WI0500116_GEOTHERMAL_20040504

May 4, 2004
MEMORANDUM
To: File
From: Thomas Slusser~
Hydrogeological Technician II
Underground Injection Control Program
Reference: UIC Permit# WI0500012
Issued to Paul Madritch
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
This permit number for a Type 5A7 injection well system was originally issued in January 199land
due to expire in October 2002. In 2003 Mr. Madritch had this system converted into a 5QW closed
loop injection well, which is currently deemed permitted by rule.
On this date the record for this permit was removed from the UIC:file database, which keeps track of
injection wells that need permits, and added to the 5QWlist database, which keeps track ofinjection
wells that do not require permits. Likewise, the paper file was moved to a drawer that stores 5QW
injection well files.
N. C. Division of Water Quality / Groundwater Section
1636 Mail Service Center Raleigh, N.C. 27699-1636
Phone: [phone] Fax: [phone] Internet: http://gw.ehnr.state.nc.us
Customer Service
1-877-623-6748
Michael F. Easley, Governor
William G. Ross 3r., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P. E. Director
Division of Water Qual Ity
CoIeen H. Sullins, Deputy Director
Division of Water Quality
May 4, 2004
Paul Madritch
1110 Olive Chapel Road
Apex, NC 27502
RE: Notification of intent to construct Type 5QW injection wells
Dear Mr. Madrztch:
In accordance with the notification you submitted to the UIC Program on April 30, 2004, the
Groundwater Section acknowledges your construction of 1 closed -loop geothermal water -only
injection well for the operation of a ground -source heat pump. The system as described in your
notification is deemed permitted by rule (North Carolina Administrative Code Title 15A:
2C.021 I (u)(2)) and will not require an injection well permit from the state. If you modify your
system at any time, including the addition of antifreeze, corrosion inhibitors, or any other substances
to the circulating fluid, you must contact the Groundwater Section to verify compliance with
applicable rules.
Thank you for submitting this notification. If you have any questions regarding geothermal heat
pump wells or injection well rules please contact me at [phone].
cc. Jay Zimmerman, Groundwater Supervisor
Raleigh Regional Office
UIC-CO files
Sincerely,
Thomas Slusser
Hydrogeological Technician II
UIC Program
N. C. Division of Water Quality J Groundwater Section
1636 Mail Service Center Raleigh, N.C. 27 699- 163 6 Customer Service
Phone: [phone] Far. [phone] Internet: httpJlgw.ehnr.stale.nc.us 1-877-623 G748

Pans S. Madritch
1110 Oflve Cbmpd Bead Home Phone — (919) 387-Q958 Ce[! (919)GiF24985 _ -
Apex, North C:arolkni, 27502-8510 a -mail— pma&*dvex3n"r.4.vw
April 29, 2004
Thomas Slusser
N.C. Dept of Water Quality J Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Reference: Your letter of April 14, 2004, re: system modification
The reason for changing my system from an open loop system to a closed loop system is
two fold:
1- Even though all the water taken from the well was returned to it, the water level
fluctuated to such an extent that at times the well pump failed to maintain
adequate water flow though the system.
2. The bottom of the well began to cave in significantly reducing the: amount of
water available for use in my heating/cooling system.
My understanding of the modification procedure used to change from an open to a closed
system is:
1. Re -drill the well to original depth (approximately 400 ft)
2. Insert closed loop piping
3. Fill hole with gravel (no sure of type of material used)
4. Cap top of hole with grout.
Please contact me if you have any further questions.

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: _________ State: __ Zip Code: _____ County: ____ _
Telephone: __________ Contact Person: ____________ _
Standard Industrial Code(s), SIC, which describes commercial facility: ________ _
F. HEAT PUMP CONTRACTOR DATA
Name: evJ/11'/ ~,,s:r S,-tn~ I.! Cu-/t171 .llf
Address: I 117 i!J&T CIIG u ,1 .,(011 0
City: I)__ P BX State:~ Zip Code: :ZOJ1tt-County: k:4l'eu
Teleph~: 3~2:-7-S,t-o Contact Person: ..1alJV-Ll -=L:..o.Lc__...:e:-e,=---t,,::........:....h.=JV'-----,c__,-_-"-=-· .::...~..::....t S.L·,C..r __ _
G. CONSTRUCTION DATA (check one)
--=/__ EXISTING WELL(S) being proposed for use as a ground-coupled heat pump
well(s). Provide the information in (1) through (3) below to the best of your
knowledge. Attach a copy of Form GW-1 (Well Construction Record) if
available.
PROPOSED WELL(S) to be constructed for use as a ground-coupled heat pump
well(s). . Provide the information in (1) through (3) below as PROPOSED
construction specifications. Submit Form GW-1 after construction.
(1) Well Drilling Contractor's Name: 'j),"NIS V£t.'-t-/v,,..I' ('1/?J f,3 z -7 f'~ 7
NC Contractor Certification number: --~----------------7
Date to be constructed: ,x. I 9 ¥ 9 Number of borings: ___ /;__ _____ _
Approximate depth of each boring (feet):_~SZ,-=------=-~---'-F_i!'IIT-_=-'-----------
(2) Well casing: Is the well(s) cased?
(a) YES __L If yes, then provide the casing information below.
Type: Galvanized steel __ Black steel /Plastic __ Other (specify). _____ _
Casing depth: From ___ to ___ ft. (reference to land surface)
Casing extends above ground ::::;:: r inches
(b) NO~
(3) Grout (grout the vertical length of the borehole to a minimum depth of 20 feet b.l.s.):
(a)
(b)
Grout type: Cement __ Bentonite Other (specify) ______ _
Grouted surface and grout depth (reference to land surface):
__ around closed loop piping; from ___ to ___ (feet).
__ around well casing; from __ to __ (feet).
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
Ver.3/01 GW /UIC-57 CL Page 2 of4
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED-LOOP
GEOTHERMAL WATER-ONLY INJECTION WELL SYSTEM
(GROUND COUPLED HEAT PUMP)
Type 5QW Wells
In Accordance with the provisions ofNCAC Title 15A: 02C.0200
Complete application and mail to address on the back page.
This is not the proper form to be used for injection wells in an open-loop geothermal system.
Do not use this form for systems that circulate any substances other than water.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: #P111 4 2. 'Z. , 20.!!_!/_
A. SYSTEM CLASSIFICATION Does the proposed system circulate potable water in continuous
piping that completely isolates the fluid from the environment?
YES ~yes, then continue completing this form.
NO If no, do not complete this form. Form GW-57 HP, Application For
Permit To Construct And/Or Use A Well(s) For Injection With A Heat
Pump System, should be completed.
B. SYSTEM FLUID Will any additives be introduced to the system's circulating heat transfer
fluid? This includes, but is not limited to corrosion inhibitors and/or antifreezes.
C.
D.
Ver.3/01
YES If yes, do not complete this form. Form GW-57 HP, Application For
Permit To Construct And/Or Use A Well(s) For Injection With A Heat
Pump System, should be completed.
NO _L" If no, then continue completing this form.
PROPERTY OWNER
Name: B vL &])IP /'1C../f
Address: _._L~L~L~t2--P~L=---I _V~l!_...,,C~f~'-/,~:!"!~t?~l:_L_~lt~fl1'~!}o<.---------------
City: /y;tr,,. State: NC... Zip Code: 2-7 f7/ 2----P Pt1
County: W (,f ij Telephone: 2 t z" 3C-7-o9 ('"Y
STATUS OF PROPERTY OWNER
Private: ~ Federal: Commercial:
State: Municipal: __ Native American Lands:
GW/UIC-57 CL Page 1 of 4
1110 Olive Chapel Road
i
37'
l
Well , "2Q'. . /'
Site
543'
-11111----160' -----
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Korth Carolina Department of Environment and Natund Resources
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
April 14, 2004
Paul Madritch
1110 Olive Chapel Road
Apex, NC 27502
RE: Notification of construction of Type 5QW injection well
Dear Mr. Madritch:
Thank you for clarifying your recently submitted STATUS OF INJECTION WELL SYSTEM form.
Changing your ground -source heat pump system from an open loop to a closed -loop water -only
system, as described during our conversation on April 13, 2004, constitutes a system modification
and not abandonment of the injection well.
Your current heat pump injection well system is deemed permitted by rule (North Carolina
Administrative Code Title 15A: 2C.0211(u)(2)} and will not require an injection well permit. Since
we need to keep track of all such systems and ensure that they are constructed properly, please fill
out the enclosed form NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL
WATER -ONLY INJECTION SYSTEM and return by April 30, 2004. On a separate sheet of paper
describe in detail the reason for and modifications of the injection well system. If you modify your
system at any time, including the addition of antifreeze, corrosion inhibitors, or any other substances
to the circulating fluid, you must contact us to verify compliance with applicable rules.
Thank you for submitting this notification. If you have any questions about this form or geothermal
injection well rules please contact me at [phone] or Evan Dane at [phone].
cc: Jay Zimmerman, Groundwater Supervisor
Raleigh Regional Office
CO-UIC files
Enclosures
Sincerely,
Thomas Slusser
Hydrogeological Technician II
Underground Injection Control Program
N. C. Division of Water Quality 1 Groundwater Section
1636 Mail service Center Raleigh, N.C. 27699.1636 F11-481
Omer ServiPhone: (9l9)733-322! Fax: [phone] Internet: httpJlgw.ehnr.state.nc.us 77-623-6749

NORTH CAROLINA t
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY, GROUNDWATER SECTION
STATUS OF INJECTION WELL SYSTEM
Permit Number:
Permittee Name: 1oyr' 17A iD1Tz#
Address: / 110 & 1 vtT Aehnx ail 2,70 2—
Please check the selection which most closely describes the current status of your injection yell. a
In addition, please provide the requested information. �4iel r
1) _ Welt is still used for injection activities. 5 i 0 c,,
2) Well is not used for injection but is used for water supply or other purposes. 77 Fil
3) _.--�Injection discontinued and: a) Well temporarily abandoned 5 ;;z
b)_,,,,�ell permanently abandoned
c) Well not abandoned `o
4) — Injection welt never constructed
If you checked (2), describe the well use (potable water supply, irrigation, etc), including pumping rate and other
relevant information.
If you checked (3)(a) or (3)(b), describe the method used to abandon the injection well. (Include a description of
how the well was sealed and the type of material used to till the well if permanently abandoned):
y..f JFD 7'4 &I M. d y4r44 BrI� e- F:;,4 #aAT
I✓Et� TM3,00 8?' lif, CCAV P?�,
6F II r-,V-0 i ,,i - I4VA-C r-on.t A;, 0­ l+.AiL e_cwreocrpol, C oeiyms h-,r4L d-Pvwra 510c
Certification: (For well abandonment) MeA, #J"I A" S4/--fjis�
1 hereby certify, under penalty of law, that I am personally responsible for the proper abandonment of any
injection well as required in Title 15A NCAC 2C .0214 Criteria and Standards Applicable to Injection Wells."
zz
f�
ignature Date
Certification. (For information verification)
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document, and that tt the best of my knowledge the information is true, accurate, and complete."
Asignai6re
e Dat
ver.9103 GWIUIC-88

Tn fttrd/y ""---?f e"-loep
5 w t+vltel 1-o c[osel t~~p 67Ste.1V1 -lC£6t'-'t~r
=+«-"'" I\
■ Complete items 1, 2, and 3. A1so complete
item 4 if 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 mailpiece,
or on the front if space permits.
1. Article Addressed to
Mr. Paul Madritch
1110 Olive Chapei Road
Apex, NC 27502-8510
A. Received by {Please Wnt Clearly} S. & pelivery
1r`t■ !In 6V
C. signat*d
'
x / ❑ Agent
0 Addressee
D. Is nelfvery address d1ferent from item 1? 0 Yes
If YES, enter delivery address below: 0 No
3. Service Type
® Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.C.
4, Restricted Deiivery? (Extra Fee) 0 Yes
?003 1010 0001 2611 0065
P5 Form 3811, July 1999 Domestic Returns Receipt 102595-00-M-0952

o�oF W A
P
� r
March 31, 2004
CERTIFIED MAIL
RETURN RECEIPT REO VESTED
Mr. Paul Madritch
1110 Olive Chapel Road
Apex, NC 27502-8510
Ref.: Expired UIC Permit # W10500012
Dear Mr. Madritch:
Michael F. Easley, Governor
William G. Ross Jr., Secreuury
North Carolina Department of Environmeni and Natural Resources
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
The Underground Injection Control (UIC) Program of the North Carolina Division of Water Quality
is responsible for the regulation of injection well construction and operation activities in the state.
Our records show that a geothermal heat pump system with associated injection well was constructed
and permitted on your property under the name of Mr. Paul Madritch. The permit for this injection
well expired on October 31, 2002; therefore, your well may be in violation of North Carolina
General Statute Section 88-870) and other state regulations.
The UIC Program would like to help you resolve this situation by completing one of the following
procedures:
1.) If a geothermal heat pump system is operating on your property and you have an injection
well as part of this system, please complete and sign the enclosed form "APPLICATION
FOR PERMIT RENEWAL TO USE A WELL(S) FOR INJECTION WITH A HEAT PUMP SYSTEM."
2.) If an injection well is not operating on your property, please complete and sign the
enclosed form "STATUS OF INJECTION WELL SYSTEM" indicating that an injection
well is not in operation on your property.
3.) If you are unsure whether you have an injection well, please contact us at the phone
number below so that we can help you make that determination.
N. C. Division of Water Quality 1 Groundwater Section
1636 Mail Service Center Raleigh, N.G. 27699-1636 Customer Service
Phone: [phone] Fax: [phone] Internet: http://gw.elaw.state.nc.us 1-977-623-6748

Mr. Madritch
Expired UIC Permit # WIOS000 12
April 1, 2004
Page 2 of 2 .
The UIC Pro2:ram is sending this letter in ex pectation that you res pond regardless of whether or not
you currently have an injection well as part of your heating and cooling system. Please note that if
you do not respond to this letter within 30 days an inspection of the property may be forthcoming to
detennine if an injection well is in operation.
If you would like assistance completing any of the forms, or if you have any questions regarding the
UIC Program or injection well rules, please contact me at [phone] or Evan Kane at (919)
715-6165 .
cc: CO-UIC Files
Enclosures
Best regards,
~~~ Jll0W,'l .
Thomas Slusser
Hydrogeological Technician II
UIC Program
Please initial and return
to Amy for processing.
/Ir /kvF flo-' j,~
Bob Cheek g ~ c 1v / I 4 l 4. L--
Amy Axon ±#v f() /JY /1;
Marcus Geist f(Ab l'Y( 3/17
··State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
·; ~·· ,, .,.. . , .. "' . . -
Mr. Paul Madritch
1110 Olive Chapel Road
Apex, NC 27502-8510
Dear Mr. Madritch:
October 15, 1997
In accordance with your renewal application dated April 12, 1997, we are forwarding Permit No .
WI0500012 for the operation of a geothermal heat pump injection well at 1110 Olive Chapel
Road, in Apex, NC, in Wake County. A copy of the laboratory test results of water samples
collected on April 25, and August 18, 1997 is also enclosed. Please note that the heat pump
· eflluent water being discharged into the well contained iron levels equal to the state's
groundwater quality standard. If the water's iron level continues to increase, the Division of
Water Quality may not issue you another permit to inject heat pump effluent in the future.
This permit shall be effective from the date of issuance until October 31, 2002, 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.
If you have any questions regarding your permit please contact me at (919) 715 -6166 or Amy
Axon at [phone] .
cc: illCFiles
RROFiles
Enclosures
Groundwater Section
Sincerely,
~d~~
Marcu s A. Geist
Underground Injection Control Program
Voice 919ll33-3221 FAX 919ll15-0588
P.O. Box 29578, Raleigh, North Carolina 27626-0578
2728 Capital Blvd., Raleigh, North Carolina 27604
An Equal Opportunity/Affirmative Action Employer
50% recycled/ 10% post-consumer paper .
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, 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
Mr. Paul Madritch
FOR THE OPERATION OF AN INJECTION WELL for the purpose of injecting heat pump
effluent. This well is located at 1110 Olive Chapel Road, Apex, North Carolina, in Wake County,
and will be operated in accordance with the application dated April 12, 1997, and in conformity
with the specifications and supporting data submitted, all of which are filed with the Department
of Environment, Health, and Natural Resources and are considered 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 Cade 2C .0100 and .0200 and any
other Laws, Rules, and Regulations pertaining to well construction and use.
This permit, No. W10500003, is a renewal and renumbering of Permit No. 91-0945-WO-
0011, which was issued on July 31, 1991, and shall be effective, unless revoked, from the date of
its issuance until October 31, 2002, and shall be subject to the conditions and limitations specified
in Parts I through VIII herein. This permit replaces and shall also supersede Permit No, 91-0945-
WO-0011.
Permit issued this the/ `/ day of October, 1997.
Arthur Mouberry, P.E., Chief
Groundwater Section
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No. W10500012
PAGE 1 OF 5

PART I -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 is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
3. 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.
4. 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.
PART II -PERFORlVIANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is
no contamination of groundwaters which will render them 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 (Division) 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 groundwaters resulting from the operation of this facility .
Permit No. WI0500012
PAGE20F5
PART ID-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 IV -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 (see attached diagram).
PART V -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 Groundwater Section Staff, Raleigh Regional Office,
telephone number [phone], 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.
Pennit No. WI0500012
PAGE3 OF 5
3 . Where the Pennittee becomes aware of an omission of any relevant facts in a permit
application, or of any incorrect information submitted in said application or in any report to
the Director, the relevant and correct facts or information shall be promptly submitted to
the Director by the Permittee.
4 . In the event that the permitted facility fails to perform satisfactorily, the Pennittee shall take
such immediate action as may be required by the Director.
PART VI -PERMIT RENEWAL
The Permittee shall, at least three (3) months prior to the expiration of this Permit,
request an extension.
PART VII -CHANGE OF WELL STATUS
1. The Pennittee shall provide written notification within 15 days of any change of status of an
injection well. Such a change would include the 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, Well Construction Standards .
2. When operations have ceased at the facility and a well will no longer be used for any
purpose, the Pennittee shall abandon that injection well in accordance with the procedures
specified in ISA NCAC 2C .0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment
procedures if the Director finds such removal will not be responsible for, or
contribute to, the contamination of an underground source of drinking
water.
(B) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that inay 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.
PermitNo. WI0500012
PAGE40F 5
(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 exc~~ding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a r~~1.!!~ 0fthe injection operations, a subsurface
cavity has been created, ~:!ch 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 VII (1) and (2) (G) shall be submitted to:
Groundwater Section -UIC Staff
DEHNR-Division ofWater Quality
P.O. Box 29578
Raleigh, N.C. 27626-0578
PART VIII -SPECIAL CONDITIONS
NONE
Permit No. WI0S000 12
PAGES OF 5
October 15, 1991
40121u ■ .. I r ui
To:
Mr. Paul Madritch
1110 Olive Chapel Road
Apex, NC 27502--8510
From:
Marcus Geist tel, (919)
715-6166
Underground Injection Control Group
NC - DEHNR, Division of
Water Duality
Groundwater Section
Raleigh, NC 27626
Re: Well
Sampling Results from April 25 and August 18,
1997.
Influent Water Sample
Effluent Water
Sample
Coliform, fecal
<l/100m1
Coliform, total
<I/100ml
Bicarbonate
24 mg/L
Bicarbonate
24 mg/L
Chloride
15 mg/L
Chloride
15 mg/L
Hardness
34 mg/L
Hardness
30 mg/L
NO2 + NO3 as N 0.18 mg/L
NO2 + NO3 as N
C0.19 mg/L
Chromium,
Cr <25 ug/L
Chromium, Cr
c25-ug/L
Copper, Cu
280 ug/L
Copper, Cu
260 ug/L
Iron, Fe
330 ug/L
Iron, Fe
300** ug/L
Manganese,
Mn <10 ug/L
Manganese, Mn
<10 ug/L
Nickel, Ni
27 ug/L
Nickel, Ni
24 ug/L
Lead, Pb
<10 ug/L
Lead, Pb
<10 ug/L
Zinc, Zn
70 ug/L
Zinc, Zn
70 ug/L
** at the State Groundwater Quality Standard (see back of sheet)

State Groundwater Quality Standards:
Classifications and Water Quality Standards Applicable To The
Groundwaters of North Carolina
(North Carolina Administrative Code Title 15A: 02L.200)
Coliform, total 1/100 ml
Chloride 250 mg/L
NO2 + NO3 as N 1 mg/L
Chromium, Cr 50 ug/L
Copper, Cu 1000 ug/L
Iron, Fe 300 ug/L
Manganese, Mn 50 ug/L
Nickel, Ni 100 ug/L
Lead, Pb 15 ug/L
Zinc, Zn 2100 ug/L
mg/L = milligrams per liter parts per million
ug/L = micrograms per liter= parts per billion
1000 ug/L = 1 mg/L
COUNTY :
QUAD NO:
WAKE
Rf..Cc.\'J[O/H\HR •
Ot r,. GP.0\J~\D \"!i\1t.R SfC.
91 SE~ -2 ~r\ \d¼~
REPORTTO : RRO Regional Office
COLLECTOR(S) : GREER
DATE: 8118197
TIME:
PURPOSE:
LABORATORY ANALYSIS
BOO 310
COD High340
CODLow335
X Coliform : MF Fecal 31616 <1
X Coliform: MFTolal 31504 <1
TOC
Turbi1 ity
Residue., Suspended 530
Tolal Suspended solids
pH
Alkalinity to pH 4 .5
Alkalinity to pH 8 .3
Carbonate
Bicarbonate
Carbon dioxide
Chloride
Chromium : Hex I 032
Color: True 80
Cyanide 720
COMMENTS :
mg/L
mg/L
mg/L
1100ml
1100ml
mg/I
NTU
mg/L
mg/L
units
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
ug/L
c.u .
mg/L
Owner:
Location or Site :
Descr iption of sampling point
Sampling Method:
Remarks:
Diss. Solids 70300
Fluoride 95 I
Hardness: total 900
Hardness: (non-<:arb) 902
Phenols 32730
Specific Cond. 95
Sulfate
Sulfide 745
MBAS
Oil and Grease
Silica
Boron
Fom10ld ehyde
NH3 as N 610
TKN as N 625
NO2 +NOJ as n 630
P: Total as P 665
PO4
DIVISION OF WATER QUALIT\'
Chemistry Laboratory Rl'porl / Ground \\later Qnnlily
SAMPLE PRI ORIT Y
~ROUTINE
□ CHAIN OF CUSTODY
~ SAMPLE TYPE
MR PAUL MADRITC H
mg/L
mg/L
mg/L
mg/L
ug/L
uMhos/cm2
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
□EMERGENC Y
□
Ag-Sil ver 46566
Al-Aluminum 46557
As-Arsenic 46551
Ba-Barium 46558
Ca-Calcium 46552
Cd-Cadium 46559
Cr-Chromium 46560
Cu-Copper I 042
Fe-Iron 1045
Hg-Mercury 71900
K-Potassium 46555
Mg-Magnesium 927
Mn-Mnnganese I 055
Na-Sodium 929
Ni-Nickel
Pb-Leod 46564
Se-Selenium
Zn Zinc 46567
Lab Number 7Gl804
Date Received 8118/97
Time Received 9:10AM
Received By HMW
Released By : DS
Date reported : 8/28/97
ug/L Organochlori.nc Pesticides
ug/L Organophosphorus Pesticides
ug/L Nitrogen Pesticides
ug/L
mg/L Acid Herbicides
ug/L
ug/L Sem i\'olatilcs
ug/L TPH-Diesel Range
ug/L
ug/L Volatile Organics (VOA bottle)
mg/L
mg/L TPH-Gasoline Range
ug/L TPII -UTE X Gasoline Range
mg/L
ug/L
ug/L
ug/L
ug/L
7G1BO-'.AUG
GROUNDWATER FIELD/LAB FORM
County__
Quad No — Serial No... _
SAMPLE PRIORITY
Lat. Long.
EZROUTINE DEMERGENCY
Report To: ARO, FRO, MR04q&)WaRO, WIRO,
❑CHAIN OF CUSTODY
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
_
Shipped by: B Courier - land Del., Q�a gt" .
_ Purpose-,
Colfector(s):Date /-5- Time Bas e, Cr
EIEL
Owner ► : f rf
pH4. _ Spec. Corid.94 at 250 C Location or -site /f / O.
Temp.la oC Odor _ _ _ _
_ Description of sampling point
Appearance _ _-
Sampling Method
Field Analysis By:
Remarks L1!._ L --azHAve
North Carolina
Department of Environment, Health, and Natural Resources
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
Lab Number Z - -r-
Date Rec,iied'1704J0-rime
2 Rec'd by:_ 1h_W From: Bus, Courier, kid Del.
Other:
Data Entry By: Ck:
Date Reported:
I CompliancelcLLUST, Pesticide Study, Federal Trust,�da
-
-Z - u
Sa pie Interval � A -, L
0-
LABORATORY ANALYSES
i
BOD 310 mco
Diss. Solids 70300 I
Flduride 951 MM
A - Silver 46556 u I
Organochlorine Pesticides
COD High 340 myl
At - Aluminum 46557 ugrl
Organophosphotus Pesticides
COD Low 335 m
a d ess _Total goo_ wl
As - Arsenic 46551 ugn
Nitrogen Pesticides
Coliform: MF Fecal 31616 1100ml
Hardness non•carb 902 I
Ba - Barium 465M uqA
Galiierm: MF Total 31504 lit]0ml
Phenols32730 I
Ca _ Calcium 4E552 mall
Acid Herbicides
TOG eso m 1
Sp ci is Cnnd. 95 P//crn2
Cd - Cadmium 46559 u (-
Turbidity 76 NTU
Sulfate 945 mg 1
Cr - Chromium 46560 u I
Semivolatile Organics
Residue., Suspended 530 mgA
Sulfide 745 Mg/1
Cu - Copper 46562 u I
Fe - Iron 46563 u
H - Menu 71900 ug4
Volatile Organics (VOA bottle)
pH 403 units
K - Potassium 46555 mgll
Atkalinity iv pH 4.5 410 mgli
Ma - Magnesium 46554 nnll
TPH - Gasoline Range
Alkalinity to pH B.3 415 m94
Mn - Manganese 46665 ugll
TPH - STEX Gasoline Range
Carbonate 445 m9A
NH as N 610 mgll
Na - Sodium 46556 M91.I
Bicarbonate 440 I
TKH as N SPS
-Ni -_Nickel uafi
Carbon dioxide 405 mgA
No + NO as N 630 I
Pb -Lead 46564 UgA
Chloride 940 mgA
P. Total as P 665 MqA
Se - Selenium u i
Chromium: Hex 1032 ugl1
Zn - Zinc 46567 ucyl
Color: True so Pt -Col
T
Cyanide 72o maA
Lab Comments:
CAW-54 REV_ 6/93
Far Dissolved Analysis - submit filtered sample and write "DIS" in block.

---·•
;,,·cF.\\l f ()I~·:~·~~ '· C f"" -(,.
~ . \ ' .
Cl r:.pr. -,.) .,/ Jl.v J
r\t 1 tQ: 49
COUNTY : WAKE
QUAD NO :
RErORTTO : RRO Regional Office
COLLECTOR(S) : GREER
DATE : 4/25/97
TIME:
rURPOSE:
LABORATORY ANALYSIS
BODJI0
CODHigh340
CODLow335
Colifonn: MF Fecal 31616
Colifonn: MF To1al 31504
TOC
Turbitily
Residue., Suspended 530
Total Suspended solids
X 7.3
X Alkalinity to pH 4.5 20
X Alkalinity lo pH 8.3 <1
Carbonate <1
Bicarbonate 24
Carbon dioxide
X Chloride 15
Chromium : Hex I 032
Color: True 80
Cyanide 720
CO~IMENTS :
mg/L
mg/L
mg/L
/I0Oml
1100ml
mg/I
NTU
mg/L
mg/L
units
mg/L
mg/L
mg/L
my/L
mg/L
mg/L
ug/L
C,ll.
mg/L
O w ner:
Location or Site :
Description of sampling poinl
Sampling Method:
Remarks :
Diss . Solids 70300
fluoride 9S I
X Hardness: total 900
X Hardness: (non-carb) 902
Phenols 32730
X Specific Cond . 95
Sulfale
Sulfide 745
MBAS
Oil and Grease
Silica
Boron
Formaldehyde
X NHJ as N 610
X TKN as N 625
X NO2 +NOJ as n 630
P: Total as P 665
PO4
DIVISION OF WATER QUALITY
Chrmbtry 11,.hnrnln~· Rrporl / Ground \Vntrr Qunlity
SAMPLE PRI ORITY
lfJROUTINE
□ CHAIN OF CUSTODY
El SAMPLE TYPE
MR. PAUL MADRITC II HF.
mg/L
mg/L
JO• mg/L
10 mg/L
ug/L
150 uMhos/c,n2
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
0 .39 mg/L
0 .5 mg/L
0 .19 mg/L
mg/L
mg/L
□EMERGENCY
[J
Ag-Silver 46566
Al-Aluminum 465S7
As-Arsenic 465S I
Ba-Barium 46S58
Ca-Calcium 46552
X Cd-Cad ium 46SS9
X Cr-Chromium 46560
X Cu-Copper I 042
X Fe• Iron 1045
Hg-Mercuoy 71900
K-Polassium 46S55
ti.lg-Magne S:i um 927
X Mn-Manganese I 055
Na-Sod ium 929
X Ni-Nickel
X Pb-Lead ~6564
Sc -Selenium
X Zn Zinc 46S6 7
l .,b Numhor 7GO'J50
Dute Rccch·cd 4/2~/97
Time Received 10:20 AM
Rccei,·ed By HMW
Released By DS
Date repo rted : 8/4 /<17
ug/L Org anochlorine Pesticides
ugll Organophosphorus Pesticides
ug/L Nilrogen Pesticides
ug/L
mg/L Acid Herbicides
<2.0 ug/L
, <25 ug/L X Sem i\:olaliles
f)V__M~ 260 ug/L TPH-Diesel Range
300 ug/L
ug/L Volatile Organics (VOA boltle)
mg/L
mg/L TrH-Gasoline Range
< 10 ug/L TPH -BTEX Gasoline Range
mg/L
24 ug/L
< 10 ug/L
u£)'L
70 ug,1..
.J
7G0950 .APR
GROUNDWATER FIELD/LAB FORM
County
Quad h
Lat.
Serial No.
Long. —
SAMPLE TYRE
W Water
❑ Soil
❑ Other
SAMPLE PRI RITY
[-Routine
❑ Emergency
Report To: ARO, FRO, MRO, Fla IaRO, WiRO, III ❑ Chain of Custody
WSRO, Kinston FO, Fed. Trust, Central Off., Other: �
Shipped by: 8 , Courier, Hand tiel., G7
Purpose:
Collector(s): 2 Date - rime fl 2 Baseline,
FIELD ANALYSEANALYSEe Owner _
pH400
Temp.14
Appearance
Field Analysis By:
Spec. Cond..4 at 250 C
— oC Odor
North Carolina
Department of Environment, Health, and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
Lab Number —1_(T— 0 15 D
Date Received Time
Reed by: From: Bus, Courier, n De .,
Other -
Data Entry By:_
Date Reported:
Ck:
, Federal � G1�
Location or site . C_ r ram"
Descrip#ion of sampling point - -� i G ' t F ] L
Sampling Method Sample Interval 5—}��
Remarks
LABORATORY ANALYSES "" "' "I " " "
BOO. 31D me 11
Diss. Solids 70300 rn it
A - Silver 46566 u A
Organvchlorine Pesticides
COD High 340 mgll
uride 951 m 11
Al - Aluminum 46557 u A
Organophosphorus Pesticides
COD Low 335 mgll
r nes : T t 0 11
As - Arsenic 46551 u 1
Nitrogen Pesticides
;ollform: MF Fecal 31616 1100ml
Hardness (non-Gwb) 902 mpll
Ba - Barium 46558 u A
Acid Herbicides
Colirorm: MF Total 31504 1100ml
P enOls 32730 UQA
Ca- Calcium 46552 m If
PCBs
TOC 680 m 11
ifi n . cm�
40
Cd -- Cadmium 46559 ur Il
Turbidity 76 NTU
Sulfate 945 rrk4A
Cr - Chromium 46560 u9il
Residue., Suspended 530 mg/l
Sulfide 745 Ma II
u - copper 46562 u 11
_
Fe - Iron 46563 ugl{
Semivolatile Organics jeo
Oil and Gfease m Il
Hg -Mercury 71900 ugll
TPH - Diesel Range
H 03 unit
K - Potassium 46555 mgll
Alkalinity to pH 4.5 410 mgll
M -magnesium 46554 m II
Alkalinity to pH 8.3 415 mgll
Mn - Manganese 46585 u 11
Carbonate 445 mgil
oNH. as N 614 m A
Na -Sodium 46556
I Volatile Organics [VOA bottle]
Bicarbonate 440 rn A
TKN an N 625 mall
-To
Mi - MrkAl uall
TPH - Gasoline Range
rbon dioxide 445 mgll
NO + NO as N 630 m Il
V
Pb - Lead 46564 u A
TPH - BTEX Gasoline Range
Chloride 940 mWI
P: Total as P 665 m 1
Se - Selenium uc 11
Chromium: Hex 1032 ug11
Zn - Zinc 46567 u II
Color: True 80 CU
Cyanide 720 mg11
Lab Comments:
GW-54 REV. 7196 For Dissolved Analysis - submit littered sample and write "DIS" in block
ly_e

REPORTED BY
CHECKED BY
REVIEWED BY
SAMPLE TYPE:
_
WATER
EHNRIDWO LABORATORY
SEMI -VOLATILE ANALYTICAL REPORT
ANALYSIS RESULTS
LAB NO. 7GO950
SUPERVISOR
DATE �� L
ENTERED BY
DATE
L i54
SEMIVOLATILES
TOL
DF I EC1 ELF
C,r.S0
SLMIVOLA-01S
I'L71. D0 EC TED
TARGET COMPOUND
tij.L
tr4 L.
TARGET COMPOUND
earl rL
62-53-3
ANILINE
10
U
606-20-2
2.6-DINITROTOLUENE
10 U
108-95-2
PHENOL
10
U
99.09.2
3-NITHOANILINE
50 U
111.44-4
BIS(2-CHLOROETHYL) ETHER
10
U
83-32.9
ACENAPHTHENE
10 LI
95-57.8
2-CHLOROPHENOL
10
U
51-28-5
ZA-DINITRO PHENOL
50 N
541.73.1
1,3-DICHLOR08ENZENE
10
U
100-02-7
4-NITRO PHENOL
54 U
106-46-7
4,4-DICHLOROBENZENE
10
U
132-64.9
❑IBENZOFURAN
10 U
100.51.6
BENZYL ALCOHOL
20
U
121-14-2
2,4-DINITROTOLUENE
10 U
95-50.1
1,2-❑ICHLORQBENZENE
10
U
84-66-2
DIETHYL PHTHALATE
IO U
95.48-7
2-METHYL PHENOL
10
U
70OS-72-3
4•CHLOROPHENYL PHENYL ETHER
10 U
108-60-1
SIS12-CHLOROISOPROPYLJ ETHER
la
U
86-73-7
FLUORENE
10 U
106-44.5
4-METHYL PHENOL
10
U
100-01.6
4-NITROANIL}NE
50 U
621-64-7
N•NITROSO-DI-N-PROPYLAMINE
10
U
534.52.1
4,6-0INITRQ-2-METHYL PHENOL
50 U
67.72-1
HEXACHLORQETHANE
10
U
86-3016
N-NITROSODIPHENYLAMINE
10 U
98-95-3
NITA08ENZENE
10
U
101-55.3
4•89OMOPHENYL PHENYL ETHER
10 U
78-59-1
ISOPHORONE
10
U
119-74-1
HEXACHLOROBENZENE
10 U
88-75-5
2-NITRO PHENOL
10
U
87-86-5
PENTACHLORO PHENOL
50 U
105-67-9
2,4-DtMETHYLPHENOL
10
U
85-01-8
PHENANLHRENE
10 U
65-85-0
8ENZOIC ACID
50
N
120-12-7
ANTHRACENE
10 U
111.91.1
BIS(2-CHLOROETHOXY} METHANE
10
L)
84-74-2
DI-N-BUTYL PHTHALATE
10 U
120-83-2
2,4-DICHLORO PHENOL
10
U
206-44-0
FLUORANTHENE
10 U
120.82.1
1,2,4-TRICHLOROBENZENE
10
U
129-00.0
PYRENE
10 U
91-20-3
NAPHTHALENE
f0
U
85-68-7
BUTYLBENZYL PHTHALATE
10 U
106.47.E
4-CHLOROANILINE
20
U
91.94-1
3,3'-01CHLOROBENZIDINE
20 U
87-68-3
HEXACHLOROBUTADIENE
i0
U
56-55-3
9ENZO(AIANTHRACENE
10 U
59-50.7
4-CHLORO.3-METHYL PHENOL
20
li
218-01.9
CHRYSENE
10 U
91-67-6
2-METHYL NAPHTHALENE
10
U
117-81-7
BIS(2-ETHYLHEXYLI PHTHALATE
10 U
77-47-4
HE)(ACHLOROCYCLOPENTADIENE
10
U
117-84-0
DI-N-OCTYL PHTHALATE
10 U
E8-06.2
2,4,6-TRICHLO80 PHENOL
10
i1
205-99-2
BEN ZO(B)FLUORANTHENE
10 U
95-95.4
2.4.5-TRICHLORO PHENOL
10
U
207.08.9
SENZOIKIFLUORANTHENE
10 U
91-58-7
2-CHLOR0 NAPHTHALENE
10
U
50-32-8
BENZO(A)PYRENE
10 U
68-74-4
2-NITROANILINE
50
U
193-39-5
INDENO13,2,3-CDI0RENE
10 LI
131.11.3
OIMETHYL PHTHALATE
10
U
53.70-3
DIBEN 7-D(A,H)ANTHRAGENE
10 U
208.96-8
ACENAPHTHYLENE
10
U
191.24-2
BENZO(G,H,I)PERYLENE
10 U

SEMIVOLATILE ORGANICS REPORT -DWQ LAB PAGE 2
:11111{1,kJll:/~l~lllll[ll~~l~:~~~lljii![:\:::i:1i~~];]ill1tl::1ir•a11111~1lilil~l;1fiil~~iit1l1
NO BASE NEUTRAL OR ACID EXTRACTABLE ORGANICS
DETECTED BY GC/MS
PROPYLENE GLYCOL NOT DETECTED TQL < 100 MG/L
LAB NO. 7G0950
TQL-Target Quantltation Limit-Subject to
change due to instrument sensitivity
T -Tentatively Identified, estimated concentration
E-Estimated Value
U-Samples analyzed for this compound but not detected
N-Sample not analyzed for this compound
D-Detected below quantitation limit
H-Holding time exceeded
COMMENTS: _____________________________________________ _
COUNTY: WAKE
QUAD NO:
;;fGf \'f~~\/t. ,l R ~ ~ l , <ri ~ ! .\ f ' 'I, ' ,\. \,
01 I\\\\;. J r\V
,. -)
p• If\:,, 0
~,, I /\,. \.ii' 'J
REPORT TO
COLLECTOR($) :
RRO Regional Office
GREER
DATE: 4/25/97
TIME:
PURPOSE:
LABO RA TORY ANALYSIS
BOD 3IO
CODllighH0
COD Low 335
Coliform: MF Fecal 31616
Coliform: MF Total 31 S04
TOC
Turbilily
Residue., Suspended S30
Total Suspended solids
X pH 6.7
X Alkalinily to pH 4.5 20
X Alkalinity to pH 8.3 <1
Carbonate <1
Bicarbonate 24
Carbon dioxide
X Chloride 15
Chrom ium :· Hex I 032
Color: True 80
Cyanide 720
COJ\l~IENTS:
mg/L
mg/I.
mg/L
11001111
1100ml
mg/I
NTU
mg/L
mg/L
units
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
ug/L
c .u.
mg/L
Owner:
Location or Site:
Description of sampling point
Sampling Method :
Remarks:
Diss. Solids 70300
Fluori~c 951
X Hardness: total 900
X 1-1:irdncss: (no n-carb) 902
Phenols 32730
X Specific Cond. 95
Sulfate
Sulfide 74S
MBAS
Oil and Grease
Silica
Boron
Formaldehyde
X NH3asN610
X TKN as N 6 25
X NO2 +NOJ as n 630
P: Total as P 665
P04
DIVISION OF WATER QUALITY
Chemistry L11boratory Reporl / Ground \Vater Q a ality
SAM PL E PRIORITY
~ROUTINE
□ CHAIN OF CUSTODY
~ SAMPLE TYPE
□EMERGENCY
□
MR. PAUL MADRITCH INFLUENT
mg/L Ag-Silver 46566
mi</L Al-A lum inum 46551
34• rng/L As-Arsenic 4655 I
14 mg/L Il a-Barium 46558
ug/L Ca-Calcium 465S2
150 uMhoslcm2 X Cd-Cadium 46 5S9
mg/L X Cr-Chromium 46560
mg/L X Cu-Copper I 042
mg/L X Fe-Iron I 045
mg/L Hg-Mercury 71900
rng/L K-Potassium 46 5S5
Mg-Magnesium 927
mg/L X Mn-Manganese 1055
0 .40 mg/L Na-Sodium 929
0 .6 mg/L X Ni-Nickel
0 .18 mg/L X Pb-Lead 46564
mg.IL Se-Selenium
mg.I L X Zn Zinc 46S67
Lab Number 7G0949
Date Recei\'ed 4125/97
Time ReCeh-•ed 10:20AM
Received By HMW
Released By : DS
Date reported : 8/4/97
ug/L Organochlorine rcsticides
u~/1 . ()1gmu•pht,sph uru s Pcsli citlc s
ug/L Nitrogen Pesticides
ug/L
rng/L Acid Herbicides
<2.0 ug/L
. ,_ <25 ug/L X Semi \·olatiles
D'-(.'{ffi., 280 ug/L TrH-Diesel Range
330 ug/L
ug/L Vo1ilt il e Organics (VOA bottle)
mg/L
rng/L TPII-Gasoline Range
< 10 ug/L TPH-13TEX Gaso line Ra nge
mg/L
27 ug/L
< 10 ug/L
ugi l
70 ug,1.
J
7G0949.APR
North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment, Health, and Natural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
County
Quad No Serial No.
Lat.
Long.
SAMPLE TYPE SAM- PLE PRIORfTy
® Water ®routine
❑ Sail ❑ Emergency
❑ Other
Report To: ARO, FRO, MRO,t WaRO, WiRO, ❑ Chain of Custody
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by: Bus, Courier, Hand Del.,,cl Purpose:
Collector[s. -� C. �_ Date 7 �— �' Time C� S �' Baselr
FIELD ANALYS Owner A -A
PH400
Temp.7e
Appearance
Field Analysis By:
Spec. Cond.s4 at 250 C
_ 0C Odor
Lab Number
Date Received
Redd by:
Other:
Data entry By:
Date Reported:
Tune
From: Bus, Courier,
Ck:
Pesticide Study, Federal Trust Other:
Location or site Zjz a P 1_-.el C-L
Description of sampling pointJrQ
Sampling Method 6iilnfler. eta.) Sample Interval 7
Remarks
LABORATORY ANALYSES
BOf] 310 m fl Diss. Solids 70300 m II A - Srtver 46566 u 1i Or anochlorine Pesticides
COD High 340 mgll
Flouride 851 1i
Al - Aluminum 46557 UgA
Organophosphorus Pesticides
COD Low 335 mgll
Hardness: Total 90o m I
As - Arsenic 46551 uQfl
Nitrogen Pesticides �
Coliform: MF Fecal 31616 1100ml
Hardness non -cart 902 m JI
Ba - Barium 46558. u !1
Acid Herbicides
Coliform: MF Total 31504 1100mi
Phenols 32730 uoA
Ca - Calcium 46552 r mlq/1
PCB's
TOG 660 m li
m2
Cd - Cadmium 46559 u-cin
Turbidity 76 NTU
Sulfate 945 nql. I
Gr - Chromium 46560 u 11
Residue., Suspended 530 mg11
Sulfide 745 mcill
L17
Cu . Co of 46562 u 11
Fe - Iron 46563 u a
Semivolatiie Organics . � . '4e
Oil and Grease m 11
Hg - Mercury 71900 ug11
TPH;-, Dlesel Range
PH 403 unit
K - POtasslUm 46565 m
Alkalinity to pH 4.6 410 mgfl
M - Ma re$srum 46554 mall
Alkalinity to pH 0.3 415 mgll
Mn - Manganese 46565 u 11
Carbonate 445 mgll
IVH as N 610 m !I
Na - Sodium 46556 11
Volatile Organics (VOA bottle)
Bicarbonate 440 m 11
JKN as N 625 MOIL
TPH - Gasoline Ran e
Arbon dioxide 405 mgll
NO+ NOas N 63a mall
Pb -Lead 48564 u I
TPH - BTEX Gasolire Range
Chloride 940 mg/l
P: Total as P 665 mqA
Se - Selenium u 11
Chromium: Hex 1032 ugli
Zn -Zinc 46567 u
Color: True 80 CU
Cyanide 720 mglI
Lab Comments:
M
GW-54 REV. 7" For Dissolved Analysis -submit lillered sample and write "DIS" in bl '-

REPORTED BY
CHECKED SY ,
REVIEWED BY
SAMPLE TYPE. WATER
CA,�9 'MVOLATILEE
FA:RGET COMPOUND
b2-53-3 ANILINE
108-95-2 PHENOL
111.44-4 BIS;2-CHLOROETHYLI ETHER
95-57-8 2-CHLOROPHENOL
541.73.1 I.3-DICHLO ROSENZENE
106-46-7 I A-DICHLOROBENZEN E
100.51.6 BENZYL ALCOHOL
95-50.1 1,2•DICHLOR08ENZENE
95.49.7 2-METHYL PHENOL
108-60.1 $IS(2-CHLOROISOPROPYL) ETHER
106-44-5 4-METHYL PHENOL
621.64-7 N-NITROSO-DI-N-PROPYLAMINE
67-72.1 HEXACHLOROETHANE
90-95-3 NITROBENZENE
78-59-1 ISOPHORONE
88.75.5 2-NITRO PHENOL
105.67-9 2,4-DIMETHYL PHENOL
65-85.0 BENZOIC ACID
111-91.1 BIS(2-CHLORO£THOXY) METHANE
120-B3-2 2,4-DICHLORO PHENOL
420-82-1 1,2,4-TRICI4LOROBENZENE
91-20-3 NAPHTHALENE
106.47.8 4-CHLOROANiLINE
87.68.9 HEXACHLOR08UTADIENE
59-50-7 4-CHLOR0-3-METHYL PHENOL
91-57-6 2-METHYL NAPHTHALENE
77-47.4 HEXACHLOROCYCLOPENTADIENE
BB-05-2 2,4,5-TRICHLORO PHENOL
95.95.4 2,4.5-TRICHI.ORO PHENOL
91-58.7 2-CHLORO NAPHTHALENE
88-74.4 2-NITROANILINE
131.11.3 DIMETHYL PHTHALATE
208-96-B ACENAPHTHYLENE
EHNR![]W❑ LABORATORY
SEMI -VOLATILE ANALYTICAL REPORT
ANALYSIS RESULTS
1z!!. Oki E.[:1 ED s AS4
10
10
10
10
10
1❑
2❑
10
10
10
10
10
10
10
10
10
10
50
10
10
10
10
20
10
20
10
10
10
10
10
50
10
10
L
U 606-20-2
U 99-09-2
U 83-32-9
U 51.28-5
U 100-02-7
U 132.54.9
U 121-14.2
U 84-fib-2
U 7005.72-3
U 86-73-7
U 100.01.6
U 534.52-1
U 86.30-6
LI 101-55-3
U 1 18-74.1
U 87.86-5
LF 85-01-8
120-12-7
u 84.74-2
U 206-44-0
U 129-00-0
U 86.68.7
U 91-94.1
U 56-55-3
U 218-01.9
U 117.81-7
U 117.84-❑
U 205-99-2
U 207-08-9
U 50.32-8
Lr 193.39.5
U 53.70.3
U 191.24-2
2,6-DINITROTOLUENE
3-NITRDANILINE
ACENAPHTHENE
2,4-DINITRO PHENOL
4-NITRO PHENOL
DIBENZCFUFiAN
2,4-DINITFIOTOLUENE
DIETHYL PHTHALATE
4-CHLOROPHENYL PHENYL ETHER
FLUORENE
4-NITROANILINE
4,6-DINITRO.2-MET HYL PHENOL
N •NITROSODIPH ENYLAM INE
4-BROMOPHENYL PHENYL ETHER
HEXACHLOROBENZENE
PENTACHLORO PHENOL
PHENANTHRENE
ANTHRACENE
DI-N-BUTYL PHTHALATE
FLUORANTHENE
PYRENE
BUTYLBENZYL PHTHALATE
3.3'-DIC14LOROBENZIDINE
BENZO(A)ANTHRACENE
CHRYSENE
BIS(2-ETHYLHEXYL) PHTHALATE
DI-N•OCTYL PHTHALATE
BENZO IB) FLUORANTHENE
BENZOIKIFLUORANTHENE
8ENZOIA}PYRE14E
1 NO ENO11, 2, 3-CO l*RENE
O IBENZOIA,H)ANTH RACENE
BENZO(G,H,I)PERYLENE
LAB NO, 7GO949
DATE
ENTERED B' ^
DATE+ r iJf
.::
. . tiL.l _ ,;
........
10
U
bU
U
10
U
50
N
50
i
10
U
10
U
10
U
10
U
10
U
50
U
50
U
10
U
1❑
U
10
U
50
U
1❑
U
10
U
10
U
10
U
10
U
10
U
20
U
1❑
U
10
U
10
U
10
U
10
U
10
U
10
U
10
U
10
U
10
U

SEMIVOLATILE ORGANICS REPORT - DWO. LAB PAGE 2
3tlsee Semi-Valatile9 �-Jett'cted betected
up tv.20 Ngheq peaks]
NO EASE NEUTRAL OR ACID EXTRACTABLE ORGANICS
DETECTED BY GC)MS
PROPYLENE GLYCOL NOT DETECTED TOL C 100 MG/L
COMMENTS:
LAB NO. 7GO949
'I QL- Target Quantitation Limit- Subject to
change due to instrument sensitivity
T- Tentatively Identified, estimated Concentration
E- Estimated Value
U- Samples analyzed for this Compound but riot detected
N- Sample riot analyzed for this compound
D- Detected below quantitation limit
H- Holding time exceeded

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVlRONMENT, HEALTH, AND NATURAL RESOURCES
APPLICATION FOR PERMIT RENEW AL TO USE A WELL(S) FOR
INJECTION WITH A HEAT PUMP SYSTEM
In accordance with the provisions ofNCAC Title 15A: 02C.0200
complete application and mail to address on the back page.
Type 5A7/5QM Wells
1Q DIRECTOR, NORTH CAROLINA DMSION OF WATER QUALITY
DATE: /p'1?1 '-I t-.19-.XL
Please type or print clearly.
A SYSTEM CLASS1F1CATION Does the system re-circulate only potable water without
any additives such as corrosion inhibitors or antifreezes in continuous piping which
isolates the fluid from the environment?
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.
N) ....c"1f no, then continue completing this form.
B. PERMIT APPLICANT
Name: &v'-eta D IP I TZ fl
Address: /// D & l-i v d C!@P tf '-da,,f}O
City: j t? e & .
County: 4(4 If t!
Zip code: .2 7 2~ 2--~S-/cJ
Telephone: 3·g-7 -09 5~ J:
C PROPERTY O)VNER (if different from applicant)
Name: ________________________ _
Address: _______________________ _
City: ___________ _ Zip code: _________ _
County: _______ _
D. STATUS OF APPLICANT
Private: --------Federal: __
State: Public: __
GW-57 HPR (April 1997)
Telephone: __________ _
Commercial: __ _
Native American Lands: __ _
Page 1 of 4
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:
County:
Contact Person:
Zip code:
Telephone:
Standard Industrial Code(s) which describe commercial facility:
F. INJECTION PROCEDURE (specif,, any modifications to the injection procedure since
the issuance of the previous injection permit)
r
G. WELL USE Is(are) the injection well(s) also used as the supply well(s) for
either of the following?
(a) The injection operation? YES - NO
(b) Your personal consumption? YES 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.
(2) NC_ State Regulations (15A NCAC, 2C, Section .020d) require the pertnittee 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?
I. CURRENT OPERATING DATA
(a) Injection rate:
(h) injection volume:
(c) Injection pressure:
(d) Injection temperature:
yes;rno_ (b) on the effluent line? yes.-, no
Average (daily)j 7 gallons per minute (gpm)
Average (daily) gallons per day (gpd)
Average (daily) i O pounds per square inch (psi)
Annual Average degrees Fahrenheit (° F)
GW-57 HPR (April 1997) Page 2 of 4

J. INJECiTON-RELATED EQUIPMENT
Attach a diagram showing an
Ld Rcattons to injection equipment since the
issuance of the previous injection perrrtit 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 neap (can, be drawn) showing: the orientation of and distances
between the injection well(s) and any existing well(s) or waste disposal facilities
such as septic tanks or drain field located within I00Oeet 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 Nan -Discharge permits
(3) Sewage Treatment and Disposal Permits
M. OTHER MODIFICATIONS: Indicate any other modifications to the injection well sysu
(equipment, fluid, operation, etc.) that have occurred since the issuance of the
previous injection permit and have not been noted elsewhere on this application.
I.
N. CERTIFICATION
�e.►v� eh=�9pE� r+'�
r ►Y.F,Ar4 r70%1 p
w `rcf-
/ *, /Old f,
"I hereby certify, under penalty of law, that 1 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 these are significant penalties, including the possibiliry of
fines and imprisonment, for submitting false information. I agree to operate,
rnairttain, repair, and if applicable, abandon the injection well and all related
appurtenances in accordance with the approved specifications and conditions of the
Permit."
r r �
(Signature of Owner or Authorized Agent)
Please supply a letter sighed by the owner
authorizing the above agent, if authorized agent is signer.
z
h
Gw-57 HPR (April 1997) Paee 3 of 4

0. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other
property rights in the well(s). A well is real property and its construction on land
rests ownership in the land owner in the absence of contrary agreement in
writing.)
If the property is owned by someone other than the applicant, the property owner
hereby consents to allow the applicant to operate an injection well(s) as outlined
in this application and that it shall be the responsibility of the applicant to
ensure that the injection well(s) conform to the Well Construction Standards
(Title 15A NCAC Subchapter 2C .0200) -..
GW-57 HPR (April 1997)
(Signature of Property Owner if Different From Applicant)
Please return the completed Application package to:
Underground Injection Control Program
Groundwater Section
North Carolina DEHNR-DWQ
. PO. Box 29578
Raleigh, NC 27626-0578 .
. (telephone: [phone])
Page 4of4
NORTH CAROLINA
ENVIROixivIENTAL MANAGEMENT COMMIS S It
DEPARTMENT OF ENVIRONMENT, HE_aLTH,-PIVU NATURAL RESOURCES
GROUNDWATER SECTION
i
Date • /G,%�t 1 Z
Name
Address:
111 0
Please check the
of your injection
information..
I} We11 is
STATUS OF INJECTION WELL SYSTEM
Permit Number: WI
G ' ;off c / 1.�
f
selection which most closely describes
well. in addition, please provide the
still used for injection activities.
-?z—X le)
the current status
requested
2) Injection discontinued;
a} Well temporarily abandoned b) well permanently abandoned
Describe the method used to properly abandon the injection well. Include a
-description of how the well was sealed and the type cf material used to
ill the well if perma-,nently abandoned:
Certification: (For well abandonment)
"I hereby certify, under penalty of law, that I am personally
responsible for the proper abandonment of any injection well as required in
Title 15A NCAC 2C .0214 Criteria and Standards Applicable to Injection
Wells."
(signature)
Certification: (For information verification)
"I herebv 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 information is true, accurate, and
complete."
7 -r'
IF (Signature)
(714 - 68

no
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE OPERATIONNSE OF A WELL OR WELL SYSTEM FOR INJECTION
In accordance with the provision of Article 7, Chapter 87;
Article 21, Chapter 143, and other applicable Laws, Rules and
Regulations
PERMISSION IS HEREBY GRANTED TO
Paul S. Madritch
FOR THE OPERATION AND USE OF AN INJECTION WELLNELL SYSTEM located at
1110 Olive Chapel Road, Apex, North Carolina in Wake County, in
accordance with the application dated June 24, 1991 and in conformity
with the specifications and supporting data submitted, all of which
are filed with the Department of Environment., Health, and Natural
Resources and are considered a part of this permit.
This Permit is for Operation and Use only, and does not waive
any provisions of the Water Use Act or any other Applicable Laws,
Rules or Regulations. operation and use of a well or well system
shall be in compliance with Title 15A North Carolina Administrative
Code 2C, and any other Laws, Rules and Regulations pertaining to well
construction and use.
This Permit shall be effective, unless revoked, from the date of
it issuance until July 31, 1996 and shall be subject to the specified
conditions and limitations set forth in Parts I and II hereof.
Permit issued this the 31 day of July, 1991.
Art hur-Mouberry, P.E.
Regional Supervisor
Raleigh Regional Office
By Authority of the Environmental Management Commission
94,wy J-

I'/r—040-00//
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
APPLICATION FOR PERWr TO CONSTRUCT AND/OR USE A WELL FOR
INJECTION = -
CLASS 5 WELLS �7s■� r=ti i
TO: DIRECTOR, NORTH CAROLINA DIVISION OF ENVIRONMENT'th.'V4N AMVW,�
DATE: ,7Zravc Z , I9 9l
�, NawVIR sEcT1011
In accordance with the provisions of Article 7, Chapter, 87; Article 21, ChT)�er rMJ pN(begulations
pursuant thereto, APPLICATION is hereby made for a PERMIT to construct and/or use a well or well system as
described below and in any accompanying data submitted as a part of this APPLICATION.
A. OWNER DATA: Name: -PAY,- - S_ .4"q! "-m-Y
Address: &fib o4t/ f C h��O' Oee- 1?Ogoz)
City: AEG 7ipcode: 2-252a nB Io
County, Telephone:
Is)
Ownership: Federal
Public
Other (Specify)
State Private Y
Commercial
FACILITY DATA (Fill out ONLY if the injection well(s) is (are) for the purpose of serving a business or
industry):
Business/Corporate Name:
Address:
City:
County:
Zipcode:
Telephone:
HEATING CONTRACTOR DATA (For heat pump systems only. Please give information for the contractor
that installed or will install your system):
Name: W-"?& --
Address:.�_:I►A[t arc
City.. 1V L Zipcode:.774-z3i Telephone: 779 3-Y1
D. INJECTION PROCEDURE: Briefly describe how the injection well(s) will be used.
OT —ZCw- AF,,ztz-
E. WELL USE: Will the injection wells) also be used as the supply well(s) for either of the following?:
(a) The injection operation? YES _4 NO
(b) Your personal consumption? YES NO 4C
F. CONSTRUCTION DATA: (check one)
EXISTING WELL being proposed for use as an injection well. Attach a copy of Form OW-1 (Well
Construction Record) and furnish (7 & 8) below. If Form GW-1 is not available, furnish the data in (1)
through (8) below to the nest of your knowledge.
Gw-57H May,1999, Replaces GW-57A, and GW-57B (2l84)

PROPOSED WELL to be constructed for use as an injection well. Furnish the data in (1) through (8)
below as PROPOSED construction specifications.
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING
OR PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
(1)
(2)
(3)
Well Drilling Contractor's Name: !3JL '-Y lov,vcn_ Co ""N ' 11 Lvt!'~t..
Date (to be) Constructed _:;n_v_"""~4 __ 1_,_f~• ?~-~: Appr6ximate Depth 'ifti ft.
Well Casing:
C o
(a) Type: Galvanized Steel 1_ Black Steel__ Plastic Other (Specify) __ _
(b) Inside Diameter: __ inches: Wall thickness (inches) __ or schedule# ___ _
(c) Casing Depth: From ___ to ___ ft. (referenced to land surface)
(4) Cement Grout:
(a) Around inner or "primary" casing: From __ to __ ft.
(b) Around outer (pit) casing, if present: From __ to __ ft.
(5) Screen(s): (if applicable)
(a) Type:-------~· Inner Diameter: ______ inches
(b) Depth: From ___ to ___ feet below land surface
(6) Gravel: (if applicable) From: ___ to ____ feet below land surface
(7) N.C. State Regulations (15, 2, 2C, Section .0200) require the permittee to make provisions for
monitoring well head processes. A faucet on both the influent (water from well) and effluent (water
into well) lines is required. Is there a faucet on (a) the influent line YES --fl--NO __ , or (b)
the effluent line YES -f-NO __ ?
(8) Attach a diagram showing the details of construction of the existing and/or proposed well(s).
G. PROPOSED OPERATING DATA: (The manufacturer's brochure should include this information.)
(a) Injection Rate:
(b) Injection Volume:
(c) Injection Pressure:
(d) Injection Temperature:
H. INJECTED FLUID DAT A:
Average (Daily) /7 gallons per minute (gpm)
Average (Daily) 4C2JO gallons per day (gpd)
Average (Daily) 7 pounds/square inch (psi)
Winter Average (Daily) <5" degrees F
Summer Average (Daily) G8 degrees F
(1) Fluid Source (From what depth and what type of rock/sediment unit does the fluid to be injected
derive, i.e. granite, limestone, sand, etc.)
Depth: ____ Rock/sediment unit: _________________ _
(2) Chemical Analysis of Source Water: The following chemical characteristics MUST accompany
this application;
pH Zrf ; Total Hardness 6 'I ppm (parts per million or mg/1); Iron ppm; L. O. I) J,,,..
Chloride~ ppm; Nitrate" /. P ppm; Coliform bacteria Q counts/100 ml
GW-57B May, 1989, Replaces GW-57A, and GW-57B (2/84)
NOTE: Assistance in obtaining these values may be facilitated by contacting (a) your local or county health
official, (b) a commercial water-testing laboratory, (c) your well drilling contractor, or (d) the Regional
Hydrogeologist, North Carolina Dept. of Natural Resources & Community Development
NOTE: If injection system is not for a heat pump, then a detailed analysis of both the source water and the
injection fluid may be required.
I. INJECTION-RELATED EQUIPMENI':
Attach a diagram showing the engineering layout of the (1) injection equipment, and (2) exterior
piping/tubing associated with the injection operation.
NOTE: The manufacturer's brochure, if detailed, should satisfy (1) above if the system is a heat pump.
J. LOCATION OF WELL(S):
Attach a detailed map showing the orientation of and distances between the proposed well(s), any existing
well(s)-that will in any way be involved in the injection opera-tion, and at least two (2) nearby reference
points such as roads, i;oad intersections, streams, etc. The roads should be identified by U.S., N.C . or SR
(county secondary road) numbers, and streams should be named. In addition, the diagram should show the
direction and approximate distance to any existing water-supply and/or injection wells within 1,000 feet of
the proposed injection well.
K. CERTIFICATION:
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the
infonnation submitted in this document and all attachments thereto and that, based on my inquiry of those
individuals immediately responsible for obtaining said infonnation, I believe that the infonnation is true,
accurate and complete. I am aware that there are significant penalties, including the possibility of fines and
imprisonment, for submitting false information. I agree to operate se the injection well and all related
appurtenances in accordance with the approved specifications con · ions of Penn· . "
I
FOR OFFICE USE ONLY:
1. Initial Application: Complete__ Incomplete __
If INCOMPLETE, Date of Notification _____ and Resubmittal ____ _
2. Standard Industrial Code(s) which best reflect the principal products or services provided by this
facility -if applicable.
(a) ___ (b) ___ (c) ___ (d) __ _
3. APPLICATION NO. ______ _
GW-57B May, 1989, Replaces GW-57A, and GW-578 (2/84)
J -tfr WAKE. COUNTY HEALTH DEPARTMENT Q
10 SUNNYBROOK ROAD - SULTE 20 f
RALEIGH, NORTH CAROLINA
BACTERICLOGICAL WAFER ANALYSIS REPORT
(individual)
Time Collected: ©l�iC3
Date Collected: � Time Received: _50 .59 01,Callected by: Ls 1-14zV11
Sample must be tested within,.24__h- rs ❑f collection: Must be kept cool.
CAREFULLY READ ALL INSTRUCTIONS ON BACK OF THIS SHEET BEFORE YOU COLLECT
THE SAMPLE.
SAMPLES ARE. ANALYZED BY THE HEALTH DEPARTMENT LABORATORY N9NRAY_1HROl1GH TIiURSQAY
FROM $c 34 a.m. to 4: jQ_ptrpj-- - UNLESS A LEGAL HOLIDAY.
SAMPLES IN CONTA>HERS OTHER THAN THOSE SUPPLIED BY THE HEALTH DEPARTMENT OR THE
N.C. DEPARTMENT OF HUMAN RESOURCES WILL NOT BE ANALYZED.
Telephone No.: �3 lzf3' �3 �`�f_
Address: /lily 04 /V-1 xG'Vj
City: - 'ar'r i C zip Code: 2-7. OZ-
Source of Water: well pool city other
Type of water sample: initial ��C resubmit sample post chlorination sample
Test requested: Coliform Fecal pH Fluoride Pseudomonas
(Qty. req'd): 100 mi. 100 mi. 50 mi. 50 MI. 500 mi.
TEST RESULTS:
Membrane Filter Most Probable Number MPN}_
Not found F--T Not. found
Positive colonies Positive MPH
Sample Kun by _ Sample reported out by:. /� J
Comments:
If your water supply is positive for coliform, the supply should be chlorinated am--1
re -sampled. Instructions for chlorinating your supply should be mailed to you if
needed with your report. If you need further assistance, please call 250-4400 and
ask for Environmental Health or Laboratory.
Explanation of terms used:
I. confluent growth: overgrowth of bacteria that cannot be isolated well enough to
determine whether or not it is coliform.
2. turbid: discolored sample, not clear.
3. sediment: visible dirt or particulate matter present on filter.
4. Gnsatisfactor v-Resubmit Sample: additional testing is required and another sampte is
requested.

Name of
System 1 L
STATE LABORATORY OF PUBLIC HEALTH
DIVISION OF HEALTH SERVICES .
N. C. DEPARTMENT OF HUMAN RESOURCES
P.O. BOX 28047 — 306 N, WILMINGTON ST., RALEIGH 27611 a
INORGANIC CHEMICAL ANALYSES -PRIVATE WATER SYSTEM
a
Complete All Items Above heavy Line D
{See Instructions on Reverse Sidej���
C ( d V 11- k- e,,- -,.
Address Y,d/0-Irc J
'C _`ZIP Z76_d Z
County _Il�� f ~r =....
Report To: Lf Al i t" I L A4't
1_
Address 4 e PIkWlt-
....... ' - - -
ZIP
Collected By: '�AcL �%/`lJ71PI jiff
Date Collected: 2- L114C Time:
Location of Sampling Point:
Remarks:
AM
PM
Source of Water:
{ �C) Ground
{ 1 Surface
.Source of Sample:
(K) House Top
.( . ) Well.jj p
Both
{ ) Purchased
Type of Sample:
(?�) Raw
i I Treated
Type of Treatment:
(K) None
{ i Lime
{ } Chlorinated
{ I Soda Ash
{ I Fluoridated
{ I Polyphosphate
{ I Filfered
{ ) Water Softener
{ I Alum
{ ) Other
Type -of Analysis Desired:
{ I Regular Parameters
{ I Both
{ I Optional Parameters
f pie
TG
N l�
vA'f �UI9S I��J��Pa•'G�,-,,,`. l �'
r/ !S Tt�C.r� C d.+�v��I t�
Regular Parameters -,• v _
�.hr.. aowlts -_s - l -
Optional Parameters (List as needed) }f.
- - - - t
� .. -�. - - - • -• Rewhi
PH
units . a r
Arsenic
, pi mgj!
y
0 /T
Load
C O. 2)0-5— mol
Iron
p mgll
Manganese
0 0 rngll
Copper
mgll
Zinc
a. vQ mg!!
Calcium
mg/l
Magnesium
�, mg/l
H8rdness•CaCO3 iCa, Mgl
mg/!
Alkalinity-C403
mg/l
Chloride
.-Mg/1
Fluoride
E % mgll
Date Received
Date Analyzed
OHS Form - 1441 Rey. 10179
Date Reported "� Reported By _
U� .)f_0 � i �:u 1 9 !
Laboratory Number
Lir r i i i��?�(ri j

COUNTY �. N.C. DEPARTMENT OF NATURAL RESOURCES LAB {NUMBER 8 I CS CA4
QUAD NO. SERIAL NO. & COMMUNITY DEVELOPMENT DATE RECEIVED `'ram Time
LAT. LONG. DIM / R 'd by:- From: Bus -Courier
GROUNDWATER FIELD/LAB FORM 60�the
Report to: APO, FRO, MRO..�WaRO. WiRO,
SAMPLE PRIORITY DATA ENTRY BY: a CK:j -
WSRO. Kinston FO Other ROUTINE ❑ EMERGENCY DATE REPORTED: �IlaLC-L_
Shipped by: Bus, ourieT, Other
COLLEGTOR(S): DATE �{ TIME PURPOSE: BASELINE, GOMPLAiNT �P�LUS' , OTHER
_ (Circle one
FIELD ANALYSES
PH400 Spec. Cond.94
Temp.1 Q oC Odor —
Appearance Taste
Field Analysis By:
LABORATORY ANALYSES
BOOS 310 moll
COD High 340 mall
Coo Lox 335 mg►l
Colllolm;MF Feeel 37616 1100m1
COIIIDrr.:MF Total 31604 L IIDOMr
TOC 690 mall
Turbldity 16 NTU
PH 403 _14units
Alkallrlily to pH 4.5 410 moll
Alkalinity to PH 9.3 415 moll
Carbnnale 445 mall
91corvenais 440 moll
Af seenl c:To to I 1002 uo It
Carbon dioxide 4D5 rnu/I
Chlerlda 940 molt
Chromiurn:Hex 109E ugll
ColorTrua 90 Pl-co
rl
Cyanide 720 nm9li
Lob Comments:
Owner r J
at 250C Location or site Ale-' -.22,C-1)
Description of sampling painter
Sampling Method Sample Interval
[pump, pailer, etc.]
riniarks - 11
C
Dlss. Solids 70300 mg/1
Fluoride 9S1 Moll
L.
02
Hardneae:Tolal 900 ,3 moll
Hardness (non-carb) 902 moll
Phenols 32730 ugll
-00
Specilic Cond. 95 216 uMn0&fem2
Sulfate 945 moll
Sulfide 745 moll
NN3 as N 6 to mail
TKN as N 625 moll
NO2 t Noa at N 630 G , moll
P:T0151 as P 665 moll
[pumping time, air tamp, etc
Aa - Silver 1077 volt
Al - Aluminum 11105 ug11
Be - Barium 1007 Moll
Ca Calcium 916 moll
Cd - cadmium 1027 u9rt
Chromlum:TOtal 1034 Woll
C - Copper 1042 ugli
s Iron 1045 'ZCC0 ug/I
Hg - Mercury 71900 ugli
K - Po195sium 937 molt
Me - Magnesium 927 mWl
Mn Manganese 1055 Moll
Na - Sodium 929 moll
Ni - Niceet 1007 Willi
Pb - Lead 1051 ugli
Se - Selenium 1147 ugli
In - ZVnc 1092 Moll
Drgannehl0r1ne Pestitidas
. ora1n Dphdapho,ua Peililudaa
CIL
Ac Jj,7r?,I C1 dal ..
Base / Neutral Extractable oroeni Ca
Acid Extractable Oroanles
Purileable Organics [VOA bottle]
i.2 orbromoothane (EDS)
/+ A' —1
GW-5evised 7185 For Dissolved Analysis - submil Wpsmkred sample and write 'DIS' in block
White copy - Headquarters 1-i 7�opy -Region Yellow copy -Lab

)
J
SEMlVOLATfLE ORGANICS REPORT -DEM LAB
LAB NUMBER: 1G994
REPORTED BY Q.J-2
CHECKED BY_ }J;:
SUPERVISOR~
DATE : '-P-/.!li LAB ff:: 1G991J-
REVIEWED BY _
I
ENTERED BY 'JJn. 10L7/q1
CHECKED BY~
SAMPLE TYPE: WATER DILUTION FACTOR
ANALYTE NAME CAS NUMBER TQL
108-95-2
111-44-4
95-57-8
S41-73-1
106-1,6-7
100-51-6
95-50-1
95-li,8-7
108-60-1
106-1,i.4-5
621-64 -7
67-72··1
98-9~-:,-3
78-59-1
88 -75-:,
105--67 -9
65-85-0
111-91-1
120-83-2
120-82-1
91-20-3
106-4:7·-8
87-68-3
59-50-7
91-57-6
77-4:7-4,
88-06-2
95-9:i -4,
91-58-7
88-74·-4,
131-11-3
;WS-96 -8
606 .. 20 -2
99-09 -2
83-32 -9
51-28-·5
ll)O-o ;~-7
l 3 2-· i;4 -9
L 2 .1.-llr2
8l,--66-2.
"/005-12··3
86-73-'/
100-01-6
534 :i:J -1
X 1
10 PHENOL
10 BIS(2-CHLOROETHYL) ETHER
10 2-CHLOROPHENOL '
10 1,3-DICHLOROBENZENE
10 1,4-DICHLOROBENZENE
20 BENZYL ALCOHOL
10 1,2-DICHLOROBENZENE
10 2-METHYL PHENOL
10 BIS(2-CHLOROISOPROPYL) ETHER
10 4,-METHYL PHENOL
10 N-NITROSO-DI-N-PROPYLAMINE
10 HEXACHLOROE'l'HANE
10 NITROBENZENE
10 ISOPHORONE
10 2-NITRO PHENOL
10 2,4,-DIMETHYL PHENOL
50 BENZOIC ACID
10 BIS(2-CHLOROETHOXY) METHANE
10 2,4-DICHLORO PHENOL
10 1,2,4-TRICHLOROBENZENE
10 NAPHTHALENE
20 4:-CHLOROANILINE
10 HEXACHLOROBUTADIENE
20 '*-CHLORO-3-METHYL PHENOL
10 2-METHYL NAPHTHALENE
10 HEXACHLOROCYCLOPENTADIENE
10 2, t1c, 6·-TRICHLORO PHENOL
10 2,4,5-TRICHLORO PHENOL
10 2-CHLORO NAPHTHALENE
~.o 2-·NITROANALINE
10 DIMETHYL PHTHALATE
10 ACENAPHTHYLENE
10 2,6 -DINITROTOLUENE
50 3-NITROANALINE
10 ACENAPHTHENE
50 2, t,.-DINITRO PHENOL
50 ~-NITRO PHENOL
10 DIBENZOFURAN
10 2,4-DINITROTOLUENE
lU DIETHYL PHTHALATE
10 4,-CHLOROPHENYL PHENYL ETHER
10 FLUOR.ENE
:>0 11,-NITROANALINE
50 4, 6-DINITRO-2 -·METHYL PHENOL
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
CONC.
UG/L
)
J
SEMIVOLATILE ORGANICS REPORT -DEM LAB
86 -30-6
101-55-3
llB-74-1
R7-86-5
85-01-8
120-12-7
8'1--74--2
206-4-'1--0
129-00-0
85-68-7
91-9(~-1
56-55 -3
218-01-9
117 -81-7
117-84--0
205-99-2
207-08-9
50-32-8
193-39-5
53 ·-70 -3
191-24--2
10 N-NITROSODIPHENYLAMINE
10 4 -BROMOPHENYL PHENYL ETHER
10 HEXACHLOROBENZENE
:,0 PENTACHLORO PHENOL
10 PHENANTHRENE
10 ANTHRACENE
10 DI.-N-BUTYL PHTHALATE
10 FLUORANTHENE
10 PYRENE
10 BUTYLBENZYL PHTHALATE
20 3,3'-DICHLOROBENZIDINE
10 BENZO(A)ANTHRACENE
10 CHRYSENE
10 BIS(2-ETHYLHEXYL) PHTHALATE
10 DI-N-OC1'YL PHTHALATE
10 BENZO(B)FLUORANTHENE
10 BENZO(K)FLUORANTHENE
10 BENZO(A)PYRENE
10 INDENO(l,2,3 -CD)PYRENE
10 DIBENZO(A.H)ANTHRACENE
10 BENZO(G,H,I)PERYLENE
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
u
OTHER SEMIVOLATILE ORGANICS F'OR ::;AMPLE NUMBER
107-21-1 50 MG/L ETHYLENE GLYCOL
1G9 9 lic
u
DIRECT AQUEOU S IN,JECTION
BY GC/FID
NO BASE /NEUTRAL OR ACID EXTRACTABLE ORGANIC
COMPOUNDS DETE CTED BY GC/MS
---------------------------
·-·-·------
TQI.:: TARGET QUANT ITA'I'ION LIMIT
'1'= TENTATIVELY IDENTIFIED ESTIMATED CONCENTRATION
E= ESTIMATED CONCENTRATION
U= COMPOUND ANALYZED FOR NOT DETEC'l;ED
N= COMPOUND NOT ANALYZE D FOR
D= DETECTED BELOW O:c.JANTITATION LIMIT
H= HO LDING TIME EXCEEDED
TQL SUBLlECT TO CHANGE DUE TO INSTRUMENT SENSITIVITY
DIVISION OF ENVIRONMENTAL MANAGEMENT
GROUNDWATER SECTION
April 10, 1991
M E M O R A N D U M
TO: Jimmy Greer
~
FROM: Rob Turner ~
SUBJECT: UIC Program Permit Issuance
The central office has completed its review of the
Underground Injection Control (UIC) program permit
application for an injection facility proposed by Mr.
Paul S. Madritch of Wake County. Attached you will find a
copy of the permit application~ along with the draft permit
and transmittal letter for this facility.
The proposed injection well system consists of a closed
loop pipe that will be installed · into two deep wells. Based
on the submitted application and on conversations with the
contractor, I believe that this system will meet all
regulatory requirements. Nevertheless, I have informed the
owner and contractor that we will not ·issue the injection
well operation permit until after we have inspected the
system. This is primarily to ensure that the wellhead is
constructed as per the regulations and that we will be able
to sample the system. Accordingly, please hold onto the
permit and transmittal letter for now and make arrangements
to visit the site after construction is finished. When you
have arranged a site visit date, please inform me so that I
can accompany you during the inspection.
Please keep in mind that you will have to obtain the
Regional Supervisor's signature, date the transmittal
letter, and fill in the expiration date and facility number
of the permit before forwarding them to the applicant.
Additionally, please remember to make copies of the
completed documents and send them to me for my files.
If you have any questions, please do not hesitate to
contact me.
Attachments
cc: Mark Shockey
Sanitary 'Nell Seal
Casing must extend min, '
r
of,$"inches above
land surface
77
Alin, 20 Ft
s� pr�►ly
r
HEAT
PUMP
����_''��1�►� R �jYTI T � ^�.. _1..t �R•I F.-S..s+►_•. 'T.F
IL COMBINATION SOURCE
a
a -
AND INJECTION WELL
STATUS: LEGAL PERMIT REDUIRED ? : YES

Sanitary Well Seal
I?-
Minj(inches casing above
land surface
wh, 20 Ft.
-7-11 e _-, r--
HEAT
PUMP
V 7511'
VERTICAL "CLOSED LOOP"
INJECTION WELL, USING
CASED WATER WELL
STATUS : LEGAL (IF HEATING/COOLING FLUID IS WATER)
STATUS : ILLEGAL (IF ANYTHING OTHER THAN WATER IS
USED AS HEATINGICOOLING FLUID)
� 441 t
Min- 5 feet of Pit Casing
(must extend at least Arinches
above land surface)
PERMIT REQUIRED? : YES
PERMIT REQUIRED?: NOT
APPLICABLE
HEAT
PUMP
7'
A
A
I . . . . . . . . . . . . . . . . . . .
VERTICAL "CLOSED LOOP
INJECTION WELL, USING
UNCASED BOREHOLE
STATUS - LEGAL OF BOREHOLE 15 FILLED WITH NON -SHRINKING CEMENT PERMIT REQUIRED? YES
GROUT AND HEATING/COOLING FLUID IS WATER)
STATUS : ILLEGAL CIF BOREHOLE IS FILLED WITH ANYTHING OTHER THAN
CEMENT GROUT AND/OR IF HEATING/COOLING PERMIT REQUIRED? NOT
FLUID IS ANYTHING OTHER THAN WATER] APPLICABLE

yr,
p -
APR i 1
PAUL S. T'IADRITCH GROUNDWATER SECTION
1110 OLIVE CHAPEL ROAD RALEIGH, NC
ApEx, NORTH CARDGIMA 27502-8510
H [phone] B [phone]
Mr. Robert Turner
Department of Environment,
512 N. SaIisbury Street
Raleigh, A(C 27611
March 31, 1991
Health and Natural Resources
Subject: Application for vertical "closed loop" injection well
Reference Enclosed schematic
Heating and cooling for my house was provided by a combination source
and injection well (500' well in schematic). However, it seems that
the water circulation within the well causes the water to become muddy
and eventually ruin the well pump. I would therefore like to convert
to a vertical closed loop injection well.
However, the 500' well will not provide adequate heating/cooling
exchange in a vertical closed loop mode. I would therefore like to
place the 450' well in series with the 500' well to provide the
required heating/cooling exchange for my house_ The fluid within the
closed system will be water f ruin my house water well.
Both front wells have been inspected and approved by your department.
The 500' well was used for heating and cooling. The 450' well was
used. as a house water source, but did not provide water in the
quantity I required. House water is now provided by the well in back
of the septic f ield.
I would like a permit to connect the wells in the front yard in series
with a vertical closed loop in each well as shown in the diagram
below:
r
1 y��it
Y urs truly,
Paul S. Madritch

State of North Carolina
Department of Environment, Health, and Natural Resources
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27611
James G. Martin, Govemor George T. Everett, Ph.D.
William W. Cagey, Jr.. Secretary Director
January 17, 1991
Mr. Paul Madritch
1110 olive Chapel Road
Apex, NC 27502-8510
Dear Mr. Madritch:
This is in response to your request for information
regarding the regulations and application process associated
with injection well permits. Enclosed please find the
following materials:
* Two blank applications for a permit to construct and/or
use a well for injection;
* 15 NCAC 2C .0100 - well Construction Standards Applicable
to Water Supply and Other Wells;
* 15 NCAC 2C .0200 - Well Construction Standards Applicable
to Injection Wells;
* Six diagrams that illustrate the common methods of
discharging heat pump return water and the requirements
associated with each method; and
* A copy of our May 25, 1990 letter to Water Furnace
International detailing our initial recommendations for
altering the design of their proposed closed -loop heat
pump system.
You will notice that the pertinent sections of the
regulations have been highlighted so that you can more
easily see the permit requirements and where our
difficulties exist in permitting the water Furnace
closed --loop injection well systems as they are currently
proposed. Any compromises regarding the design of these
closed -loop systems will have to be worked out during the
permit process.
f MOudon Prevention Pays
P.O. Sax 27687. Raleigh, North Carolina 27613-7687 Teiephone 9i9.733.7015
An Equal Opportunity Affimnative Action Employer

I hope that you will find this information useful
should you choose to submit an injection well permit
application. Please keep in mind that all of the
information requested on the enclosed application forms is
necessary, and any design aspect of your proposed injection
system that does not conform to the regulations will require
detailed documentation proving that the proposed design
characteristic is essential and will not endanger human
health or groundwater quality (see 15 NCAC 2C .0118 -red
booklet). In short, the burden of proof is on your
shoulders. Should you require additional information
regarding the permit application process, please give me a
call at [phone].
Enclosures
RT/Madrit
Sincerely,
_4 fJ _L.. =---
7 ~ -J~--
Robert Turner
Hydrogeologist
Permits & Compliance Unit
\
State of North Carolina
Department of Environment, Health, and Natural Resources
Division of Environmental Health
Public Water Supply Section
P.O. Box 29536 • Raleigh, North Carolina 27626-0536
Telephone [phone]
James G. Martin, Governor
William W Cobey, Jr., Secretary
Mr. Robert 0. Walton, III
Permits and Compliance Group
Goundwater Section
September 12, 1991
Division of Environmental Management
North Carolina Department of Environment, Health
and Natural Resources
Post Office Box 29535
Raleigh, North Carolina 27626-0535
"' '
Richard K. Rowe
Director
Re: Application for Injection Well Permit
Paul S. Madritch
Dear Mr. Walton:
1110 Olive Chapel Road
Apex, North Carolina
Wake County
We have reviewed the material submitted to this office concerning the above
referenced subject.
Considering the legal matter of endorsing this proposal, we believe we do not
have sufficient information to deny the request due to a threat to the ground water
source or to the public health.
Our recommendation that an assessment be made of the effects these systems
might have on groundwater remains.
If we can be of further assistance please let us know.
Sincerely,
f,_,_L_j IL 4r,,,-<_ C £ 'S
Richard K Rowe
RKR/RWC/mhj
An Equal Opportunity Affinnative Action Employer
State of North Carolina
Department of Environment, Health, and Natural Resources
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27604
James C . Martin, Governor
William W. Cobey, Jr., Secretary
George T Everett, Ph.D.
July 18, 1991
Mr. Richard Caspar
Public Water Supply Section
Division of Environmental Health
P.O. Box 27687
Raleigh, NC 27611-7687
Dear Mr. Caspar:
Oireccor
This off ice has received the applications for Fermi t to use a
well or well system for injection, as listed below. In accordance
with Article 7, Chapter 87-88(j), General Statutes of North Carolina,
we submit the following applications, in addition to a draft copy of
each proposed Permit, to DHR for review and recommendation:
Oper. Renewal
APPLICANT Permit Permit
Paul s. Madritch Yes No
Deborah K. Turner Yes Yes
Billy E. Smith Yes Yes
Rosert Paul Hensel Yes No
Injection Source
Heat Pump Effluent
Heat Pump Effluent
Heat Pump Effluent
Heat Pump Effluent
Please note that each application complies with the specified
requirements as prescribed by 15 NCAC 2C .0200.
If we have not received any comments or recommendations within
t~n (10) working days of the above date, we will assume that DHR has
no objection to the projects as proposed. Please do not hesitate to
contact me at 733-3221 if you have any que~tions.
Enclosures
Asheville
704/251-6208
Fayetteville
9!9/486-1541
Mooresville
704/663-1699
Sincerely yours,
Robert 0. Walton III
Permits and Compliance Unit
Groundwater Section
Regional Office5
Raleigh
919/733-2314
Washington
919/946-6481
Pollution Prevention Pays
Wilmington
919/395-3900
Winsto n-Salem
919/76 1-2351
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone]
An Equal Opportunity Affirmative Action Employer
.surf
State of North Carolina r i Department of Environment, Health, and Natural Resources R{,
Division of Environmental Health
P.Q. Box 27687 0 Rzdeigh, North Carolina 27611-7687
M41oN
James G. Martin, Govemor
William W. Cobey, Jr., Secretary
April 17, 1991
MEMORANDUM
TO: Nathaniel C. Wilson
Permits and Compliance Group
Groundwater Section
Division of Environmental Management
FROM: Richard W. Caspar ftv-/
Environmental Engineer
Public Water Supply Section
SUBJECT: Application for an Injection Well Permit
Mr. Paul Madritch
Permit No. 91--WO-0011
� u NUVVA;Et% 5
WchArd K. k6We
Director
We have reviewed the material submitted to this office concerning
the above referenced subject.
Considering the legal matter of endorsing this proposal, we
believe we do not have sufficient information to deny the request due
to a threat to the ground water source or to the public health.
our recommendation that an assessment be made to the effects
these systems might have on groundwater remains.
If we can be of further assistance, please let us know.
RWC/cft
An Equal OppoiTunity AffirmaNe Action Employer

State of North Carolina
Department of Environment, Health, and Natural Resources
Division of Environmental Management
512 North Salisbury Street + Raleigh, North Carolina 27611
James G. Mardn, Governor
VAiam W. Cobey, Jr.. secretary
April 8, 1991
Ms. B. D. Browder
Public Water Supply Section
Division of Environmental Health
P.O. Box 27687
Raleigh, NC 27611-7687
Dear Ms. Browder:
George T. Everett. Ph.D.
Director
This office has received the application for Permit to
Construct and/or Use a well system for injection, as listed below.
in accordance with Article 7, Chapter 87-88(j), General Statutes of
North Carolina, we submit the following application, in addition to
a draft copy of the proposed Permit, to DHR for review and
recommendation:
Const. Oper. Renewal
APPLICANT Permit Permit Permit I_n7ection Source
Mr. Paul Madritch No Yes No Heat Pump Effluent
Please note that the application complies with the specified
requirements as prescribed by 15 NCAC 2C .0200.
If we have not received any comments or recommendations within
ten (10) working days of the above date, we will assume that DHR
has no objection to the project as proposed. Please do not
hesitate to contact me at 733-3221 if you have any questions.
Enclosures
Sincerely yours,
Robert J. Turner
Permits and Compliance Unit
Groundwater Section
Pvliudon Prew"don Pays
P-Q. Box 27687. Raleigh, North Carolina 276JI-7687 Telephone [phone]
An Eoual Ci000minity A, lrmmive, Artion Emolover

NORTH CAROLINA DEPARTMENT of NATURAL RESOt14CES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT' 1OUNDWATER SECTION
C.O. BOX 27887 - FIALEIGH,N.C. 27511.'r..JNE [phone]
WELL CONSTRUCTION RECORD
FOR OFFICE USE ONLY
Ouan, ..v. Serial No-
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent._
DRILLING CONTRACTORr�'J
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER � I � PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below) , r
Nearest Town: 4r�� l t
1_�flu ILX&�
(Road, Community, or Subdivision and Lat No.) wit"' �
2. OWNER -:� �
ADDRESS �De-le
Street or Route Nod
City or Town State Zip Code
3, DATE GRILLED 5-Z7-'!�-7 USE OF WELL n`` C
4. TOTAL DEPTH _ CUTTINGS COLLECTED gMas ❑ No
S. DOES WELL REPLACE EXISTING WELL? ❑ Yes Cap
6. STATIC WATER LEVEL: FT_ ❑ above TOP OF CASING,
B- mlow
TOP OF CASING IS FT. ABOVE LAND SURFACE.
7. YIELD (gpm): _ C METHOD OF TEST -WOL10
8. WATER ZONES (depth):. _ kn(> 3`t\
9. CHLORINATION: Type Amount
10. CASING:
wall Thickness
Depth
rrDiameter or Weight/Ft. Material
Frcm To -�l�Z - Ft. X/
From To FL _
From — To Ft_
11 GROUT:
Depth Materi Method
From _ O _ To7—A-2 _Ft.
From Ta Ft-
12. SCREEN'
Depth Diameter Slat Site Material
From To Ft. _ _ in. in.
Feam Tv Ft, in. in.
From To Ft. in. Ir1.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
County: L-t�
Depth DRILLING LOG
From To Formation Description
-zLf
Wei ac,� -
It additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NC%C 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS EN PRpVtDEDT 7E : WELL O ER, l
SIG ' TARE IMF ONTFIACTOR OR AGENT DATE
GW-1 Revised 11/84 Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTW-w OF NATURAL RESOV"CmES AND COMMUNTY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMEW ROLINDWATER SECTION
I'_ 0. BOX 27887 - RALE16KN.C. 27811. PHONE t8IS) 733-6083
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
DRILLER REGISTRATION NUMBER
I. WELL LOCATION: (Show sketch of the location below)
Nearest Town: �k,211 -
(Road, Community, or Subdivision and Lot No.) w
2. OWNER _� �C ^ t Y►Lilwl�j
ADDRESS
Street or Route No.
City orTownState Zip Code
3. DATE DRILLED { USE OF WELL 42
4. TOTAL DEPTH CUTTINGS COLLECTED des ❑ No
5, DOES WELL REPLACE EXISTING WELL? ❑ Yes O=Mu-
S. STATIC WATER LEVEL: — FT, ❑ above TOP OF CASING,
❑ below
TOP OF CASING IDrS L— FT. ABOVE LAND SURFACE.
7. YIELD fgpm): L!' - METHOD OF TEST �� 1
B. WATER ZONES (depth): Q — _ + c--P _
9. CHLORINATION; Type Amount
10, CASING:
Well Thickness
Depth Diameter or Weiig�h�tllFt. Material
From 0 To 30L_ Ft. V y
From —To—Ft.—
From _- To Ft. --
11- GFIDUT:
From
From
12, SCREEN;
From
Frjm
From
13. GRAVEL PACK. -
From
From
14. REMARKS:
Depth Mato Method
_ To 0 Ft-
_ To Ft.
Depth Diameter Slot Size Material
Tv F I. in. in.
_ To Ft. in. in.
To Ft. in. in.
Depth
_ To_
To
Ft.
Ft.
Size Material
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent.
STATE WELL CONSTRUCTION
PERMIT NUMBER:
County: .416-1 4;��Z _ -
Depth DRILLING LOG
From To Formation Description
0- Z0 C
-3 E)
LAZ
It additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance trom at least two State Roads,
or other flap reference points)
5s
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH--15 NCAC 20. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL WNER.
SiGWATURE OF"CONTRACTOR OR AGENT DATE
GW-t Revised 11/84 Submit original to Division of Environmental Management and copy to well owner.

PFSTAT Ver 2.04
Copyright (c) Trimble Navigation, Ltd, 1991, 1992. All rights reserved
3.COR Statistics Version 2.13
Recs Mean Std Dev Minimum
Latitude 211 35°44'18.66948"N 5.09002 35°44'18.14956"N
Longitude 211 78°52'34.61180"W 6.81794 78°52'35.14532"W
Altitude 211 87.82082 9.47754
East Vel 210 0.23681 0.39690
North Vel 210 -0.15447 0.22349
Up Vel 210 0.06069 0.41275
Velocity 210 0.28918 0.61469
No DOP records in file.
start GPS Week #739 on 03/11/94 at 20:53:18
End GPS Week #739 on 03/11/94 at 20:58:30
Datum
Coordinate System
Altitude Mode
Altitude/Distance Units
Velocity Units
WGS-84
Latitude/Longitude
Height Above Ellipsoid
Meters
Meters/Second
49.88473
-0.52319
-0.72316
-0.61525
1.08408
Maximum
35°44'19.69539"N
78°52'33.80363"W
127.72967
1.05307
0.50365
1.05554
1.57378