHEM ❑ PEST ❑ SVOA
❑ hiETALs ❑ VOA
Brinell head Review (initial): l
QA/QC Review (initial . Logged into dztaaasc by (initial):

MEMORANDUM
DIVISION OF WATER QUALITY
GROUNDWATER SECTION
October 15, 2002
To: Jay Zimmerman, Groundwater Supervisor
Groundwater Section
Raleigh Regional Office
From: Evan Kane ftk-
Manager, Underground Injection Control (UIC) Program
Central Office
Re: Application for renewal of permit # WI0500033 (William B. Ott); request for inspection
and routine sampling of Mr. Ott's geothermal injection well system. This system is
located at 2701 Weaver Hill Drive, Apex, North Carolina.
1. Please review the renewal application and submit any comments to CO-UIC group.
Retain the application for your UIC file. ·
2. Please inspect the injection well site to verify that the location and construction plans
submitted in the application are accurate and that the NCAC Title 15A 2C.0200 standards
are being complied with, using the enclosed Injection Facility Inspection Report (Form
B) as appropriate.
3. Collect samples from the influent and effluent sampling ports and submit the results to
the CO-UIC.
Please return the completed Injection Facility Inspection Report (Form B) to the CO-UIC by
October 30, 2002. If the inspection and review can not be accomplished by this date, please
inform the CO-UIC. The UIC group greatly appreciates your assistance with this review. If you
have any questions regarding this review or the UIC program, please contact me at (919)715-
6165 or [e-mail].
cc: CO-UIC Files
Enclosures
F W�QrE Michael F. Easley, Governor
-ODD RAG William G. Ross Jr.. Secretary
North Carolin, rart ment of Environment and Natural Rssourcas
�+] r Alan W. Klimek, P.E. Director
pluislon of Water Quality
A `C
October 15, 2002
Mr. William B. Ott
2701 Weaver Hill Rd.
Apex, NC 27502-6548
Dear Mr. Ott:
Your application for renewal of a permit to use a well for injection of geothermal heat pump
effluent has been received and is currently 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 site and collect water samples as part of the review.
If you have any questions regarding the status of your permit application or regarding injection
well rules please contact me at [phone] or Mark Pritzl at [phone].
Sincerely,
o'
Evan O. Dane, P.G.
Underground Injection Control Program Manager
cc: Raleigh Regional Office
CO -[.TIC files
*A
UnrN—V
Groundwater Section 1636 Mail Service Center Raleigh, NC 27699-1635 [phone] Customer Service
1 800 623-7748

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
r
APPLICATION FOR PERMIT RENEWAL TO USE A WELL(S) FOR INJECTION WITH
A HEAT PUMP SYSTEM
TO:
A.
Q
Type 5A7 and 5QM Wells
In accordance with the provisions of NCAC Title 15A: 02C.0200
complete application and mail to address on the hack page.
DIRECTOR, N RT CAROLINA DIVISION OF WATER QUATY D�� �
DATE: �! r3 ��oat. 20LI►�1
SYSTEM CLASSIFICATION: Does the system re -circulate only potble water without any additives such as
cc�,rroslon iiSh:%itors or antifreezes in continuous piping which isolates the fluid :%corn the enviroiinrent?
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
PERMIT' APPLICANT
Naive: LA/ I -t_ i A rw% IS- 0 I-T'
Address: 1-1 U 1 W-tA" R 1 a j« P t `.
city: A A X _ State: L Zip code- -L 75y 2-
County. LAB V* 1+' FL Telephone: 5 t S- 3 d 3- o o S I
C. PROPERTY OWNER (if different from applicant) -�
Name:
Address: _
City: State: Zip code:
rw
County: 'Telephone:
D. STATUS OF APPLICANT
Private: X Federal: 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: w Telephone: Contact Person: _
Standard Industrial Code(s) which describe commercial facility:_ ___
ver.3/01 GWMIC-57 HPR Page 1 of 3

F. INJECTION PROCEDURE (specify any modifications to the injection procedure since the issuance of the
previous injection permit)
V j rD rJ rL
G. WELL USE Is(are) the injection well(s) also used as the supply well(s) for either of the following?
(1) The injection operation? YES X NO
(2) Your personal consumption? YES >C NO
H. CONSTRUCTION DATA
(1) Specify any and all modifications to the well casing, grout or screens since the issuance of the previous
injection permit.
I�Jr•��L
(2) NC. State Regulations (15A NCAC, 2C, Section .0200) require the permittee to make provisions for
monitoring well head processes. A faucet on both influent (groundwater entering heat pump) and
effluent (water being injected into the well) lines is required. Is there a faucet on:
(a) the influent line? yes X no
(b) on the effluent line? yes y no
1. CURRENT OPERATING DATA
(1) Injection rate: Average (daily) gallons per minute (gpm)
(2) Injection volume: Average (daily) 6 b 0 gallons per day (gpd)
(3) Injection pressure: Average (daily) 5'O pounds per square inch (psi)
(4) Injection temperature: Annual Average 60 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 piping/tubing associated
with the injection operation. The manufacturer's brochure, if detailed, should satisfy (1).
K, LOCATION OF WELL(S) Attach a map
Include a site map (can be drawn) sbowing: the orientation of and distances between the injection wells) and
any existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet of the
ground -source heat pump well system; include buildings, property lines, surface water bodies, any other potential
sources of groundwater contamination. Label all features clearly and include a north arrow to indicate
orientation.
L. PERMIT 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 GWMC-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,
ti0./FL
N. CERTIFICATION
"I Hereby certify, under penalty of law, that I have personally examined and am familiar with the informanon
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 inforrriation. 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 of Well Owner or Authorized Agent)
If authorL:ed agent is acting on behalf of the well owner,
please supply a letter signed by the owner
authorizing the above agent.
0. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property rights in the
wells). 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)
(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 GWUC-57 HPR Page 3 of 3

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LVGH NORTH CAR jNA 2T61

Michael F- Easley, Governor
William G. Ross Jr., secretary
North Carolina L-,artment of Environment and Natural Resources
September 6, 2002
William Ott
2701 Weaver Hill Drive
Apex, NC 27502
Dear Mr. Ott;
Alan W. Klimek, P.E- Director
Division of Water Quality
Our records show that the operating permit for the injection well on your property did expire on
December 31, 2001. In addition, our records do not indicate that the well has been abandoned.
In order to comply with the regulatory requirements forpermitted injection facilities (15ANCAC 2C
.0211), you trust submit either 1) the enclosed Application for Permit Renewal to Use a Well(s)ifor
Injection with a Heat Pump System (form GW-57 HPR) if you are still using your injection well or
2) the enclosed Status oflnjection Well System (form GW-68) that certifies that the injection well is
no longer in use.
If the well is no longer to be used for any purpose, it must be permanently abandoned according to
the regulatory requirements (15A NCAC 2C .0213), and you must submit the enclosed Well
A bandonmen t Record (forth GW-30). The appropriate form(s) should be forwarded to us by October
1, 2002 to allow adequate time for well water sampling and analysis.
If you have any questions regarding the permit and injection well rules or would like assistance
completing these forms please contact Mark Pritzl at [phone].
cc: CO-UIC Files
RRO-UIC Files
Enclosures
A*
amn 4
Customer Service
1 800 623.7748
Sincerely,
Evan 0. Kane, P.G.
UiC Program Manager
Division of Water Quality 1 Groundwater Section
1636 Mail Service Center Raleigh, NC 27699-1636
Phone: [phone] Fax: [phone] Internet: http:11gw.ehnr.state.nc.us

AF'
�A,
htCDENR
JAMPS B. HUN7.�I]t,'
GOVERNOR - -_
13IL-L HOI-MAN
SECRETARY
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
December 22, 1999
William Ott
2701 Weaver Hill Drive
IfERR T. STEVENS Apex, NC 27502-6548
DMECTOR
Dear Mr. Ott:
Per our phone conversation, the Groundwater Section has amended Permit No.
WI0500033 for the operation of a geothermal heat pump injection well. It is our
understanding that the street address listed in the original permit application, 1617
Pricewood Lane, Apex, North Carolina 27502-9410, did not reflect the physical
location of the injection well. In accordance with the information you provided, the
amended injection well permit now reflects the appropriate address at 2701 Weaver
Hilt Drive, Apex, North Carolina 27502-6548, in Wake County.
If you have any questions regarding your permit please contact me at [phone]
or Amy Axon at [phone].
Sincerely,
PU /�J
F-IN
Mark Prital
Hydrogeological Technician II
Underground Injection Control Program
cc: UIC Files
RRO Files
-—Enclosures � y
I
GROVNCw ATIER SrCT1ON
1036 MAIL SERVICE CZNTIER, RALEIGH, NC Z7899.1636 - 2728 CAPITAL, BLVD., RALEIGH, FfC 27604
IIHONL O I R-733.3221 FAX 919-715-O586
AN EpUAL OPPORTUNITY I AFFIRMATIVE ACTION EMPLOYER - 50% RCCYCLEDI10% POOT-CONSUhWER PAPEPI

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
· William Ott
FOR THE CONSTRUCTION AND OPERATION OF AN INJECTION WELL for the purpose
of injecting heat pump effluent. This sy$tem is located at 2701 Weaver Hill Drive, Apex, North
Carolina, in Wake County, and will be constructed and operated in accordance with the
application dated July 9, 1998, and in conformity with the specifications and supporting data
submitted, all of which are filed with the Department ofEnvironment 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 shaH be effective, unless revoked, from the date of its issuance until December 31,
2001, and shall be· subject to the specified conditions and limitations set forth in Parts· I through
X hereof.
Permit issued this the :l Iv day of <[}l?:C ~~ , 1999.
<[L ~kZ>
Ted L. Bush, Jr., Assistant Chief
Groundwater Section
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No. WI0500033 PAGE10F6
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this pennit 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 connectseparate 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 ra.te of
injection, as describ~d in the application and other supporting data.
Permit No. WI0500033 PAGE20F6
2. This pennit 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 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 Permittee of the responsibility of
complying with any and all statutes, rules, regulations, or ordinances which may be
imposed by ~ther local, state, and federal agencies which have jurisdiction. Furthennore,
the issuance of this permit does not imply that all regulatory requirements have been met.
PART N -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 assi~ilate 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 Pennittee 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.
Permit No. WI0500033 PAGE30F6
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 'Yith 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 pemiit
application,· or of any incorrect information submitted in said application or in any report
to the Director, the relevant and correct facts or infonnation shall be promptly submitted to
the Director by the Permittee.
4. In the event that the permitted facility fails to perfonn satisfacto·rily, the Permittee shaII
take such immediate action as may be required by the Director.
Permit No. WI0500033 PAGE40F6
PART VIII-PERMIT RENEWAL
The Permittee shall, at least three (3) months prior to the expiration of this perm~t,
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 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
purpos~, the Permittee shall abandon that injection well in accordance with the procedures
specified in 15A NCAC 2C .0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of
abandonment procedures if the Director finds such removal will not be
responsible for, or contribute to, the contamination of an underground
source of drinking water. '
(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.
( ~) Each well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could lead to the contamination of an
underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be
introduced into the well through a pipe which extends to the bottom of the
well and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and screens have
not been removed, the casing shall be perforated opposite the gravel pack,
at intervals not exceeding 10 feet, and grout injected through the
perforations.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner
that will prevent the movement of fluids into or between underground
sources of drinking water and in accordance with the terms and conditions
of the permit.
Permit No. WI0500033 PAGE 5 OF 6
(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:
UIC Staff
Groundwater Section
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART X -OPERATION AND USE SPECIAL CONDITIONS
NONE
Permit-No. WI0500033 PAGE60F6
DIVISION OF WATER QUALITY
GROUNDWATER SECTION
December 9, 1999
MEMORANDUM
To: Jay Zimmerman
Groundwater Section
Raleigh Regional Office
From: Mark Pritzl /lip
Hydrogeological Technician II Mark.Pritzl [e-mail]
UIC Group
Groundwater Section
Raleigh Central Office
Re: Issuance of injection well permit type 5A7 Geothermal Heat Pump:
Permit Number WI0500033 to operate a well for the injection of ground -source heat pump
effluent has been issued to Mr. William Ott, in Apex, 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

NOW,
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Dms10N OF WATER QUALITY
December 9, 1999
Mr. William Ott
1617 Price*bod Lane
Apex, NC 27502-9410
Dear Mr. Ott:
In accordance with your new application dated July 9, 1998, we are forwarding
Permit No. WI0500033 for the operation of a geothermal heat pump injection well at
1617 Pricewood Lane, Apex, NC, in Wake County. A copy of the laboratory test
results of water samples collected on July 12 and September 2, 1999 are also
enclosed. Please note due to elevated Fe(iron) and Mn(manganese) 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 Fe(iron) and Mn(manganese)
concentrations.
This permit shall be effective from the date of issuance until December 31, 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 months prior to
its expiration date on December 31, 2001.
If you have any questions regarding your permit please contact me at [phone]
or Amy Axon at [phone].
Sincerely,
Ajkp-�
Mark Prital
Hydrogeological Technician II
Underground Injection Control Program
cc: UIC Files`
xlto Files
Enclosures �
o-• y. - ' .w - GROUNDWATER SECTION
1838 MAIL SERVICE GENTRR/ RAL910H.'NC•27881.1i7s'-' 2728 CAPITAL, 8LYO.i RAL910K, NC;7SOd +•
. 7 �L PHONE 01A`733-3221 FAX [phone]
AN E9VAL OPPORTUNITY / APPSRNATIVR ACTION IMPLOY[R.+ 567E RECYCLE011C% POf T•CQNSUAIER PAP -ILA

:·' ··.·_NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION . . . .
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES·
'-~:. RALEIGH, NORTH CAROLINA . . . .
.. :}\;:, PE~ FOR nm coNsTRucTmN ANO oPERA TION oF AWELL FOR INJEcnoN .. :, <. '., .t :(_,:·.~-,· ;· . . ··-• . ~-. • -• ·• . ~ '. . ' • :· '
In accorda.nc-e with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and
other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
WiIIiam Ott
FOR THE CONSTRUCTION AND OPERATION OF AN INJECTION WELL for the purpose
of injecting heat pump effluent. This system is located at 1617 Pricewood Lane, Apex, North
Carolina, in Wake County, and will be constructed and operated in accordance with the
application dated July 9, 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, ~d does not waive any provisions of the
Water Use Act or any other applicable Laws, Rul~s, or Regulations. Operation and use of an
injection weII shall be in compliance with Title ISA No Carolina Administrative Code 2C
.0100 and .0200, and any other Laws, Rules, and Regq tio_ns pertaining to well construction and
use.
This permit shall be effective, less revoked, fro the date of its issuance until December 31,
2001, and shall be subject to e specified condittons and limitations set forth in Parts I through
Xhereof. ·
.... . ;
: Permit No. WI0500033 .. . ) . ~
PART I-WELL CONSTRUCTION GENERAL CONDITIONS . \
:·· . -~~ , .. ~-,t
·::t t ·: :.<Tiie Permittee must comply with all conditions of this permit and with the standards and
criteria specified in Criteria and Standar~ App!icable to Injection Wells (ISA NCAC 2C
.0200). Any noncompliance with conditio~s of this permit constitutes a violation of the
North Carolina Well Construction Act and is ·gr9unds ·ror'enforcement action as provided
for in N.C.G.S. 87-94. · · -~ , •
2. This permit' shall bec_ome voidable unless the facility is constructed in accordance with the
conditions of this permit, the approve~_pl~ and specificatiQns, an.d other supporting data.
3. Each injection well shall not hydraulically ·corinect 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 wapiing 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 identificat~on plate.
8.· A completed Well Construction Record (Form.GW-l)'must be submitted for.each
injection well, to the Division of Water Quality (Division), within 30 days of completion
of well construction. · · ·
PART Il -WELL CONSTRUCTION SPECIAL CONDITIONS
' _:;'.t:*:; __ ·;., ... ,-. ~~~·-·
. . .. _ -,~, .. t. ·.~·-'_~:-· ·;·~ i , __ ... ,~-·: t ~t:. • ' . ·~ : ....
At least forty-eigh~ (48) hours'prior to.c9nstructing eacl(_injection well, the Permittee shall
notify the Groundwater Section·-. Underground Injection Control (UIC), Central Office
staff, telephone _number (919). 715-6165. ,. :'.. _,, -: . .
f ·. 'I :.·
_·_PART'm~~ OPERATION AND ·usE GENERAL·coNDrr10NS
• • 0C :,, 1, "••~; • , :' ,_
0
) ~ • ' I '
J
1. Thi!(p~nnit is effec~ve.only wfth respect :tothe nature, volume o(µiate.tjals ~d r~fe:of.
injection, as described in the application and other supporting·~ta:; · ·:: · 'f .:1.-'-.·\ j••::.,.s·-
• -1~. • \ ·•• • -_. ·.' ~ -~.-:~ -~' / --., ~ ~ ~i
i f -1: :· !. . ' ~ • .,; _:s,,_.
-tPermi~No;;,wiosoooiJ PA913 2 OF 6 ·,. -.-' ' ___ ,._ ·f ,.::' t . ;•'~ .•'' ·-. ·/·;:~ ?:;f{ii ;,t
2. This pennit is not transferable without prior notjce to, and approyal by, the Director of the
Division of Water Quality (Dir~ctor). In ~e event there is a desire for the facility to
change ownership, or -~ere i~ _atname c~arige of the Permittee, a formal perinit amendment·
request must be submitted to the Director;••including any supporting materials as may be
appropriate, at least "30 'days prior' to the dat~ of the cliange. .,
3. The issuance of this permit shall not reli~ve'tbe Pe~ittee of the responsibility of
~_ginplying with_ any · and all statutes~ rules; regulations, or ordinances which may be
:t }W: itµp·osed by other local~· state, aitd federal' agencies which have jurisdiction., Furthermore,
the issuance of this p~rmit does not· imply that all regulatory requirements have been met.
PART IV-PERFORMANCE STANDARDS
1. The injection facility shall.be effectively maintained and operated at all times so that there
is no contamination of groundwater which will render it unsatisfactory for normal use. In
the event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Pennittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or
abandonment of the injection facility.
2. The Permittee shall be required to comply .with the .terms and conditions of this permit
even if complianc~ requires a reduction or elimination ofthe·permitted activity.
3. The issuance of this permit shall not relieve the Pennittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. Tlie injection facil!ty shall be properly maintained and operated at all times.
~-... r~; ~ . .-., . .-\-~:.-, f:~t, . . ... ·?
2. . The Pennittee must riotify the Division ansJ. receive prior written approval from the
D_irector of any planne_dpliysical ~lteratipns or additions in the permitted facjljty or
activity not specifically authorized by the permit. _ . -...
~, _-• -J , .. , \ ~
·3: _At least forty-eight (48) hours prior_t(?. ~e-~itiation ·ofthe operation ofthe _facility for
injection, the Permittee mu~t -notify by,telephone .the·_Groundwater Section -Underground
·-··• _lnjectiqn Control (VIC), G.en~l Office s~ff, ·telephone rt~ber(919) 715-6165. .
· ... , ~oti_fic3:tion, is _Jeq~ii~<!soJhat Dtv~si9n··staff canin_spec~_or. otherwise rexiew .~e injection
_·\i · .. :.fa.~i}.ity ~4. de~eI'IJl~_i.f it i~ in corµpliance with permit conditions~ · '' :• ..
j•·tf';, ;-' ,';: ... .-_'.'·, •. ,_., ~~ ,.)\.'_f-?:· ·, t i ~:;t.~---.· .. .,;J .• )-t:"-: __ ~-~)}_,,··_:·.-:_:_~.'_ .... ::: f ~' . .
: ~.. "=4:. . ~ ~· : ~ .. .;,r.f:; • ';/:;:_,-' \ ' . .. . ' >.:;\~ ' . " ''}t :, 1:\ ;,-~.
-.:.: ··:· . •· PennitNo •. WI0S0003J-.·: •': ,r,·1~ .:! •. -_ ·• . _ :-.. -
!tif ,·}t;\_:·;, ._ .. ;:,.··<~:1-t·.,,•· 11.:···}'.'~:t;f;,1:llt;:;1t~\}
-; f~,\.-: t \ •. ~.-:-.• ~ • i'!';_-~:~:· ....
• ·.1!.-~,i., \~ . ' '" . . .. 'I?'~
l
• J
PART VI-INSPECTIONS
► ~ :
1. · Any duly authorized officer, employee~ or representative of the· Division of W ijter Quality
m~y, upon presentation of credentials, en~er and inspect any prop_erty, premises, or place
on or related to the injection facility at any reasonable time for the purpose of determining
coinpliarice with this permit, may inspect ot copy any records that must be· maintained
under the terms~and conditions of this pe~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 sampling associated 'with injection and any relat~d -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 circums~ces;
Q3) Any f~ilure due to ~own or
1
~own reasons, that renders the facility
_ incapable of proper injection operations~ such as mechanical or electrical
. ;: .. ···failures.··
3. Where the Permittee becomes ~w~e of~ Qmission of any relevant facts in _~ permit
· application, or of any incorrect information submitted in said appl~cation o~ ~ any report -~
-·. · to the Director, the.relevant and correct facts or information shall be promptly#submitted to ··,
~, :i•t._the Director by the Permittee .
., . . ·' 'f . ::,:. ••. ·,.'1. -·
· -Pertnit No .. WI0S00033 , ·
•• '.. . 'l
PA,.RT VIII:~ ~ER.MIT RENEW AL
t<l. .-. ~ t, .. ,
The Permittee shall, at least three (3) months prior to the expiration of this permit,
_ reque~t an extension.
PART IX-CHANGE OF WELL STATUS
~ . ' ~. :
r. 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 .Q213(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:
(A) All casing and materials may be rem(?yed prior to initiation of
abandonment procedures if the Director finds such removal will not be
responsible for, or contribute to, the contamination ofan underground
source of drinking water.
(B) The entire depth of each well shall b~ sounded before it is sealed to insure
freedom from obstructions that may inte~ere 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 ~~ter. i .
(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 $rough the '-·
. .. ' perforations. , ., ,,,:!t. -~i,'t-\,: ~-· . :( .~_;;'. :}~(';"•,~<.
(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
,• • C that' will prevent the movement of flui4s ~to or between underground .
··._}··--~ources of drinking ·water 'and in accordance with the terms and cond!tions >~. -\_':i ofthe permit. · ·r"''·-~'.'· ·
Permit No,. WIOS00033 ·, PAGESOF6
i\
OlC',",0 •h •
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30)
as specified in lSA NCAC 2C .0213(h){l) within 30 days ~f completion ._
of abaridonment. "'· · ·
3. The written· documentation required in Part IX (1) and (2) (G) shall be submitted to:
. ~-'· . ·:~ ~-. :·; ·me s~rr' •;: -, __
. ~--Groundwater· Section
'··:'.oENR~Di~ision of Water" Q'uality
1636_ Mail Service Center
Raleigh, NC 27699-1636
PART X-OPERATION AND USE SPECIAL CONDITIONS
NONE
Permit No. wi0S00033
I •
MEMORANDUM August 30, 1999
To: Mr. William Ott
From: Mark Pritzl tel. [phone]
Re: Groundwater Sampling Results from July 12, 1999
Influent Water Sam pl e Effl ue nt Water Sam ple
Coliform, total <1/100 ml Coliform, total <1/100 ml
Coliform, fecal ns Coliform, fecal ns
pH 7.0 pH 7.2
Chloride 4mg/L Chloride 7mg/L
Total Dissolved Solids ns Total Dissolved Solids ns
Total Hardness 54 mg/L Total Hardness 42 mg/L
NO2· + NO3-as N 0.03 mg/L NO2· + NO3-as N 0.31 mg/L
TKN 0.2 mg/L TKN 0.2 mg/L
NH3 <0.01 mg/L NH3 0.01 mg/L
Aluminum, Al ns Aluminum, Al ns
Calcium, Ca ns Calcium, Ca ns
Cadium, Cd < 2.0 ug/L Cadium, Cd <2.0 ug/L
Chromium, Cr <25 ug/L Chromium, Cr <25 ug/L
Copper, Cu ns Copper, Cu ns
Iron, Fe 370 ug/L Iron, Fe 1,400 ug/L
Potassium, K ns Potassium, K ns
Magnesium, Mg ns Magnesium, Mg ns
Manganese, Mn 79 ug/L Manganese,Mn 95 ug/L
Selenium, Se <5.0 ug/L Selenium, Se <5.0
Nickel, Ni <10 ug/L Nickel, Ni <10 ug/L
Lead,Pb ns Lead, Pb ns
Zinc, Zn 3,500 ug/L Zinc, Zn 1,300 ug/L
State Groundwater Quality Standards:
Classifications and Water Quality Standards Applicable-To The Groundwater's of North Carolina
(North Carolina Administrative Code Title ISA: 02L.200)
Coliform., total <1/100 ml
Coliform, fecal <1/100 ml
Chloride <250 mg/L
Total Dissolved Solids <500 mg/L
N02· + NO3-as N <10 mg/L
Cadium < 5.0ug/L
Chromium, Cr <50 ug/L
Copper, Cu <1000 ug/L
Iron, Fe <300 ug/L
Manganese,Mn <50 ug/L
Nickel, Ni <IO0ug/L
Lead,Pb <15 ug/L
Zinc, Zn <2,IO0u~
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
( I gram/1,000grams )/1,000grams
( 1 gram/1 ,000,000grams )/ 1,000grams
MEMORANDUM December 8, 1999
To: Mr. William Ott
From: Mark Pritzl tel. [phone]
Re: Groundwater Sampling Results from September 2, 1999
Influent Water Sample Effl ue nt W ater Sam ple
Coliform, total ns Coliform, total ns
Coliform, fecal ns Coliform, fecal ns
pH ns pH ns
Chloride Iis Chloride ns
Total Dissolved Solids ns Total Dissolved Solids ns
Total Hardness ns Total Hardness ns
NO2· + NO3-as N ns NO2· + NO3-as N ns
TKN ns TKN ns
NH3 ns NH3 ns
Aluminum, Al ns Aluminum, Al ns
Calcium, Ca ns Calcium, Ca ns
Cadium, Cd < 2.0 ug/L Cadium, Cd <2.0 ug/L
Chromium, Cr <25 ug/L Chromium, Cr <25 ug/L
Copper, Cu 21 ug/L Copper, Cu 17 ug/L
Iron, Fe 330 ug/L Iron, Fe 470 ug/L
Potassium, K ns Potassium, K ns
Magnesium, Mg ns Magnesium, Mg ns
Manganese, Mn 96 ug/L Manganese,Mn 100 ug/L
Selenium, Se ns· Selenium, Se ns
Nickel, Ni <10 ug/L Nickel, Ni <10 ug/L
Lead, Pb <10 ug/L Lead, Pb <10 ug/L
Zinc, Zn 3,900 ug/L Zinc, Zn 2,500 ug/L
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
Coliform, fecal <1/100 ml
Chloride <250 mg/L-
Total Dissolved Solids <500 mg/L
NO2· + NO3-as N <10 mg/L
Cadium < 5.0 ug/L
Chromium, Cr <50 ug/L
Copper, Cu <1,000 ug/L
Iron,Fe <300 ug/L
Manganese, Mn <50ug/L
Nickel, Ni <100 ug/L
Lead,Pb <15 ug/L
Zinc, Zn <2,100 ug/L
1 Liter ·of water = 1,000 grams at 20_° C
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
( 1 gram/ 1,000,000grams )/ l ,000grams
'19 NO 16 Aid !Q' 37
COUNTY WAKE
QUAD NO:
REPORT TO RAO Regional Cdiice
C()LLEcmR(S7 : GREER
DATE: ALL
TIME:
DIVISION OP WA•1 ER QUALrry �`r,,�.+`'� L V I
Chcw4 I.+4ar.lory Repwd 1 Gre..d W.ler pe `` "'��(�' H �Erii "' -� -� �
J&MPL� ORITY �,`~ W1�f� !
�ROu-n NE ❑EMERGENCY=�FI�'�[ p
CHAIN OF CUSTODY
SAMPLE TYPE
PURPOSE: Owrwr; !l71t ►YILLIAhi OTT
Location or Site:
Description of sampling point
SampSna Method:
RemaTla-
C.YaSIBIEK"
LR6 Number 9G 1719
Date Received WV1999
Time Reuived I1 "
Received By : 14MW
Rekased lay : AR
Dafr repormd : 1GaV1999
901719YS

Lat.
NDWATER FIELD/LAB FORM
No Serial No
Long.
SAMPLETYPE SAMPLE ,PRIQRITY
Water ❑ Routine
Soil ❑ Emergency
❑ Other
Report To: ARO, FRO, MRO RRO aRO, WiRO, 111 Chain of custody
WSRO, Kinston FO, Fed. Trust, Central Off_, Other:
Shipped by: B , Courier, Hand Del., t� /?
Purpose:
Collectortsj:5k2
Date a1' Vqz2& Time %/ 1 � Baseline
FIELD ANALYSES Owner�7� Imo'
pH,0D Spec. Cond.94 at 250 C
Temp.,, °C Odor
Appearance
Field Analysis By:
location or site
North Carolina
Deparlment of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
Lab Number
Date Rec ived Time
Rec'd by: From: Bus, Courier, and .,
Other:
Data Entry By: Ck:
Date Reported:
y Compliance LUST Pe tillt de Study, Federal Tru-_ OFhAr J �.�) G
Description of sampling point 1z-IC_-
Sampling Method Sample Interval 1- S_4a2
Remarks u
In.n., Oki
LABORATORY ANALYSES --"
BOD 310 rwA
Diss. Solift 70300 m 1
A - Silver 4S5E6 u_qfl
Or anochlorine Pesticides
GOD High 340 mgA
Flouride 951 m A
Al - Aluminum 46W u A
Organophospho►us Pesticides
COD Low 335 I
Hardness: Tolig 900 MC0
As - Arsenic 46551 Mg
Pesticides
Coliform: MF Fecal 31616 /100ml
Hardness non-carb 902 m 1
'Nitrogen
Ba- Barium 46558 u n
Acid Herbicides
Coliform: MF Total 315D4 1100ml
Phenols 7
Ca - Calcium 46W m A
PCB's
TOC 6so m l
1 z
Cd - Cadrnlum 46559 uco
Turbidity 76 NTU
Sulfale 946 m-w
Cr - Chromium 465W u if
Residue., Suspended 530 mW
Sulfide 745 nigA
Cu - Copper 46562 u
Fe - Iron 46563 u II
Semivolatile Organics
Oil and Grease M911
A
Ff - MerCury 71900 uJ:�A
TPH - Diesel Range
pH 403 unit
K - Potassium 46555
Alkalinity to pH 4.5 410 mgli
M - Magnesium 46554
Alkalinity to pH 8_3 415 mgll
Mn - Manganese 46565
Carbonate 445 nw
NH as N 610 m fl
Na - Sodium 465W
Volatile Organics (VOA bottle)
Bicarbonate 440 m I
TPH - Gasoline Range
Carbon dioxide 405 mgtt
ND + NO as N 630 mqA
Pb - Lead 46564 ug
TPH - BTEX Gasoline Range
chloride 94o mo
P: Total as P 665 m A
Se - Selenium ugA
Chromium: Hex 1032 u 11
Zn -Zinc 46561 u A
Color: True so Cu
Cyanide 720 mgn
Lab Comments:
1wFor Dissolved Analysis - submit filtered sample and write "DW in r
1• .

COUNTY : �1'AkE
QUAD NO:
REPORTTO RRG
RegionalOffim
COLLECTORS) : GREER
DATE: zal19ss
TIME:
PURPOSE:
Owner
Location nr Sise:
Dew6ptlon Of sampling point
sampling Method_
Remarla:
LABORATORY ANALYSIS
COMMENTS:
�l
DIVISION Of WATER QUALITY
Ch.mistry L�bamla T Rgwrl I Gmaad wek:m Qw-My �~` �F� H s' a Nunrinn : 9G 1718
99 NOV 16 AM 10: 37 - Rfcm'�.
it Rcorlved - 71t1177f
SAMPLE PR10R1TY�� �r -
DROUHNE LIEMERGENCY
CHAIN OF CUSTODY
I
W� SAMPLE TYPE
57 R. IYl LL1Ahl5 QTT
me Received : 11:20AM
Reeerred By HMW
Rckased By : AR
Date rcpOr4d : Iw=1999
Oe aochWrine Pesliades
Or hams Pesuadrs
Nilmgea Pnlicidrs
Acid Habiodes
SemirOlaOks
TPH-Diesel Ran
Vobdk Org=cz VQAbWk)
TPH-Gualioe Range.
TPH-BTEX Gasoline Ran r
96s719.ds

North Carolina
G � O U N D WATE R FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
C unty SAMPLE TYPE SAMPLE PRIORITY Lab Number
uad No Serial No. Water ❑ Routine Date Rece'ved a Time
Svit Emergency
Eat. Long. ❑ Other Rec'd by: From: Bus, Courier, and De
Other:
Report To: ARO, FRO, MR WaRO, WIRO, L-13 Chain of Custody 1(a Data Entry By: Ck:
WSRO, Kinston FO, Fed. Trust, Central Off., Other: Date Reported:
Shipped by: BUS. Courier, Hand �t)3 5ns��
Purpose:
Cotlectortsj: Date �� r7q a7_ Time �i G ?� � Baselin m lain ampllance LUST Pesticide Study, Fedora} Tres Other 1 tom_
FIELD ANALYSES Owner
PH400 Spec. Cond.g4 at 250 C Location or site r l —
Ternp.io °C Odor Description of sampling paint 7
Appearance Sampling Method Sample Interval -- S�
Field Analysis By- Remarks
°`'}
LABORATORY ANALY5QS -
BOt7 3 1 o m 11
Di . Solids 7WW mqA
A - Silver 46566 ugA
Or anochlorine Pesticides
COD High 340 mgli
Flouride 951 m A
AI - Aluminum 46557 UgA
Organophosphorus Pesticides
COI] Low 335 ►n /l
Hardness: of m
As -Arsenic 46551 u
Nitr2gen Pesticides
Colilnrm: MF Pecal 31616 1100ml
Hardness non -cart 9M m
Ba - Barium 46558 u A
Acid Herbicides
Coiiform: MF Total 31504 1100ml
peals 32720 yco
Ca - Calcium 46W m 1
PCB's
TOC sea m
cond. 95
Cd - CadmlUm 46559 u 1
Turbidity 76 NTV
Sulfate 945 m I
Cr - Chromium 46560 uqA
Residue., Suspended 530 mgA
Sulfide 745 Mq1l
Cu - Copper 46562 u A
j�
Fe - Iron 46563 u A
Semlvolaille Organics
Oil and Grease m Il
Hg - Mercury 71goo UV
TPH - Diesel Range
pH 403 unit
K- Potassium 46555 mgA
Alkalinity to pH 4.5 410 mgA
M - Magnesium 46554 MR!]
Alkalinity to pH 8.3 416 mgA
Mn - Manganese 46565 u A
Carbonate 445 mgll
NH as N 610 mull
Na - Sodium 46556 m I
Volatile Organics (VOA bottle)
Bicarbonate 440 m
TPH - Gasoline Range
Carbon dioxide 405 mgA
NO + NO. as N 63o m-qA
Pb - Lead 46564 u !I
TPH - BTEX Gasoline Range
Chloride 940 mgA
P: Total as P 665 m l
Se - Selenium uaA
Chromium: Hex 1432 ugA
Zn - Zinc 46567 u A
Color: True 80 Cu
Cyanide 720 mgA
Lab Comments:
For Dissolved Analysis - submit liltered sample and write "DIS" in t

Page i 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. W1
NAME OF OWNER 7,Z, 6;. ZI
DATE 9 q D 3 Z Z,
ADDRESS OF OWNER IZ f G,.,Ic
(Sirrell road or IN and juddhinon, county, town)
LOCATION OF PROPOSED INJECTION WELL (and source well(s), if applicable)
�'r7' a � t3L � _�--��.H_ t.t<� s C r n 5 S i Hr fie. c�7 �. I/ �I C _ G❑`f ,S _ _i
treed road or 161 and suddh, on , county, to d0erent than awn address, plus dexripkon of locatico, on site)
Potential pollution source It1 .4�1 z Distance from well -t I a2a
Potential pollution source Distance from well
Potential pollution source
Distance from well '
Minimum distance of proposed well from property boundary 6 v r
Quality of drainage at site C�AFlooding potential of site
good degvate,poor) (high,moderate�
DRAW SKETCH OF SITE
(Taw property boundaries, buildings, wells, parential pollution sources, roads, approxinmte wale, and north arrow.)
C
TY4
(o
Cn
L.
44, /March 98

Page 2 of 2
PRECONSTRUCTION INJECTION FACILITY
INSPECTION REPORT - FORM A (coot.)
CoMyMN TS
INSPECTOR
r�x G k
Office .S7a ') z
M 7 j
WITNESS E p!` o r
Address�V�t3
WITNESS
Address
MW1 98

North Caro: Department of Environment and P- tral Resources
Division of Water Quality - Groundwater Section
Zd
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PER -NUT NO. WI DATE
NAME OF OWNER ► -� d3 —do3
ADDRESS OF OWNER7 f =
(Streetl road or lot and subdivision, county, town)
LOCATION OF INJECTION WELL (and sours well(s), if applicable)
e j R
(Streeil road or lot and subdivision, C10 , town, ifiliffereo address, plus description of location on site)
Potential pollution source � , �W Distance from well 4 rLp
Potential pollution source Distance from well
Potential pollution source Distance from well
Minimum distance of well from property boundary A _v_ �
Quality of drainage at site Flooding potential of site _
dequare,poor) (high,moderate, Z)
DRAW SKETCH OF SITE (Show property boundaries, buildings, wells, potential pollution sources, roads, approximate scale, and
north arrow) r— r^f
S� -o r 1
C,
DESCRIBE INJECUQMSIVSTEM vertical closed Ioop, uncased borehole or cased water well; separate source well and
injection weII, om�nation source and injectio - • , or other description as applicable)

INJECTION FACILITY INSPECTION REPO n T -FORM B (cowmuw
WELL CONSTRUCTION
Date constructed 7 —
Drilling contractor: Name
Address
1 _.-
�a
Registration number
44
Total depth of well 9 P O
Total depth of source well
� : _ q-3 e
(:f applicable)
Inspection point
Measurement
Meets minimum standards
Comments
Yes
No
Casing
Depth
Q l
Diameter
&
e�
Height (A.L.S.)
7.''
s%
Grout
Depth
�
f ZZo
Screens
Depth(s)
62,cla -dole- .
Length(s)
I.D. Plate
-k
--
Static water level
'3a
Well yield
i�� In
Enclosure
,
Enclosure floor
(concrete)
Sampling port
(labeled)
Water tight pipe entry
Well enclosure entry
t�
Vent
Functioning of hest pump system (Determine from the owner if heat pump functions properly.)
INSPECTOR
Office
WITNESS
Address
WITNESS Address March 1998

RECEIVED 1 uEvik
(IVll G91 003'00ATER 5EC"UM
99 NUG 25 AM 10: 45
COUNTY r
WAKE
QUAD Na.
REPORT TO -
RRO
COLLECMR(S) 7
GREER
DATE:
7112199
-ITAIE:
PURPOSE'
LABORATORY ANALYSIS
Regional Office
HOD 310 m L
COO Hi h 340 m I.
COD Low 335 stirI I.
Coliform: RIF Fecal31616 I001n1
!C
Cotiform:METotal 31504 al /10Dnd
ROC m ,1l
Twbitiry NTU
Residue -Sus wvdrd530 m L
Total Sua ended solids m L
H 7.0 units
Alkalinitv to pH 4.5 m /L
Alkalinity Io p1l8.9 m L
Carbonate m /L
Bicarbonate m /L
Cwbondioxide m /L
Y
Chloride 4 -LIL
Chromium' Hex 1032 w /L
Color. True 80 C.u.
[Cyanide 720 m /L
COMMENTS
Owner.
Location or Sit,:
Description of sampling point
Sampling Method:
Remarks:
DIVISION OF WATER QUALITY
CbmiAry Laboratory Report 1 Growrnd Rater Quallty
5AMFa PRIORITY
ROUTINE EMERGENCY
CHAIN OF C9J.SIDUY
WD SAMPLE TYPE
MR. WILLIAM OTT
QM, Solid. 7MM
rn L
Fluoridc 951
sn /b
?[ 11famine=tv1019w
54
m• L
Ilardnew. non-caeb 902
in•/L
Phenols 32730
u L
5 •rcifie Cwsd. 95
umhos cus2
Sulfate
m lL
Sulfide 745
to L
MBAS
m L
Oil and Grease
m L
Silica
m L
Borah
Furmaldehs de
m l L
X
NH3 mN610
K0.01
m /L
R
TKN as N 625
0.2
m /L
X.NO2
rNO3 as n 630
0.30
m L
P: Total as P 665
mjrf L
POI
m /L
A -Silver 46566
u L
A] -Aluminum 46W
1.191L
As-Ar.enic4655L
u L
W-Barium46558
u /L
CaX'akium 46552
m / L
x
Cd-Cadium46559
<2.0
a L
X
Cr-Chmudum 46560
<25
u L
Ca r 100
u L
Fe- hoer 100
370
n L
IxCu-
Ii . Mercun' 719011
URIL
K-Potassium 46555
m L
M - Ma nesium 927
m L
x
mn-Irten aneae Im%
79
u /L
Na- Sodium 929
m L
R
Ni-Nickel
<10
u L
Pb-Lead 46564
u I.
1L
Se-Seludum
e5.0
u L
7[
Zn_Zurc 46567
3500
u L
Lnb Number 9i:1281
Date Received '
711NF4
Time Received :
11; l0
Received By
HMw
Released 8y : DS
Date reported, 812309
Or anochlorine Pesticides
❑r rna plea phorus Pesticides
Nitroran Pcslkides
9GM-2.luk-

North Carolina
.GROUNDWATER FIELD/LAB FORM Department al Environment, Health, and Natural Resources
DIVISION. OF WATER QUALITY - GROUNDWATER SECTION
County i A_ke- SAMPLE TYPE SAMPLIzP_RIORITY Lab Number G r
Water El Routine
Quad No Serial No. Sil Date Recei d Time
Lat.. Long. ❑ other El Emergency Rec'd by: From: Bus, Courier, and De
T_ Other:
Raport To: ARO, FRO, MRO, 9WaRO, WiRO, ❑ Chain a1 Custody Data Entry By: Ck:
VVSRO, Kinston FO, Fed. Trust, Central Off., Other: Date Reported:
Shipped by: Bus, Courier, Hand Oel.on_h: iYl U �l
Purpose:
Collectorts): c7f eff Date - . Time 10a Z) Baseline, Complaint, Compliance LUST, Pesticide Study, Federal Trus Other: ` VI
FIELD ANALYSE Owner �il� owl
PH400 Spec. Cond.94 at 250 C Location or site i
Temp.10 oC Odor Description of sampling point —
Appearance Sampling Method Ouvyo Sample Interval_ _ Q co
Field Analysis By: Remarks
IpurnpinQ 4M„n. aV IcrrK,. mc.)
LABORATORY ANALYSES
BOD 310 m h
COD High 340 mgll
COD Low 335 mgli
Cotilorrn: MF Fecal 31616 11Dan-i1
Colilorm: MF Total 31504 1100m]
TOC 660 rrlgli
Turbidity 76 NTU
Residue., Suspended 530 mgli
pH 403 unit'
Alkalinity to pH 4,5 410 mg/1
Alkalinity to pH 8.3 415 mg/I
CarbWate 445 rngll
Bicarbonate 440 inr 11
Carbon dioxide 405 mgll
Chloride 940 mgll
Chromium: Hex 1032 ugll
Color: True 80 CU
Cyanide 720 rngfl
Lab Comments:
Flouride 951
n4 - rXJYC1 WOW _
Al -Aluminum 46W
Ac _ Artanic-dFr L;1
l Hardness (non-carb) 902 mall I I I Ba - Barium 4655b uall
Sulfate 945 n
Sulfide 745 11
I Oil and Grease rng11
[,?!I-] Nli, as N 610 nu111
NO, + R ,vas N 630
f -. Total as P 665
\.,[d - Nand Ul l l 907J1 " f l ll Li
Cd - Cadmium 46559 uc11i
Cr - Chromium 4656n ugli
Cu - Copper 46562 ugA
Fe - Iron 46563 ug/l
Hg _ Mercury 71900 ugll
K - Potassium 46555 mgll
Mg=Magnesium 46554 mgll
_ f
Mn - Marulanese 46565 urgll
Na - Sodium 46556 rr1rJ11
i - ic_k@I �1_&
Pb - Lead 46564 u !I
Se - Selenium ugll
_
Zn - ZinC 46567 ua11
anochiorine Pesticides
ananhosohorus Pesticides
Nitrogen Pesticides
Acid Herbicides
PCB's
Semivolatile Organics
TPH - Dlesell Range
_ Volatile Organics (VIDA boftlej
TPH - Gasoline Range
TPH - BTEX Gasvllre Range
G%N'-54 REV.: For Dissolved Analysis - submit liltered sample and write "DI in L f r ..1

COUNTY: WAKE
QUAD NO.
REPORT TO : RRt7
COLLECTOR(5) : GREER
DATE: VIN99
TIME!
P1IRPOSC:
r•
LABORATORY ANALYSIS
R^GEIyQ r DEF-R
DWu SECT104
59AUG 2 5 IFS IG` 4 5
Regional ❑i(kv
6OD 3I0 m ,/ L
COD Hi h340 m /L
COO Law 335 m / L
Colifunm: NIF Fecal31616 100m1
t
Colilvrrm MF-To W 31504 <1 /Iwml
TOC m /I
Turbititt NTU
Residue., Sum F.,nded 530 rI.
Total Smsended solids m / L
Y
ri 7.2 units
AlkaHrtily to +F14.5 m /L
Alkalinitc to pH 3.3 i n , L
Cnrbonale rtl /L
Bicarbonate m /L
Carbon dioxide m / L
X
Chloride 7 mg/_L
Chromium: Hex 1032 1- , L
Color. live 80 c.u.
Cyanide 720 m / L
COMMENTS
Owner
Location or Sile:
Descri pi ion of sampling point
Sampling Me":
Remarks:
DIVISION OF WATER QUALITY
Ctfembtry Lalrorntury Report Ground Wafer Qunrity
SAMPLE PRIORTIY
DROU"F1NEEMERGENCY
CHAIN OF CUSTODY
E
W SAMPL.E TYPE
MR WILLIAM OTT
Disc. Solids 70300
m / L
F luoride 95)
m /L
x
H+udness: total 9W
42
m 1_
Hardness: non arb 902
m L
Phenols 32730
u / L
5 ific Cond.95
nmhm/cm2
Sulfate
m /L
Suiftde745
rngj L
MSAS
m /L
Oil and Grease
rn /L
Silica
m /L
Soren
FPnnaldehvdc
rr+ /L
Y
N113 as N 610
0.01
m L
x
TKN as N 625
0.2
in /L
%
NO2 +NO3 as n 630
031
rn /L
p Total asp 665
err L
PO4
m /L
Lab Number
9C 1282
Date Received
1112l99
Time Received _
11;40
Received lly
FLMW
Released By : D5
Dote reported: "f99
9G1282 JUL

North Carolina
`GROUNDWATER FIELDILAB FORM Department of Environment, Health, and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
'v County_ V�r � SAMPLE TYPE SAMPLE PRIORITY
Quad No Serial No_ &Water ❑ Routine
❑ soil [] Emergency
Lat. Long. ❑ other
—
Report To: ARO, FRO, MRO, RQ WaRO, WiRO, ❑ Chain of Custody
Lab Number a
ODate Rey 'vec
Rec'd by:_m
E Other:
Data Entry By:
�'10�,_Time
From: Bus, Courier, land De
Ck:
WSRO, Kinston FO, Fed. Trust, Central Off., Other: Date Reported:
Shipped by: Sus, Courier, Hand Del ether
Purpose;
_
Collectorjsj: (W 'Date Titre _� _0 1_� Baseline, Complaint, Compliance,LUST, Pesticide Study, Federal Trust, Cher)
FIELD ANALYSE _ Owner r v }
pH490 Spec. Cond.94
Temp.,, oC Odor
Appearance
Field Analysis By:
LABORATORY ANALYSES
BOC, 310 mgll
COLT High 340 mg/1
COO Low 335 mgli
Coliform: MF Fecal 31616 1100ml
T
Colilorm: MF Tolal 31504 1100ml
TOC 680 mgll
Turbidity 76 NTU
Residue., Suspended 530 mgll
pH 403 unit.
Alkalinity to pH 4.5 410 mgll
Alkalinity to pH 8.3 415 mgll
Carbonate 445 mg/I
Bicarbonate 440 mgA
_
Carbon dioxide 405 mglf
Chloride 940 mgll
Chromium: Hex 1032 ugll
T
Color: True 80 CU
Cyanide 720 mgll
Lab Comments:
at 250 C Location or site
Description of sampling point U%J G, t t VA
Sampling Method
Remarks {PUr ,
Diss. Solids moo mg/1
Aq - Silver 46566 ugn
Flouride 951 m /1
At - Aluminum 46557 u A
Hardness: Total goo mg/1
As - Arsenic 46551 ugll
Hardness (non-carb) 902 mq
Ba - Barium 46558 ugll
_
Phenols 32730 UEO
Ca - Calcium 46552 mall
S�ecillc Cond, 95 uMhoslcm'
Cd - Cadmium 46559 uyll
Sulfate 945 m lg_I
Cr - Chromium 46560 uglf
Sulfide 745 ma
_
Cu - Copper 46562 u A
Fe - iron 46563 ugll
Oil and Grease mgll
fig - Mercury 71900 ug/l
K - Potassium 46555 mg/1
Mg - Magnesium 46554 mgtl
Mn - Manganese 46565 ugA
NH as N 610 melt
Na - Sodium 46556 T m 11
ga
N4. - NiQkgl- -- - - - gall
NO, + NO, as_N 630 mall
_Pb - Lead 46564 ugll
P: Total as P 665 m A
Se - Selenium ugll
_
Zn - Zinc 46567_ ugll
Sample Interval q C� t
hlorine Pesticides
Organophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
PCBs
Semivolatile Organics
TPH - Diesel Range
Volatile Organics (VOA boltle)
TPH - Gasoline Flange
TPH - BTEX Gasollre Ranee
GW-54 REV.; For Dissolved Analysis - submit lillered sample and write "DIS" in bi,,&

North Caroliu 1epartment of Environment and Nq al Resources
Division of Water Quality - Groundwater Section
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PERMT NO. W1
NAME OF OWNER
ADDRESS OF OWNER
DATE
(Streeil road or lot and subdivision, county, town)
LOCATION OF INJECTION WELL {and sours well(s), if applicable}
r
3 —,aa3 i
WP& r S�%/
(Street mad or lot and subdivision, c(km , town, if diffiereik-than owner's address, plus description of location on site)
Potential pollution source S 7.�4, �� � e h Distance from well �
Potential pollution source eOf — Distance from well
Potential pollution source
Distance from well
Minimum distance of well from property boundary 110
Quality of drainage at site
dequate,poorj
Flooding potential of site _
(high, moderate, w)
DRAW SKETCH OF SITE (Show property boundaries, buildings, wells, potential pollution sources, roads, approximate scale, and
north arrow,)
Sic �o r �a 23-��
DESCRIBE �T10XSYSTEM rvertical closed loop, uncased borehole or cased water well; separate source well and
injection well; combination source and injection , or other description as applicable)

INJECTION FACILI'T'Y INSPECTION REPOFT -FORM B(CONTINUED)
WELL CONSTRUCTION
Date constructed 7—
Drilling contractor; Name f' At
Address 7
Registration number 1 _3-4 ;
Total depth of well _!a2V Total depth of source well
(f applicable)
Inspection point Measurement Meets minimum standards Comments
Yes No
Casing
Depth
ICE Q /
Diameter
& " 4
Height (A.L.S.)
r
T
Grout
Depth
Screens
Depth(s)
Length(s)
I.D. Plate
Static water level
r
Well yield
�'2. wm
Enclosure
y
Enclosure floor
c
(concrete)
J
Sampling portf
(labeled)
Water tight pipe entry
Well enclosure entry
t�
Vent
Functioning of heat pump system (Determine from the owner if heat pump functions properly)
INSPECTOR
Office
WITNESS
Address
WITNESS Address March 1998

3L 3 — 0, 03/
North Caroiine
Depae-nent of Environment, Health, and Natural 'resources
Division of Environmental Manageme.
Groundwater Section r-3 5 J. U-1
Well Location. •% _2G y
[sown, Com (unity, SubdMsion and Lot W) cj
Drilling Contractor
lam�
Permlt 3g;i&% ? QNj
Locatlon - Distance From:___....
Water Tight Sewage/waste collection..
Waste disposal (septic tank drain field)
Other Poll. Source r }
Other Poll. Source { 1
Calino
Type.....................................................
Depth....................................................
Weight/thickness..................................
Height (A.LS.) ......................................
Other ( } .
12rilllnn Fluids/Additives
Type.....................................................
Grout
Type.....................................................
Thickness.............................................
Depth....................................................
Other
Screens
Screened interval .... . ...........................
Other ( 1 .
02y2lument.........................................
Total Suspended solids ........................
Turbidity...............................................
Settleable Solids ...................................
ate
Well
Contractor .....................................
Abandonment.......................................
Temporary ............................................
Permanent ............................................
GW-36 Rev. 1[11i.q9
Construction
. N
UTOR
Date 9 4 o
WELL TYPE
County.
Road/Street 42, �v��c �
Quad No. j�t
Serial No.
Lat. Lono.`
Check Items
Measured
Meets Min. Standards
Yes No
BeMarks
(Permit No. }
...............
i
(Circe one)
Iaie5tiC Carbon Slain. St. Other
-
s�
Oa 4
A
pr'rAlti !
bG
1'
Applies lies to wells constructed after December 1, 1992

Check items
Measured
WellTest ..............................................
Meets Min.
Yes
standards
No
Remarks
Duration................................................
Frequency/Accuracy of measurements
Other ) .
Disinfection...... ...................................
V
�
Chlorination
Other ( j
Guttlnas................................
Reportsts.................................................
Construction (GW-1 ) ............................
Abandonment (GW-30) .......................
Miell Bead Cgmpletlorl
Access port ...........................................
Hosebib ..............................................
Pitless Adaptor ....................................
Pitless Adaptor Unit ..............................
Suction line ..........................................
Tee(jet? ................................................
Valved flow ...........................................
Vent.....................................................
Water tight pipe entry ......,....................
Wellentry.............................................
;..
t�
Date-Viell r d -2- l -S-r `e
Pump Installation Contractor
Name
Applies to wells constructed after December 1, 1992
Pump Ins#allation
Address
PUMP IONTRACTOR l.l]. PLATE PRErgEMT ? (Y[0 pat? Pump Installed
Violations noted attributable to the pump installation contractor are as follows:
Reg. #
(2)
(3)
INSPECTOR J
Name Office
Witnesses)
(it Available) Name Address Type
Name Address Type

Page 1 of 2
North Car,,.ina Department of Environment and l.atural Resources
Division of Water Quality -Groundwater Section
PRECONSTRUCTION INJECTION FACILITY INSPECTION
REPORT -FORM A
LNJECTION WELL PERMIT NO. Wl
NAME OF OWNER e? &�� Z4,4 1�2 e�2_ f-
DATE g 9 D 3 z z
ADDRESS OF OWNER ZA .. �4 _,, L e Gog_.1C _... .
363 — a n 3/ V a-_,
(Streed road or lot and suddivision, county, Aron)
LOCATION OF PROPOSED INJECITON WELL (and source well(s), if applicable)
'&reed road or lot and suddivision , county, toa dierenl than awn address, plus description of location on site)
Potential pollution source 2 Distance from well p
Potential pollution source - Distance from well C_ a
Potential pollution source Distance from well �� w
�v
Minimum distance of proposed well from property boundary
n
Quality of drainage at site Flooding potential of site na
goad dequate poor) (high,modera rw�
DRAW SKETCH OF SITE
(Show property boundaries, buildings, we14 potentialpalIunon sources, roads, approximate scale, and north arrow)
C J
V
4h / it-

Page 2 of 2
PRECONSTRUCTION INJECTION FACILITY
INSPECTION REPORT - FORM A (cons)
CON VIEN S
Gt. 1�1 a 0 J L-p�
r� i
Jam. 1 i .)- _ _f I• /. - I - I I _ • . f , • • •1 A _ . Y
IN5PECTOR A -A 6Z�4� � / �'�
Office ?gam 1 L
ja f za I = R
WITNESS
Address
WITNESS
Address
March 98

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
DATE _9 g- rD 3 7, Z_
NAME OF OWNER 17
ADDRESS OF OWNER /4 7 ZrZ.A►t ._2��
(Streetl road or lot and suddivmon, county, town) �'—
r =;
LOCATION OF PROPOSED INJECTION WELL. (and source wells), if applicable) ~'
_ treet/road or lot and suddivision , county, to different tiro„ own address, plus desmphon of locawn on site]
Potential pollution source Distance from well -t
Potential pollution source— Distance from well —
Potential pollution source
Distance from well
M mimurn distance of proposed well from property boundary 4, o "
Quality of drainage at site Flooding potential of site
good dequare,poar} (high,modera ow
DRAW SKETCH OF SITE
(Show property boundaries, $uildings, welk potential pollution sources, roads, approximate scale, and north arrow)
G
V r,
`J4, /March 98

Page 2 of 2
PRECONSTRUCTION INJECTION FACILITY
INSPECTION REPORT - FORM A (cant.)
CKi]uM r ork
INSPECTOR
Office 4�:a z
WITNESS
Address
WITNESS
Address
March 98

nul ill VO1 WIIa4 a
Department of Environment, Health, and Natural Resources
❑ivisiorr of Environmental Managemer
3L 3 r r7 0 -5, Groundwater Section r":) 5 -.� L'4 k -
Weil Location: —1k,�- 44
Crown, Comrf(unily, Subd< Won and Lot No.)
Owner. AA r L p� L ,� y►.�
Address- 16 ! U r'J tie. Q o a
jy� 2
Well Construction
WELLTYPE
County
Road/Street
Quad No.
Serial No.
Lat. Lonc.
Drilll�nrg Contractor �� 'S �--��ii ,2G� , r G . 6� 0 -.I:N et 1,S4Q
Name Address
IE
14
Water Tight Sewagetwaste collection..
Waste disposal (septic tank drain field)
Other Poll. Source [
Other Poll. Source
Type.....................................................
Depth... ...... . . . ....................................
Weight/thickness..................................
Height (A.L.S.) ......................................
Other ( }
DrillIng Fluidsl6ddMI22
Type......................................................
grout
Type.....................................................
Thickness.............................................
Depth....................................................
Other ( ) .
Screens
Screened interval .................................
Other ( 1 .
❑eyelLop,Ment........................................
Total Suspended solids ........................
Turbidity..... ........ ..».............................
Settleable Solids ...................................
D- elate
1.Well Contractor........ .. .. .........................
Abandonrngntr..................................�
Temporary...........................................
Permanent..,.
7 L.
ea. u ►,
Cher2c Items Meets Min.
Measured Yes
Standards
No
Remar�s
(Permit No. }
............
(Circle one)
plastic Carton alp. Stain. St. Other
r
l♦
bG FI is& h ❑zw
GW-36 Rpv- 1 n/a9
"w Applies to wells constructed after December 1, 1992

-led[ Items
Measured
Meets Min.
Yes I
Standard.&
No
Remy
Duration..................».. ... .........
Frequency/Accuracy of measurements
Other
DislnfiectfQd..» ........... ..........
Chlorination ............ ............................
Other [ y
Quitings
�
Reim.................................................
Construction (GW-1 ) ._.................
Abandonment (GW-30) .......................
Access port.. ............................... o ..........
Hosebib ........ ._._........... .....................
Pitless Adaptor .....................................
Pitless Adaptor Unit .............................
Suction line ...........................................
Teebet) .............. ............................
Valved flow.... .....................
Vent.....................................................
Water tight pipe entry...._.___,.v
Wellentry .............................................
Applies to wells constructed after December 1, 1992
Pump Installation
Pump Installation Contractor �v►,mom _ _
Name Address Reg. #
PUMP T N (Y u fled 5,�-mt ,�s e.-e
Violations noted attributable to the pump installation contractor are as follows:
(,)am-Z�:) s16==1=;9
(2)
(3)
INSPECTOR
Name Office
Witness[esl
(if Available} Name Address Type
Name Address Type

: INJECTION FACILITY INSPECTION REPORT -FORM B (CONTINUED)
WELL CONSTRUCTION
Date constructed 7 1 57—
Drilling contractor: Name Af � I .� 7C• ��
Address
Registration number j _5 0 V
Total depth of well 9 22p Total depth of source well m
(f applicable)
Inspection point Measurement Meets minimum standards Comments
Yes No
Casing
Depth
Diameter
Height (A.L.S.)
Z'
s�
Grout
Depth
f z�
Screens
Depths)p'�.
Length(s)
I.D. Plate
Static water level
Well yield
�1Z , M
Enclosure
Enclosure floor
(concrete)
Sampling port
i
(labeled)
Water tight pipe entry
Well enclosure entry
!f
Vent
Functioning of heat pump system (Determine from the owner if heatpump functions properly.)
INSPECTOR
WITNESS
Office
Address
WITNESS Address March 1998

HECEIV-EO / OENR
OWQ GHOUNOWATEH SECTION
03 HAY 15 PH 1+: 0 I
. :: ... •·,• ... ; .·
,,'•. '
·./J~MES B. HUNT,JR-~
WAYNEM.COEVl1T
SECRETARY
'A. 'PRESTON HOWARD,
JR,, P.E~
DIRECT(?,~
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GROUNDWATER SECTION
July I 0, 1998
l\1EMORANDUM
To:
From:
Jay Zimmerman
Jim Greer
Groundwater Section
Raleigh Regional Office
AmyAxonJltf-
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 Geothermal Resources, Inc. for a new pennit
for the construction and operation of an injection well at William Ott's residence, 1617
Pricewood Lane, Apex, NC. The proposed injection well will be part of an open loop
geothermal heat pump system, therefore a type 5A7 well. 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 ISA 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
July 28, 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 C:\wordocs'shells\Pennit\ASKRWHP.doc
GROUNDWATER SECTION
P.O Box 29578, RALEIGH, NC 27626-0578 -2728 CAPITAL BLVD., RALEIGH, NC, 27604
PHONE [phone] FAX [phone]
AN EQUAL OPPORTUNITY/ AFFIRMATIVE ACTION EMPLOYER· !50% RECYCLED/10% POST-CONSUMER PAPER
NORTH CAROLINA
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 WeRs
In Accordance with the provisions of NCAC Title 15A: 02C.0200
Complete application and meal to address on the back page.
TO: DIRECTOR, NO TH CA OLINA DIVISION OF WATER QUALITY
�
DATE: — ` t 19
A. SYSTEM CLASSIFICATION Please check column which matches proposed system.
Type 5A7 wells inject water used to provide heating or cooling for structures.
I:?
C
(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 antifrcezcs 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 Offntent To
Construct A Closed -Loop Geothermal -Water Only Injection Well System,
PERMIT AP 1? I4CANT '
Name:
Address:
C ity.
Telephone
PROPERTY O R (if different from p Iicant)
Name: i t.'
Address: i'O ! j -T- :'U ',:L .•"�,�
City: Sate: E�
Telephone:
D. STATUS OF PPLICANT
Private; Federal:
State: Municipal
Zip Code;21Sb1County:
Commercial:
Native American Lands:
OW-57 HP (May 199$) Page I of

E. FACILITY (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal, State, Municipal or Commercial).
Name of Business or Facility:
Address:
city:
Telephone:
Zip Code:
Contact Person:
F. HEAT PUMP CONTRACTOR PA A [�
Name:
Address: U-, L-0" ,e 'O
City: '' .JAJt C Zip Code:
Telephone: b a t:l Contact Person:
County:
County:
G. IN ECTION P CEDURE (,(3riefly describe how thenection well(s) wi
Ok
H, WELL USE Will the injection wells) also be used as the supply wells) for the following?
(1) The injection operation? YES L' NO
(?) Personal consumption? YES NO
i, CONSTRUCTION DATA (check one)
EXISTING WELL being proposed for use as an injection well. Provide the data in
(1) through (7) below to the best of your knowledge. Attach a copy of Form GW-
I (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-I after construction.
(1) WeIl Drilling Contractor's Name: C , W, 6 -
NC Driller Registration number:
(�} Date to be constructed:-- Number of borings:
Approximate depth of each boring (feet): n Q 0
(3) Well casing; Is the well(s) cased?
(a) YES V If yes, then provide the casing information below.
Type: Galvanized st�eelr� Black steel Plastic Other (specify)
Casing depth: From to rOD ft. (reference to land surface)
Casing extends above ground _ 1 inches
(b) NO
GW-57 HP (May 1998) Page 2 of 4

(4)
(5)
Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement__\L_ Bentonite Other (specify) _______ _
(b) Grouted surface and grout depth (reference to land surface):
/ __ around closed loop piping:,.~~~~ to (feet).:
\/~ound well casing; from F to '..)12._. (feet).t1-fMt'
Screens (for Type 5A7 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 )he well) lines is required. Will there be a r7:on:
(a) the influent line? yes_V_· _ n 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 form to the best of your knowledge.
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 OPERATING DATA (for Type 5A7 wells)
(1)
(2)
(3)
(4)
Injection rate:
Injection Volume:
Injection Pressure:
Injection Temperature:
K. INJECTION FLUID DATA
Average (daily) / 0 gallons per minute (gpm).
Average (daily) /d00 gallons per day (gpd).
Average (daily)~unds/square inch (psi).
Average (January) ,S:S: ° F, Average (July) 68 ° F.
(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: ______ Formation: ______ Rock/sediment unit: _____ _
(2) Chemical Analysis of Source Fluid (for Type SQM wells)
Provide a complete listing of all chemicals added to the circulating heat transfer fluid:
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 welI(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 arrow,
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
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
O. 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 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 Well Owner or Authorized Agent)
If authorized agent is acting an behalf of the well owner,
please supply a letter signed by rite 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 property 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 1 SA 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 4

0
William & Virgina Ott
1617 Pricewood Lane
Apex, NC
27502-9410
[phone]
To whom it may concern,
I hearby authorize Richard. Blosser to act as my agent in the matter of and limited
15a NCAC, sub chapter 2C section .0200.
w-uludim

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MAY 19 '83 29:51
North Carollna - Department of Environmonl and Natural Resources
Division of Water Quality - Groundwater Section
P.D. Box 29578 - Raleigh, N.C. 2762"578
Phone (919) 733-=1
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: '
STATE WEII
tQR bPF1h L j l
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NMe�p[i�aa'R?.: f •i1 rye �r f !
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.L CONSTRUCTION
DRILLER REGISTRATION NUMBER: S4{ PERMIT NUMBER-
1. WELL LOCATION: (Show ketch of the location below)
Nearest Town- "( County: t0k l+ A f
W -e-a U I., /V,111 rI r.
{Road, Community, or Subdivision and Lot No.) � D iaTH
2. OWNER From To
ADDRESS........D - ► 7
(Street or Rouse No.)
Ciiy or Town State Zip Gods
3. DATF DRILLED 7 '!'12P USE OF WELL A"S
4, TOTAL DEPTH. '?40
5. CUTTINGS COLLFCTED YFFS [] NOM
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO[n
7, STATIC WATER LEVEL Below Top of Casing: 66 FT.
(Use •+" if Above Top of Casing)
8- TOP OF CASING 18 FT. Above Land Surface*
Casing Terminated attar below Wid surtaee Is 111e9al unless a vwlarlce to lsauod
in accordance with IGA YUC 20 At ie
9_ YIELD (gpm):- %3 —AMETHOD OF TEST-':"
In. WATER ZONES (depthy:.1Q0 - ad o - 3y0-Vda { tiau aa
11. CHLORINATION, Type ��� Amount
12 CASING,
Wall Thlelmoss
Depth Dlarnater or WeighUR- Material
Event To ° �' Ft.— • let? C>y i s� e I
From To--- - Ft.
From To Ft.---- —
13. GROUT:
Depth Material Method
From ❑ To x o Ft.
From -To Ft.
14. SCFIEIrN:
Depth Diameter
From —To Ft in.
From To Ft. in.
From To Ft. in.
15, SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To_ Ft.
16. REMARKS;
slot Size Material
In.
in.
Material
S 7 — gav
DRILLING LOG
Formafion oescription
red e_fAg
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7L1:.s:e I'ae j
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k
It additional Vane Is needed use back of form
LOCATION SKETCH
(Show direction and dletance from at isast two State
Roaft or other reap reference points}
ClarS� ny
wry — ,c; rt
pr
I
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH t5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO Y OF THIS RECORD HAS BEEN PROVIDED TO THE WFLL OWNER.
SIGNATURE OF 00 R OR AGENT DATE ;!
Submit original to Division of VVetw Quality and copy to wsO owner.
GW4 REV, ilea
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Contour interval
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