WI0500186_GEOTHERMAL_20130618

Permit Number WI0500186
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Margaret Laroe SRF
Location Address
384 Potluck Farm Rd
Rougemont
Owner
Owner Name
Margaret
Dates/Events
NC 27572
Laroe
Scheduled
Orig Issue
09/29/08
App Received Draft Initiated Issuance
04/08/13
Regulated Activities
Heat Pump Injection
Outfall NULL
Central Files: APS_ SWP_
06/18/13
Permit Tracking Slip
Status
Active
Project Type
Renewal
Version
2.00
Permit Classification
Individual
Permit Contact Affiliation
Margaret Laroe
384 Potluck Farm Rd
Rougemont
Major/Minor
Minor
Region
Raleigh
County
Person
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Margaret Laroe
384 Potluck Farm Rd
Rougemont
NC
NC
Public Notice Issue
06/14/13
Effective
06/14/13
Re q uested/Received Events
RO staff report requested
RO staff report received
27572
27572
Expiration
08/30/18
04/26/13
06/03/13
Waterbody Name Stream Index Number Current Class Subbasin
Central Files: APS SWP
06/13/13
Permit Number W10500186 Permit Tracking Slip
Program Category Status Project Type
Ground Water In review Renewal
Permit Type Version Permit Classification
Injection Heating/Cooling Water Return Well Individual
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facile
Facility Name
Margaret Laroe SRF
Location Address
384 Potluck Farm Rd
Rougemont
Owner
Owner Name
Margaret
Dates/Events
NC 27572
Permit Contact Affiliation
Margaret Laroe
384 Potluck Farm Rd
Rougemont
Major/Manor Region
Minor Raleigh
County
Person
Facility Contact Affiliation
NC 27572
Owner Type
Individual
Laroe Owner Affiliation
Margaret Laroe
384 Potluck Farm Rd
Rougemont NC 27572
Scheduled
Orig issue App Received Draft Initiated Issuance Public Notice iissu Effective qE'rati np09/29/08 04/08/13 &jfq 113�1 ORegulated Activities ReguestedlReceived Events
Heat Pump Injpction J RD staff report requested 04/25/13
RD staff report received 06/03/13
Outfall NULL
Waterbody Nama
Stream Index Number Current Class Subbasin

RA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Margaret LaRoe
384 Potluck Farm Rd.
Rougemont, NC 27572
Division of Water Quality
Thomas A. Reeder
Acting Director
June 14, 2013
Re: Issuance oflnjection Well Permit
Permit No. WI0500186
Geothermal Heating/Cooling Water Return Well
Person County
Dear Ms. LaRoe:
John E. Skvarla, Ill
Secretary
fu accordance with your application received April 8, 2013, I am forwarding Pennit No. WI05OO186 for
the operation of geothermal heating/cooling water return well(s) located at the above referenced address.
This permit shall be effective from the date of issuance until August 30, 2018, and shall be subject to the
conditions and limitations stated therein.
The Raleigh Regional Office inspected your geothermal system on May 23, 2013, and collected water
samples. A copy of the laboratory analytical results will be sent to you when it becomes available.
fu 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 ex:piration 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 pennit or the Underground fujection
Control Program please call me at [phone].
~ /<,--
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
cc: Rick Bolich, Raleigh Regional Office
Central Office File, WI05OO186
Person County Environmental Health
1617 Mail Service Center, Raleigh , North Carolina 27699-1617
Location : 512 N. Salisbury St Raleigh, North Carolina 27604
Phone: 919~07-6300 I FAX: 919~07-6492
Internet: www.ncwaterguality.org
An Equal Opportunity I Affirmative Action Employer Ni1ithCaro1ina
/vaturall!I
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Margaret LaRoe
FOR THE OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER RETURN WELL(S),
defined in Title 15A North Carolina Administrative Code 2C .0224, which will be used for the injection of heat
pump effluent. This injection well is located at 384 Potluck Farm Rd., Rougemont, Person County, NC 27572,
and will be operated in accordance with the application received April 8, 2013, and in conformity with the
specifications and supporting data, all of which are filed with the Department of Environment and Natural
Resources and are considered a part of this permit.
This permit is for operation of an injection well shall be in compliance with Title 15A North Carolina
Administrative Code 2C . 0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date ofits issuance until August 30, 2018, and shall be
subject to the specified c;:onditions and limitations set forth in Parts I through VIII hereof.
Permit issued this the · \4 ~y of ~ , 2013
, ~ ~~(,Jlh
Tom Reeder, Acting Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Penn.it #WI0500186 DIC/Return Well.: RENEW AL
ver. 01/2013
Page I of5
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be permanently labeled with a warning that it is for injection purposes and the entrance to each well
must be sealed with a watertight cap or well seal, as defined in G.S. 87-85(16).
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.01070).
8. Copies of the Well Construction Records shall be retained on-site and available for inspection.
PART II-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a ' ' name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
4. Continued operation of the injection system will be contingent upon the effluent not impacting
groundwater quality. The water quality of the effluent cannot be that of a lower quality than the influent,
which results in a degrading of water quality of the aquifer.
Permit #WI0500l86 DIC/Return Well -RENEWAL
ver. 01/2013
Page 2 of5
PART HI-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater which will render it unsatisfactory for normal use. In the event that .the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART IV -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
PART V -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department repre~entatives shall have reasonable access for purposes Qf inspection, observation, and
sampling associated with injection and any related facilities as provided fof 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 Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Raleigh Regional Office, telephone number 919-791-4200, any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
Permit #Wl0500186 DIC/Return Well-RENEWAL
ver . 01/2013
Page 3 of5
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Pennittee becomes aware of an omission of any relevant facts in a 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 injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0240,
Abandonment and Change-of-Status of Wells.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0240, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if .
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
' '
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
Permit #WI0500186 UIC/Retum Well-RENEWAL
ver. 01/2013
Page 4 of5
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0224(±)(4) within 30 days of completion of abandonment.
3. The written documentation required in Part VIII (I) and (2) (G) shall be submitted to :
Pennit #WI0500186
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
NA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Division of Water Quality
Charles Wakild, P. E
Director
May 24, 2013
MEMORANDUM
To:
Through:
From:
Michael Rogers, The Central Office, APS
Rick Bolich ·~
Lin McCartney
John E. Skvarla, III
Secretary
RECE\VEDIDENR/DWO
JUN O 3 2013
Aqutter Protection Section
_Subject: Staff Report-WI 0500186, Margaret LaRoe, Geothermal
Heating/Cooling Water Return Well Renewal Application
Person County
Aquifer Protection Section
1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Location: 3800 Barrett Dr., Raleigh, North Carolina 27609
Phone: [phone]\FAX: [phone]
Internet: www.ncwaterguality.org
An Equal Opportunity \ Affirmative Action Employer
Nirthcarolina
)Vatural/11
AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: Ma 24, 2013
To: Aquifer Protection Central Office
Central Office Reviewer: Michael Rogers
Regional Login No: __ _
County: Person
Permittee: Margaret LaRoe ·
Project Name: Open-Loop Geothermal
Injection Well
Application No.: WI0500186
L GENERAL INFORMATION
1. This application is (check all that apply): D New [gl 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 D 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? ~ Yes or D No .
a. Date of site visit: 05-23-2013
b. Person contacted and contact information: Margaret LaRoe, 336-364-1353
c. Site visit conducted by: Lin McCartney
d. Inspection Report Attached:~ Yes or D No.
2. Is the following information entered into the BIMS record for this application correct?
RECEIVEDIDENRIDWQ
JUN O 3 2013
Aquifer Protection Section
[gl Yes or D No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions: __
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude: __
e. Regulated Activities/ Type of Wastes (e.g., subdivision, food processing, municipal wastewater): __
For Disposal and Injection Sites:
(If multiple sites either indicate which sites the information applies to. cop y and paste a new section into the
document for each site , or attach additional pages for each site )
a. Location(s): 384 Potluck Farm Rd., Rou gemont nc 27572
b. Driving Directions: Take US-70 W. take US-501 N . turn ri ght onto US-50 1, turn right onto Red Mountain
Rd .. turn left onto Moriah, turn left onto Potluck Farm Rd.
c. USGS Quadrangle Map name and number:
d. Latitude: 36-14-56 Longitude: 78-50-55
IL NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or minor
modifications, skip to next section)
Description Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification: __
FORM: Laroe-staff report
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:
[gJ Heating/cooling water return flow (5A7)
D Closed-loop heat pump system (5QM/5QW)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5L/''Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? [gJ Yes D No
3. Are there any potential pollution sources that may affect injection? [gJ Yes D No
What is/are the pollution source(s)? The septic tank. The septic tank is approximately 150 feet distance from
the well.
4. What is the minimum distance of proposed injection wells from the property boundary? 80 ft.
5. Quality of drainage at site: [gJ Good D Adequate D Poor
6. Flooding potential of site: [gJ 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)? [gJ 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.
In jection Well Permit Renewal And Modification Only :
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid , poor heating/cooling)?
D Yes [gJ 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 g roundwater remediation permits ( of any tvp e ). will
continued/additional/modified in iections have an adverse im pact on mim-ation of the plume or management of
the contamination incident? D Yes D No. If es. explain:
FORM:· Laroe-staff report 4
AQUIFER PROTECTION REGIONAL STAFF REPORT
4. Drilling contractor: Name: ACME Well Co. Inc.
Address:
7990 NC H wy . 75 L Durham. NC 27703
Certification number: 2949
5. Complete and attach Well Construction Data Sheet.
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet-if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? D Yes ~ No. If yes, please explain
briefly . __ .
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a 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: Laroe-staffreport 5
AQUIFER PROTECTION REGIONAL STAFF REPORT
7. Recommendation: D Hold, pending receipt and review of additional information by regional office; D Hold,
pending review of draft permit by regional office; D Issue upon receipt of needed additional information; [8J
Issue; D Deny. If deny, please state reasons: __
8. Signature of report preparer(s): -~d_· _i _r"_~~--(_~~=6....,........~----~-+---+1--------
Signature of APS regional supervisor: ------,~"r-,-+---d.~Ti!:-""---~ ___ SJ__,/,,_7~ :J.-t,,~•,_,/,~~1----,,,J~------
Date: ______ _
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
Well construction inspection and well water sampling were conducted on May 23, 2013.
Based on the description of the well by visual inspection and a review of the well construction data,
the subject geothermal injection well has been constructed in accordance with N.C. State
Regulations (Title 15A NCAC 2C), Well Construction Standards.
The following comments are highlighted as a result of the inspection.
A review of the construction data indicates that the subject geothermal injection well has been
constructed in accordance with N.C. State Regulations (Title 15A NCAC 2C), Well Construction
Standards.
The following items were checked:
1. Well Casing
• Casing :Diameter: 6.25 inches
• Casing depth: from ground to 43 feet. Casing extends above ground 16 inches
• Type: Galvanized Steel.
2. Grout
• Grout type-unknown
• Grout surface and grout depth-Around well casing from 0 to 40 feet.
3. Identification plate
• The well has an identification plate.
• The plate contains the following information: Contractor: ACME Well; Registration
No. 2949; Date Well Completed 05-01-2007; Total Depth of Well: 405 ft; Casing
Depth: 43 ft; Diameter: 6 ¼ inches; Static Water Level: 25 ft; Yield: 12 GPM.
4. The location of the well
• The septic tank (potential pollution source) is approximately 150 feet distance from
the well.
• The minimum distance of the well from the property boundary is about 80 feet.
• The minimum distance of the well from the building is 36 feet.
FORM: Laroe-staff report 6
AQUIFER PROTECTION REGIONAL STAFF REPORT
Over all, this geothermal injection well is still in compliance with well construction standards.
However, we are awaiting the lab results of the well water to complete this permit renewal
application process.
FORM : Laroe-staffreport 7
Permit: WI0500186
SOC:
County: Person
Region: Raleigh
Compliance Inspection Report
Effective: 09/29/08 Expiration: 08/31/13 Owner: Margaret Laroe
Effective: Expiration: Facility: Margaret Laroe SRF
384 Potluck Farm Rd
Rougemont NC 27572
Contact Person: Margaret Laroe Title: Phone: [phone]
Directions to Facility:
From Rougemont, NC take Red Mtn Rd/NC1471 E appx 5 miles. Road forks to left on Berea Rd and go appx 1 mile. Turn Lon Potluck
Farm Rd . Go aiwx .35 mi and property is off road on R.
System Classifications:
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 05/23/2013
Primary Inspector: Lin McCartney
Secondary lnspector(s):
Entry Time: 10:00 AM
Certification:
Exit Time: 11 :30 AM
Phone:
Phone: [phone]
Ext.4243
Reason for Inspection: Routine Inspection Type: Compliance Sampling
Permit Inspection Type: Injection Heating/Cooling Water Return Well
Facility Status: ■ Compliant O Not Compliant
Question Areas:
■Wells
(See attachment summary)
Page: 1
Permit: WI0500186
Inspection Date: 05/23/2013
Owner -Facility: Margaret Laroe
Inspection Type: Compliance Sampling Reason for Visit: Routine
Inspection Summary:
Well construction inspection and well water sampling were conducted on May 23, 2013.
The following comments are highlighted as a result of the inspection.
A review of the construction data indicates that the subject geothermal injection well has been constructed in accordance
with N.C. State Regulations (Title 15A NCAC 2C), Well Construction Standards.
The following items were checked:
1 . Well Casing
Casing :Diameter: 6.25 inches
Casing depth: from ground to 43 feet. Casing extends above ground 16 inches
Type: Galvanized Steel.
2. Grout
Grout type-unknown
Grout surface and grout depth-Around well casing from Oto 40 feet.
3. Identification plate
The well has an identification plate.
· The plate contains the following information: Contractor: ACME Well; Registration No. 294~; Date Well Completed
05-01-2007; Total Depth of Well: 405 ft; Casing Depth: 43 ft; Diameter: 6 ¼ inches; Static Water Level: 25 ft; Yield: 12
GPM.
4. The location of the well
The septic tank (potential pollution source) is approximately 150 feet distance from the well.
· The minimum distance of the well from the property boundary is about 80 feet.
· The minimum distance of the well from the building is 36 feet.
Over all, this geothermal injection well is still in compliance with well construction standards.
However, we are awaiting the lab results of the well water to complete this permit renewal application process.
Page: 2
A QUIFER PROTECTION SECTION
APPLICATION REVIEW RE QUEST FORM
Date: A pril 26 , 2013
To: D Landon Davidson, ARO-APS
□ Art Barnhardt, FRO-APS
D Andrew Pitner, MR.O-APS
~ Rick Bolich, RRO-APS
0 David May, WaRO-APS
0 Morella Sanchez King, WiRO-APS
0 Sherri Knight, W-SRO-APS
From: Michael Ro e:ers Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Mail: Michael.Ro2:[e-mail]
A. Permit Number: WI 0500186
B. Owner: LaRoe
C. Facility/Operation: ~
D Proposed
D. Application:
1. Permit Type: D Animal
D Recycle
~ Existing D Facility D Operation
D SFR-Surface Irrigation□ Reuse D H-R Infiltration
D I/E Lagoon D GW Remediation (ND)
~ UIC -Geo,thermal Heating/Cooling Water Return Well
For Residuals: D Land App. D D&M D Surface Disposal
D 503 · D 503 Exempt D Animal
2. Project Type: D New D Major Mod. D Minor Mod. ~ Renewal D Renewal w/ Mod.
E. Comments/Other Information:
NOTE: Please record all information on the well tag. if present, and put on staff report. Thanks.
~ Return a completed APSARR after the site inspection. At a later date, after sampling & the lab
results are received, please send us a copy of the letter you send to the Permittee containing
laboratory analytical results.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
D Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: -------------------Date: _____ _
FORM: APSARR 07/06 P age 1 of 1
NCDENR
North Carolina department of Environment and Natural Resources
Pat McCrory
Governor
Margaret LaRoe
384 Potluck Farm Rd.
Rougemont, NC 27572
Dear Ms. LaRue:
Division of Water Quality
Charles Wakild, P.E.
Director
April 23, 2013
John E. Skvaria, III
Secretary
Subject: Acknowledgement of
Application No. W10500186
Margaret LaRue SFR
Injection Heating/Cooling
Water Return Weil System
Person County
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on 04/08/2013. Your application package has been assigned the number listed
above, and the primary reviewer is Michael Rogers.
Central and Raleigh Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Aquifer Protection Section requests your assistance in
providing a timely and complete response to any additional information requests.
Please note that processing standard review permit applications may take as long as 64 to 90 days
after receipt of a complete application. If you have any questions, please contact
Michael Rogers at [phone] or [e-mail].
r-.
cerely,
for Debra 7.` w tts
Groundwater Protection Unit Supervisor
CC: Raleigh Regional Off -ice, Aquifer Protection Section
Permit File W10500186
AQUIFER PROTECTION SECTION
1636 Wail Service Center, Raleigh, North Camlins 27699.1636
EocaWn: 512 N. Salisbury St., Ralaigh. North Carolina 27604
Phone. 91 MOT-64641 FAX: [phone]
1memet. 2M .nnvatemuality,om
An Equal ❑ppertunily I Affmadve AduR Employer
Otte
NofthCaroJna
Nahm lly

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of ISA NCAC 02C .0200
OPEN-LOOP GEOTHERMAL INJECTION WELLS
These wells discharge groundwater directly into the subsurface as part of a geothermal heating and cooling system
(check one) __ New Application ✓ Renewal* Modification
* For renewals complete Parts A-C and the signature page.
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: :7Y\a,A..,,c£_ cl] , 20 13
PERMIT NO. W JO 5 0Ot8 lo (leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Non-Government: Individual Residence .'I.,. B usinessiOrganization __
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:
,VJ flBGA l:{£C L aRo e ," 1 ' 7,,1·
Mailing Address: 3 8 ~ Po +-l u c.\S t'Rd
City: --'--'--=->o!..:........,_'-'--'-'=-c...L..___ ____ State :Jl/C Zip Code: q 75 U County: PE RSo N
Day Tele No.: 33 (e -.3 h t-j ·-\ 3 5=3 Cell No.:
EMAIL Address: fa) l-.Jt\ R ot"@ E:S i(V'(l , Fax No .:
C. LOCATION OF WELL SITE -Where the injection wells are physically located:
-~ (1) Parcel Identification Number (PIN) of well site: tJ CJ q ~ (.,[ 'Z County: P £ R ~ 0 Al
(2) Physical Address (if different than mailing address): ___,.5=--A-'--'-/vl_,_b"'------------
City: _______________ State: NC Zip Code:-=-==....----~.-....--
RECElVED/OENRJDWQ
D. WELL DRILLER INFORMATION APR O 8 2013
Well Drilling Contractor's Name : -------------------.--=c--=Pl.....,._onr..-e.-Aq uifer Protection Sect ion NC Well Drilling Contractor Certification No.: ____________________ _
Company Name: ______________________________ _
Contact Person.~: --------------=E=MA=IL~A=d=d=r=es=s~: __________ _
Address: ________________________________ _
City: _________ Zip Code: ____ State: __ County: ________ _
Office Tele No.: Cell No .: ,,..F=axc=..Nc..c=o=.: _______ _
GPU/UIC 5A 7 Permit Application (Revised 3/18/201 I) Page I
E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: —
Contact Person: EMAIL, Address_
Address:
City:
Office Tele No.:
Zip Code: _ _ ---_. — State: County:
Cell No..
Fax No.
F. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES NO
(2) Personal consumption? YES NO
G. WELL CONSTRUCTION DATA
PROPOSED Well(s) to be constructed for use as an injection well. Provide the data in (I) through
(6) below as PROPOSED construction specifications. Submit Form GW-I after construction.
EXISTING Well(s) being proposed for use as an injection well. Provide the data in (1) through (6)
below to the best of your knowledge. Attach a copy of the Well Construction Record (Form
GW-1) if available.
(1) Well Construction Date: Number of borings:
Depth of each boring (feet):
(z) Well casing type: Galvanized steel Black steel Plastic Other (specify)
Casing thickness (in.): Diameter (in.) --
Well depth: from: to: feet below land surface
Casing extends above ground inches
(3) Grout material surrounding well casing:
(a) Grout type: Cement Benton.ite* Other (specify)
*,By selecting hentonite grout, a variance is hereby requested to 15A NCAC 2C .0213(d)(1)(A), which requires a cement type grunt
(b) Depth of grout around well casing (relative to land surface): from to feet
(4) Well Screen or Open Borehole depth (relative to land surface): from to _ feel
(5) N.C. State Regulations (Title ISA NCAC 2C _0200) require the Permittee to make provisions for
monitoring wellhead processes_ A faucet on both Influent (groundwater entering heat pump) and Effluent
(water being injected back into the well) lines is required, Is !here a faucet on:
(a) Influent line? Yes No (b) Effluent line? Yes No
(6) Source Well Construction Information. if the water source well is a different well than the injection
well, attach a copy of the well construction record (Form GW-1). If Form GW-I is not available, provide
the following data:
From what depth, formation, and type of rock/sediment units will the groundwater be withdrawn'? (e.g.
granite, limestone, sand, etc_)
Depth: Formation: Rock/sediment unit:
NOTE: THE WELL DRILLING OR HEAP PUMP CUNIRACI'dlt CAN IIELP SUPPLY THE DATA IF THIS
INFORMATION IS OTHERWISE UNAVAILABLE.
GPUIUIC 5A7 Permit ApplicaCian (Revised 3/18/2011) Page 2

J. CERTEFICATION (to be signed as required below or by that person's authorized agent)
l SA NCAC 02C .02I 1(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 d 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 ail 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 ans 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_"
-�� 0- L-T - l e)' �"
Signature off roperty Owner/Applicant
dirt ttG64kET-- E- L.R1Qa
Print or Type Full Name
Signature of Property Owner/Applicant
Print or Type FulI Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
'Telephone [phone]
REGEJVEDIDENRMWQ
APR 0 8 203
Agder protection Section
CPUIUIC 5A7 Permit Application {Revised 3/1$1201 l} Page 4

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Acting Director Secretary
July 16, 2013
MEMORANDUM
To: Michael Rogers, The Central Office, APS
Through: Rick Bolich 9
From: Lin McCartney
Subject: Analytical Results Report- WI0500186, Margaret LaRoe
Geothermal Heating./Cooling Return Water Well Renewal
Application
Person County
Aquifer Protection Section
1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Location: 3800 Barrett Dr., Raleigh, North Carolina 27609
Phone: [phone] FAX: [phone]
Internet: www.ncwatemuality.or�
An Equal opportunity 1 AiFinnative Action Employer
REMMOMM
JUL 10 2013
AMpRlOUSefto
One
Na Warohna
;Vaturall'ff

JE,'A
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Division of Water Quality
Thomas A. Reeder John E. Skvarla, III
Secretary
Margaret LaRoe
384 Potluck Farm Rd.
Rougemont, NC 27572
Dear Ms. LaRoe,
Acting Director
July 16, 2013
Subject: Analytical Results of Well Water
Permit No. WI0500186
Geothermal Heating/Cooling Water
Well .
Person County
Enclosed please find the analytical results of the subject well water which was sampled on May 23,
2013. Your geothermal well was sampled as part of the permit renewal application process. The influent
(groundwater entering the heat pump) and the effluent (groundwater being injected into the well) of the
geothermal well system were sampled.
The analytical data indicate that all the parameters are in compliance with Groundwater Quality
Standards and the construction of the subject well is in compliance with the permit conditions. If you
have any questions, please contact me at [phone].
Cc: RRO-APS Files
The Central Office-APS Files
Aquiter Protection Section
1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Location: 3800 Barrett Dr., Raleigh, North Carolina 27609
Phone: [phone] \ FAX: [phone]
Internet: www.ncwaterquality.org
An Equal Opportunity I Affirmative Action Employer
Sincerely,
ifi'Y\ h'\LGJ·~N,~
Lin McCartney 0
Environmental Senior Tech
Nirth Carolina Naturally
AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Division of Water Quality
Thomas A. Reeder
Acting Director
John E. Skvarla, III
Secretary
Margaret LaRoe
384 Potluck Fann Rd.
Rougemont, NC 27572
Dear Ms. LaRoe,
July 16, 2013
Subject: Analytical Results of Well Water
Permit No. WI0500186
Geothermal Heating/Cooling Water
Well
Person County
Enclosed please find the analytical results of the subject well water which was sampled on May 23,
2013. Your geothermal well was sampled as part of the permit renewal application process. The influent
(groundwater entering the heat pump) and the effluent (groundwater being injected into the well) of the
geothermal well system were sampled.
The analytical data indicate that all the parameters are in compliance with Groundwater Quality
Standards and the construction of the subject well is in compliance with the permit conditions. If you
have any questions, please contact me at [phone].
Cc: RRO-APS Files
The Central Office-APS Files
Aquifer Protection Section
1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Location : 3800 Barrett Dr., Raleigh, North Carolina 27609
Phone : [phone]\ FAX: [phone]
Internet: www.ncwaterquality.org
An Equal Opportunity\ Atlirrnative Action Employer
Sincerely,
2'1'ri Yv\(&i·~~
Lin McCartney {j
Environmental Senior Tech
Nirth Carolina
;Vaturalll/
r: r
0WO f a6oratery Section t
esufts
County:
PERSON
INA7FR
Sample ID'
AB35892
River Basin
OF
O�QG
PO Number #
13G0433
Report To
RROAP
to f
Date Received:
G512312013
^�
Time Received'
13-30
Collector:
L MCCARTNEY
Lahworks LoginlD
MSWIFt
Region:
RRO
Final Report Hate:
6121113
Sample Matrix:
GROUNDWATER
Final Report
Report Print gate'
07/15/2013
Loc. Type:
WATER SUPPLY
Emergency Yes/No
Visitl❑
COC Yes1No
Loc. Oescr.: MARGARET LARGE 384 POTLUCK FARM RD. ROUGEMONT NC 27612
Location ID:
5PO73W10600186 IN
Collect Date: 05/2312013
Collect -Time: 10:00
Sample Depth
If this report is labeled preliminary report, the results have not been validated.
Do not use for Regulatory purposes.
CAS # Analyte Name PgL
Result/
Units Method
Analysis
Validated by
Qualifier
Reference
Date
LAB
Sample temperature at receipt by lab
2.3
eC
5/23113
HMORGAN
MIC
Coliform, MF Fecal in liquid 1
182
CFL1ltboml APHA9222D-20th
5123113
ESTAFFDRDI
Coliform, MF Total in liquid 1
4
CFU1100ml APHA922213-20th
5123113
ESTAFFORD1
WET
Ion Chromatography
TITLE_
mglL
EPA 300.0
5130/13
CGREEN
Chloride
1.0
6.1
mglL
EPA 300.0
5130113
CGREEN
Fluoride
0.4
0.4 U
mg1L
EPA 300.0
5130/13
CGREEN
Sulfate
2_p
8,4
mglL
EPA 300.0
5/30/13
CGREEN
Total Dissolved Solids in liquid
12
222
mg1L
APHA2540C-18TH
5129113
CGREEN
NUT
NO2+Na3 as N in liquid
0.02
0.02 U
mg1L as N
Lao10-107-04-1-c
5129113
CGREEN
Phosphorus fatal as P in liquid
0.02
0.02
mg1L as P
LacIO-115-01-IEF
5/30/13
CGREEN
MET
7440-22-4
A0 by ICPMS
1.4
1.0 U
ug/L
EPA2D0.8
6113/13
ESTAFFORD1
742"0-5
Al by ICP
50
87
ug/L
EPA 200.7
617113
ESTAFFDRDI
7440-36-2
As by ICPMS
2.0
2.0 U
Ug1L
EPA 200.8
6113/13
ESTAFFDRDI
7440-38-3
Ba by ICP
10
120
ug1L
EPA 200.7
617113
ESTAFFDRD1
7440-70-2
Ca by ICP
0.10
37
mg1L
EPA 200.7
617113
ESTAFFDRDI
7440-43-9
Cd by ICPMS
0.50
0.50 U
ug/L
EPA 200.8
6/13113
ESTAFFDRDI
744D-47.3
Cr by ICPMS
10
1Q u
ug/L
EPA200.8
6/13113
ESTAFFDRD1
7440-50-8
Cu by ICPMS
2,0
4,5
ug1L
EPA200.8
6113113
ESTAFFO.RD1
7439-89-8
Fe by ICP
50
50 U
ug/L
EPA200.7
617113
ESTAFFDRDI
Hardness by Calculation
1.0
110
mglL
SM2340SEPA 200.7
617113
ESTAFFDRDI
7439-97-6
Hg 245.1
0.2
0.20 U
ug/L
EPA 245A
615113
ESTAFFORDI
7440-09-7
K by ICP
0.10
0.45
mg1L
EPA 200.7
617113
ESTAFFDRDI
7439-95-4
Mg by ICP
0.10
4.9
mglL
EPA 200.7
617113
ESTAFFDRDI
7439-96-5
Mn by ICP
10
250
uglL
EPA 200.7
517113
ESTAFFOR❑1
7440-23-5
Na by ICP
0.10
37
mg/L
EPA 200.7
W113
ESTAFFDR❑I
7440-02-0
Ni by ICPMS
2.0
2.0 U
ug/L
EPA200.8
6113/13
ESTAFFDRD1
7439-92-1
Pb by ICPMS
2.0
2.0 U
ug/L
EPA200A
6113/13
ESTAFFDRDI
Laboratory Section>> 1623 !Nail Service Center, Rafei9h, NC 27699-1623 (219) 73 3-39 08
For a detailed dasdription of tie quaiiliar codes War to Q"Iiffor codes<httu:IlflomJ.ncdenr,o-r�kstrhraltablst�[itn_raltechas�utz
Page 1 of 2

v4",, I :NC <DWQ £a6oratory Section (}?gsu[ts
Location ID : 5P073WI0500186_IN Samp le ID: AB95892 Collect Date : 05/23/2013 Co ll ect Time :: 10:00
MET
CAS# Analyte Name PQL Result/ Units Method Analysis Val idated by Qualifier Reference Date
7782-49-2 Se by ICPMS 5.0 5.0 U ug/L EPA200.8 6/13/13 ESTAFFORD1
7440-66-6 Zn by ICPMS 10 30 ug/L EPA200.8 6/13/13 ESTAFFORD1
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed description of the qualifier codes refer to http:/Jportal.ncdenr.org/web/wg/lab/stafflnfo/tec:hassist#Dara Qualifier Codes <http:/jportal.nedanr.org/web/wg/lab/stafffnfo/techassist>
Page 2 of 2
North Carolina
GROUNDWATER FIELDILAB FORM Deparhrrerrt of ErMwonerrt and Natural Resources
DIVISK)N OF WATER DUALiTY41ROUNDWATER SECTtOR
Location code � -� 3 _'� 10S �[� ! G __ Irk SAMPLE 71rpE � loRrsv 3� p
Coemty (e c5 0 r`) - _ � Water 10 Routine � Lab Number AlB CA
Quad No Serial No. ❑ son --
❑ other lair R17 5-L3 Thule:D ; O
tat. tong. Reed fay: �p Fmm:Bus. Courier, d Oe .
❑ Chan of Cuxstody Othet
Report To: ARO. FRO. Mm),vua WaRO. WeRO, - — - Data Entry By: Ck:
WSRO, Kinston FO. Fed. Trust. Cerehat Oft„ other. r[ Date Reported:
Shipped bar- Bus. and Other. Purpose:
Cafleeta►(sy:_ L ir., ''t Date S � - ime {) Baselis+e, Carnplaint Can JL. Pest
wner icide 54udy, Fed4►ral Trull, other:
FIELD ANALYSES 3 oM G'f'� G Y e-' r 6• }r e tLUUS� T
PH aeo '_ Spec. Cond.9 at 25°C
Temp.io 'G Oda_ �YL
Appearance G Psi
Field Ar+alytsis By ae i n
LABORATORY ANALYSES
500310
myL
COD "h 3+0
rngit
Cod Lour 335
myL
Carft m: W Fecal S7M
IrC[M7+1
w4mm: W TOW 31s"
IlooRd
1= elm
ngR
Tur6" 7B
A[Tt1
11t�sid+>r. Tonal Suuspr*ded Sad
nugeL
PH ■0�
wm
ANa rRly to CH 41410
nglL
Oft0nlfy 10 PH UP 413
M91L
CarApn"ft 445
"9&
sicalto a* MO
n4k
Caeom dowide +05
w4k
x ChW* 9410
m9k
Crerpnienm: "ff 102
WYL
COW.True EQ
Ctr
Cyarade �24
mgll
Location or Site " V 120T I U C k Fcxtr" Pej ov err. h C-
Description of sampling point
SampTmg Method Sample —Interval
Remarks
t�+w,o rr,,,r, w �.. •� i
Ghee. Sa11ds 7Q3pt1
rrxjrt
F7ue>.ide aS1
MWL
HardnursS: TCM 2W
wwL,
rta &*n irm-c+m1 t172
"K
PHermh 327M
UO
sowfkCand.9S
}Awtnnsldn
S # to $45
moll
Sultlde 7R5
rngR
Ca aed Gmmw
►r VL
w% a711614
m92
T1CN as N 62S
molt
rf8i + � a3 ti b3G
�
�[ P: Tdtat as P ws
mgrL
fiRrytt [ND, ens f+y tt241
ergrL
t+rieete 0m, as m 015
IT
Lab Comments
GW-SA REV, AIDS Far m"dired Anarrsis�wbrnh Frlered sampte and wi to lW in fleece_
r17 -

1
i
County:
PERSON
WAr�p
sample ID:AS95893
River Basin
t?�
QG
PO Number #
13G0434
��
Report To
RROAP
rig j
Date Received:
05/23/2013
Collector.L
I+RCCARTNEY
j
� + � �
Time Received:
13:30
Regina:
RRO
�
Labworks LoginlD
MSWIFT
Final Report Date:
6121113
Sampfe Matrix:
GROUNDWATER
Final Report
Report Print Date:
07115/2013
Lac. Type:
WATER SUPPLY
Emergency YeslNo
VisitlD
COC YeslNo
Loc. Descr.: MARGARET LARGE 384 POTLUCK FARM RD. ROUGEMONT, NC 27572
Location ID:
5P073WI0500186_OUT
Co4ect Date: 0512312813
Collect Time: 11:00
Sample Depth
If this report is labeled preliminary report, the results have not been validated.
Do not use for Regulatory purposes.
GAS * Analyte Name PQL
LAB
Sample temperature at receipt by lab
MIC
Result) Units Method Analysis Validated by
Qualifier Reference Date
2.3 °C 5123/13 HMORGAN
Coiiform, MF Fecal in liquid 1 1 B2 CFU1100ml APHA9222D-20th 5123113 ESTAFFORDI
Coiiform, MF Total in liquid 1 3 CFU1100mi APHA9222a-20th 5123/13 ESTAFFORDI
WET
Ion Chromatography
TITLE_
mglL
EPA 300,0
616113
CGREEN
Chloride
1.0
5.8
mglL
EPA 300.0
616113
CGREEN
Fluoride
0.4
0.4 U
mg1L
EPA 3G0.0
616113
CGREEN
Sulfate
2.0
9.0 J3
mg1L
EPA 300.0
618113
CGREEN
Total Dissolved Solids In liquid
12
2"
m91L
APHA2540C-18TH
5/29/13
CGREEN
NUT
NO2+NO3 as N in liquid
0.02
0.02 U
mg1L as N
LactO-107-04-1-c
5129113
CGREEN
Phosphorus total as P in liquid
0.02.
0.03
mglL as P
LaclO-115-01-IEF
5/30/13
CGREEN
MET
7440-22-4 Ag by ICPMS 1.0 1.0 U ug/L EPA200.8 6/13113 ESTAFFORDI
7429-90-5 Ai by ICP 50 SOU ug/L EPA 200.7 617113 ESTAFFORDI
7440-38-2
As by ICPMS
2.0
2.0 U
uglL
EPA200.8
6113113
ESTAFFORDI
7440-38-3
Ba by ICP
10
IOU
uglL
EPA 200.7
60113
ESTAFFORDI
7440-70.2
Ca by ICP
0.10
0.10 U
mg/L
EPA 200.7
617113
ESTAFFORDI
7440-43-9
Cd by ICPMS
0.50
0.50 U
ug1L
EPA 200.8
6113113
ESTAFFORDI
7440-47-3
Cr by ICPMS
10
IOU
uglL
EPA 200.8
6113/13
ESTAFFORDI
7440-M-8
Cu by ICPMS
2.0
3.9
uglL
EPA 200.6
6/13113
ESTAFFORDI
743mg-6
Fe by ICP
50
50 U
uglL
EPA 2001
6R113
ESTAFFORDI
Hardness by Calculation
1.0
0.66
mg1L
SM2340BEPA200.7
617113
ESTAFFORDI
7439-97-6
Hg 245.1
a2
0.20 U
ug/L
EPA 245.1
615113
ESTAFFORDI
7440-09-7
K by ICP
0.10
0AO U
mglL
EPA200.7
WM3
ESTAFFORDI
7439-95-4
Mg by ICP
0.10
0.10 U
mg1L
EPA 200.7
517113
ESTAFFORDI
7439-96-5
Mn by ICP
10
10 U
uglL
EPA 200.7
617113
ESTAFFORDI
7440-23-5
Na by ICP
0.10
93
rng/L
EPA 200.7
6 7/13
ESTAFFORDI
7440-02-0
Ni by ICPMS
2A
2.0 U
uglL
EPA200A
6/13113
ESTAFFORDI
7439-92-1
Pb by ICPMS
2.0
2.0 U
uglL
EPA200.8
6113113
ESTAFFORDI
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed deacripliori of the quaHria<codes refer tQ htt rta .r. d n_o. w h w ; alSinto tRtnassiit�4ata iifRar Cads <hn ml.rKdenr.o Ixh sratfi tec as 1 0
Page 1 of 2

:NC <ZYWQ La6oratory :Section ~su{ts
Location.ID: 5P073WI0500186_ OUT Sample ID: AB95893 Collect Date: 05/23/2013 Collect nme:: 11:00
MET
CAS # Anal yte Name PQL Result/ Units Method Analysis Validated by Qualifier Reference Date
7782-49-2 Se by ICPMS 5 .0 5.0 U ug/L EPA200.8 6/13/13 ESTAFFORD1
7440-66-6 Zn by ICPMS 10 10U ug/L EPA200.8 6/13/13 ESTAFFORD1
Sample Comments
WET:-S04-J3-ESTIMATED-MATRIX INTERFERENCE IN MS/MSD
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detail ed description of the qualifier codas refer to http://portal.ncdenr.org/web/wg/l1b/st1f1info/techassist#Data Quolin,r Codes <http ://portal.ncdenr.org/wob/wg/lab/st•flinfo/techassist>
Page 2 of 2
GROUNDWATER FIELDILAB FORM
Location code. 5 P U rt3 %,/ r q 0Z-) U G_ o
Quad No Serial No.
Lat. Long.
Report To: ARO, FRO. MRO, RO MRO, WiRO,
WSRO.1Cmtorl FO, Fed. Trust. Central Of., Other
North Cami'ma
Oeparin►ent of EnuirnnmeM and Natural Resoumes
0WISION OF WATER QUALM .GROUNLIWATER SECTioH
► � IF PRIORITY y3 C?D�{ 3
Water 0 Routine Lab Number A 131 M � 3
❑ Sni4 ❑ Emergency
❑ Other Dole Receiver �3� Time. 3
Reed i3y;�,7L"_ From:Bus. Courier.
El Chain of Custody Other
- — - o u t Data Entry BY Ck:
Date Reported,.
Shipped by. Ow Courier, a e . Other: Purpose:
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FIELD ANALYSES owner, o r rnr e + L c,r0 tdwEIR"
pH ,m 6 Spec. Cond-% at 25°C Location or Site P c4 I y c r►n ►tz yen L.� P .,, ter, C
Temp -it) � 3 _ °C Odor n 0 5n _ Description of sampring point
Appearance L P& r Samprmg Method Sample Interval
Field Analysis By: _ 71 ILC ar v) �_ -d _ _ _ Remarks
LABORATORY ANALYSES mt.)
t3C7D 310 r
con ►j% 3+a
COO Low 335
Coerorw W FeW 31615
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wrU
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SU%de 745
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unli%
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T
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nqR
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TIJR
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I

i; Nufnhur W10500186
Program Catetgnry
Ground Water
Permit Type
;ejection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael.rogers
Permitted Flow
Facility Name
Margaret Laroe SRF
Location Address
384 Potluck Farm Rd
Rougemont
Owner Name
Margaret
NC 27572
Central Files: APS SVVP
10101 /08
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
IVlajorUnvr Region
Minor Raleigh
County
Person
Facility Contact Affiliation
Owner Type
Individual
Laroe Owner Affiliation
Margaret Laroe
384 Potluck Farm Rd
Rougemont NC 27572
Scheduled
Ong Issue App Received Draft Initiated Issuance Public Notice Issue Elfeetive Expiration
09/29/08 06116/08 09/29/08 09129/08 08/31113
t,ad S juestedlReceived Events
Beat Pump Injection RO staff report requested 06/25/08
Additional intorriation requested 07/10/08
RO stab report received 07/15/08
Additional information received 09/19/08
OiAttzll i'lU'
Waterbody Name Stream Index Number Current Class Subbasin

Permit Number WI0500186
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael.rogers
Permitted Flow
Faci litv
Facility Name
Margaret Laroe SRF
Location Address
384 Potluck Farm Rd
Rougemont
Owner
Owner Name
Margaret
Dates/Events
Orig Issue App Received
06/16/08
Re g ulated Activities
Heat Pump Injection
Outfall NULL
NC 27572
Laroe
Draft Initiated
Scheduled
Issuance
Central Files: APS_ SWP_
09/24/08
Permit Tracking Slip
Status
In review
Project Type
New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Raleigh
County
Person
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Margaret Laroe
384 Potluck Farm Rd
Rougemont NC
Public Notice Issue Effective
q\:>.,q\oi
Re g uested/Received Events
RO staff report requested
Additional information requested
RO staff report received
Additional information received
27572
Expiration 1\3'1 ]-3
06/25/08
07/10/08
07/15/08
09/19/08
Waterbody Name Stream Index Number Current Class Subbasin
QY von+��
Q, Michael F. Easley. Governor
G] ! William G. Ross Jr„ Secretary
i Norlh Carolina Department of Envimttment and Manual Resnunces
*Ism W
Coleen 1.1.5u1iins, I?irector
Division of Water Quality
September 29, 2008
Margaret Laroe
384 Potluck Farm Road
Rougemont, NC 27572
Re: Issuance of Injection Well Permit
Permit No. W10500186
Issued to Margaret Larne
Dear Ms. Laroe;
In accordance with your signed and completed application received. June 16, 2008, I am
forwarding Permit No. W105001.86 for the operation of a 5A7 geothermal underground injection
well (CTIC) heat pump system located at 384 Potluck Farm Road, Rougemont, Person County,
North Carolina 27572. This permit shall be effective from the date of issuance until August 31,
2013, and shall be subject to the conditions and limitations stated therein..
Please -gay special attention to the molded language in the permit. in order to continue
uninterrupted legal use of this well for the stated purpose, you should submit an application to
renew the permit four (4) months prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of
the Division of Water Quality.
Also, please find attached the laboratory analytical results from samples collected from the UIC
geothermal well system. If you have any questions regarding your permit or the Underground
Injection Control (UIC) Program please call Mr. Qu Qi at [phone] or me at (919) 715-
6166.
Best Regards,
9- � -I- � �
Michael Rogers
Environmental Specialist
GPU — [..TIC Control Program
cc: Jay Zimmerman — Raleigh Regional Office
Central Office File — W10500186
Person County Environmental Health Department
Attachment(s)
attrrrr�l�aj Car+ 'ne
Aquifer Protection Section 1636 Mail Service Cenw Raleigh, NC 27699-1636 Teiephone: {919y 733-3221
Internet- httr;llwwwo eruualitv_gv 2728Capita! Boulevard RaleigIL NC 2760+3 Fax 1: (919] 715-0588
Fax 2: [phone]
An Equal OppodunitylAffirmalive Action Employer-50% Recyrjedfl0% Post Consumer Paper Customer Service: [phone]

NORTH CAROLINA
ENN RONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
s
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other
applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
MARGARET LAROE
FOR THE OPERATION OF A TYPE 5A7 INTJECTION WELL, defined in Title 15A North
Carolina Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat
pump effluent. This injection well is located at 384 Potluck Faun Road, RoLigemont. Person
County, North Carolina, and will be operated in accordance with the application received June
16, 2008, and in conformity with the specifications and supporting data submitted, all of which
are filed with the Department of Environment and Natural Resources and are considered a part of
this permit.
This permit is for Operation only, and does not waive any provisions of the Water Use Act or
any other applicable Laws, Rules, or Regulations. Operation and use of an injection well shall
be in compliance with Title 15A North Carolina Administrative Code 2C .0100 and .0200, and
any other Laws, Rules, and Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until August 31,
2013, and shall be subject to the specified conditions and limitations set forth in Parts I through
VIII hereof.
IV —
Permit issued this the '30 day of 92008,
Coleen H. Sullins. Director
Division of Water Quality
By Authority of the Environmental Management Commission.
W10500196 Page 2

PART l-WELL CONSTRUCTION GENERAL CONDITIONS
1. The Perrnittee must comply with all conditions of this permit and with the standards and
criteria specified in Criteria and Standards Applicable to Injection Wells (ISA NCAC 2C
.0200). Any noncompliance with conditions of this permit constitutes a violation of the
North Carolina Well Construction Act and is grounds for enforcement action as provided
for in N.C.G.S. 87-94. •
2. This permit shall become voidable unless the facility is constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface
cannot migrate into the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and
use. Each well shall be permanently labeled with a warning. that it is for injection purposes
and the entrance to each well must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during
construction and use.
7. Each geothermal well injection system shall have permanently affixed an
identification plate according to 2C .0213(g).
PART II -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
2. Thi~ p~rrnit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In the event there i~ a desire for the facility to
change ownership, orthere 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.
WI0500186 Page 3
•
PART Ill-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there
is no contamination of groundwater, which will render it unsatisfactory for normal use. In
the event that the facility fails to perform satisfactorily, including the creation of nuisance
conditions or failure of the injection zone to adequately assimilate the injected fluid, the
Permittee shall take immediate corrective actions including those actions that may be
required by the Division of Water Quality such as the repair, modification, or abandonment
of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit
even if compliance requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwater resulting from the operation of this facility.
PART IV -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the
Director of any planned physical alterations or additions in the permitted facility or activity
not specifically authorized by the permit.
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for
injection, the Permittee must notify by telephone the Aquifer Protection Section-
Underground Injection Control (UIC), Central Office staff, telephone number (919) 715-
6166. Notification is required so that Division staff can inspect or otherwise review the
injection facility and determine if it is in compliance with permit conditions.
PART V -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises, or place
on or related to the injection facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained
under the terms and conditions of this permit, and may obtain samples of groundwater,
surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection,
observation, and sampling associated with injection and any related facilities as provided
for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
WI0500186 Page4
PART VI -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed
necessary by the Division of Water Quality to insure surface and ground water protection,
will be. established and an acceptable sampling reporting schedule shall be followed.
2. The P&rmittee shall report bytelephone, 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, which-results in any unusual
operating circumstances;
(B) Any failure due to known or unknown reasons, that renders the facility
incapable of proper injection operations, such as mechanical or electrical
failures.
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit
application, or of any incorrect information submitted in said application or in any report to
the Director, the relevant and correct facts or information shall be promptly submitted to
the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall
take such immediate action as may be required by the Director.
PART VII -PERMIT RENEW AL
The Permittee shall, at least 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 iIJ.clude 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 will not be
WI0500186 Page 5
responsible for, or contribute to , the contamination of an underground
source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure
freedom from obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director
determines that failure to do so could.Jead to the contamination of an
underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be
introduced into the well through a pipe, which extends to the bLaroeom of
the well and is raised as the well is filled.
(E) In the case of gravel-packed wells in which the casing and screens have
not been removed, the casing shall be perforated opposite the gravel pack,
at intervals not exceeding 10 feet, and grout injected through the
perforations.
(F) In those cases when, as a result of the injection operations, a subsurface
cavity has been created, each well shall be abandoned in such a manner
that will prevent the movement of fluids into or between underground
sources of drinking water and in accordance with the terms and conditions
of the permit.
(G) The Permittee shall submit a Well Abandpnment Record (Form GW-30)
as specified in 15A NCAC 2C .0213(h)(l) within 30 days of completion
of abandonment.
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-DIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART IX -OPERATION AND USE SPECIAL CONDITIONS
None.
WI0500186 Page 6
LABORATORY ANALYTICAL RES UL TS
5A7 GEOTHERMAL UNDERGROUND INJECTION CONTROL (UIC) WELL
PERMIT NO.: WI 0500186
PERMITTEE: Margaret Laroe
SAMPLE COLLECTED DATE: 7/10/2008
Coliform, total Coliform, fecal pH
1 CFUl100ml 1 CFUl100ml units
MCl= 1 MCl=1 MCl = 6.5-8.5
Influent 1 1 7.94
Effluent 1 1 8;07
NO2-+ NO3-as N Phosphorus Nitrate
mall mall mall
MCL = 10 MCl= nss MCl = 10
Influent <.02 <.02 <.02
Effluent <.02 0.02 <.02
Calcium, Ca Cadmium, Cd Chromium, Cr
mgll uall uall
MCl= nss MCl= 1.75 MCl= 50
Influent 6.3 <1 <10
Effluent <.1 <1 <10
Manganese, Mn Sodium, Na Nickel, Ni
ua/l mg/L µgll
MCl= 50 MCL = nss MCL= 100
Influent 45 89 <10
Effluent <10 98 <10
MCL = Maximum Contamination Level per NCAC 2L .0200 (GA Standards)
nss = no state standard
na = not analyzed
Total Dissolved Solids
mall
MCl= 500
237
250
Nitrite
mall
MCl= 1
<.01
<.01
Copper, Cu
µall
MCl = 1000
3.1
4.7
lead,Pb
1-tall
MCl = 15
<10
<10
*parameter not dectected but higher POL used due to matrix interference and/or sample dilution
Chloride, Cl
mg/l
MCl=250
4.2
4.2
Silver, Ag
uall
MCl= 17.5
na
na
Iron, Fe
µgll
MCl=300
<50
<50
Selenium, Se
uall
MCl=50
na
na
Flouride
mgll
MCl=2
0.5
0.5
Al uminum, Al
uall
MCl=nss
na
na
Mercury, Hg
µgll
MCl = 1.05
na
na
Zinc, Zn
ua/l
MCl =1050
72
<10
Sulfate Ammonia, NH3* TKN
mgll mall mall
MCl=250 MCl= nss MCl= nss
na <.1· <.2
na <.1* <.2
•
Arsenic, As Barium, Ba
uall µgll
MCl = 50 MCl = 2000
<5 na
<5 na
•
Potassium, K Magnesium, Mg
mall mgll
MCl= nss MCl= nss
na 0.68
na <.1
County:
PERSON
River Basin
Anport To
RROAP
CvllectoF
J GREER
Region-
"P
Sample Matrix
GROUNDWATT%R
Loc. Type:
WATER SUPPLY
Emergency Yes/No
GOC Yes/No
Location JD: RROAPNLCJD: RROAPNLC
0.5 Qa /96 a OF
1
4A/ r— c�Y
Visiflo
Loc. Descr.: MARCARET iAROE
Collect Date 0711012GOB collect Time:: 10.00
Sample Qualifiers and Comments
Sample ID.
PO Number 4
Dale Recelved:
Time Received:
Labworks LoginlD
Date Reported:
Report Generated:
I�
Sample Depth
A83243d
8GO873
0711012008
11:10
MMATHIS
7130108
0713012008
1 1 S { 00
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwglab.org under Staff Access
A-Va[ue reported is the average of two or more determinations
N3-Estimaled ooncentratic n is < PQL and WI}L
81-Countable membranes with 40 colonies; Estimated
NE -No established PQL
$2- Counts from all filters were zero-
83-Countable membranes with more than 80 or 80 colonies; Estimated
84-Filters have counts of bath > 6 0 or 80 and a 20; Estimated Q1-Holding time exceeded prior to receipt at lab.
85-Too many colonies were present; 4qp numerous to count (TNTC) Q2- Holding time exceeded following receipt by lab
J2- Reported value failed to meet QC criteria for either precision or accuracy. Estimated PQL- Practical Quantitation Limit -subject to change due to instrument sensstivity
J3-The sample matrix interfered with the atility to make any accurate determination; Estimated l4- Samples analyzed for this compound but not detected
.lfi-7he lab analysis was hom an unpraserved or improperly chemically preserved sample; Estimated xt- sample not analyzed for this compound
N1-The component has been tentatively identified based on mass spectra; library search and has an estimated value
tit: tU I Lib,:t't 01 VU
LAB
Rq:.'l•.Lr Proledon Semw
SEP IS 2003
Laboratory Section>> 11623 MO service Center, Raleigh, NC 27699-1623 (919) 7333908 Pagel of 3

'NC ©'WQ La6oratory Section -~sufts SamplelD AB32434
location ID: RROAPNLC Collect Date: 07/10/2008
Loe. Descr.: MARGARET LAROE Collect Time:: 10:00
VISitlD
CAS# Analyte Name PQL Result Qual ifier Units Analyst/Date . Approved By /Date
Sample tempera1IJre at recelp by lab 9 .9 ·c HPARKER MMATHIS
Method Reference 7/10/08 7nOI08
MIC
Cdlfonn, MF Fecal In llqud 1 1 82 CFUl100ml PCOTTEN MOVERMAN
Method Reference APHA9222D-20lh 7/10/08 7/15/08
Colforrn, MF T olal In lkpd B2 CFUl100ml PCOTTEN MOVERMAN
Method Reference APHA9222B-20th 7110/08 7115/08
Alkallnlly 1D pH 4.5 of llquld _TTTt.£_ mg/I.. as CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20lh 7/14/08 7/18/08
Allcallnlty4.5 160 mg/I.. as CaC03 NDEO MOVERMAN
Method Reference APHA23206-20th 7/14/08 7/18/08 .
Alkallnlty8.3 u mglL as CaC03 NDEO MOV ERMAN
Method Reference APHA2320B-20lh 7114/08 7n8/08
Blcarbonale 160 mg/l..asCaC03 NDEO MOVERMAN
Melhod Reference APHA2320B-20th 7/14/08 7/18/08
Carbonate u mgllasCaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 7/14/08 7/18/08
pHJJkallnlty 7.94 mgll. as CaC03 NDEO MOYERMAN
Method Reference APHA2320B-20th 7/1.WS 7/18108
WET
kln01romatography _m LE_ mglL MIBRAHIM1 MOVERMAN .
Method Reference EPA300.0 7/18/08 7/30108
Total DlssolYed Sollds In liquid 12 237 mgll AWILLIAMS MOVERMAN
Method Reference APHA2540C-18TH 7/16/08 7/23/08
Qllorlde 1.0 4.2 mgll MIBRAHIM1 MOVERMAN
Method Reference EPAJOO.D 7118/08 7/30/08
Fluollde 0.4 0.5 mg/L MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 7118/08 7/30/08
Sulfate 2.0 X1 mglL MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 7/18/08 7/30/08
NUT
NH3 as N In lquld 0.02 . 0.10 U,P rngL.asN MOVERMAN CGREEN
Method Reference Lacl0-107--06-1.J 7/10/08 7/15/08
Total l<Jeklahl N as N In liquid 0.2 0.2 u mgll..asN GBELK CGREEN
Method Reference Lachat107-06-2-H 7/16/08 7117/08
N02+N03 as N In liquid 0.02 0.02 u mg/1.asN MOVERMAN CGREEN
· Method Reference Lac10-107-04-1-c 7/10/08 7/15/08
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 2of3
:NC <DWQ, La6oratory Section (j{esu{ts Sample ID AB32434
Location ID: RROAPNLC Collect Date: 07/10/2008
Loe. Descr.: MARGARET LAROE Collect Time:: 10:00
Visit ID
-CAS# Analyte Name PQL Result Quallfier Units Arialyst/Date Approved By /Date
Phosphorus_tolal as P In liquid 0.02 0.02 mg/I.. as P MA.JAY! CGR E EN
Method Reference Lac10-115-01-1EF 7/15/08 7/17/08
Nitrate as N In llqukl 0.02 0.02 u mg/1..asN MOVERMAN CGREEN
Method Reference Lachat107-04-1-c 7/15/08 7/15/08
Nl1rlle as N In llqufd 0 .01 0.01 u ff111Las N MAJAY1 CGREEN
Method Reference Lachat107-04'1-c 7/11/08 7/15/08
MET
7440-38-2 N!bylCPMS 5.0 5.0 u ug/1.. DSTANLEY EST AFFORD
Method Reference EPA200.8 7114/08 711Bl08
7440-70-2 CabylCP 0.10 6.3 mg/I.. SGOSS EST AFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7440-43-9 CdbylCPMS 1.0 1.0 u ug/1.. DSTANLEY EST AFFORD
Method Reference EPA200.8 7114/08 7/18/08
7440-47-3 CrbylCPMS 10 1 0 u ug/L DSTANLEY EST AFFORD
Method Reference EPA200.8 7115/08 7/1BIOB
7440-50-8 CUbylCPMS 2 .0 3.1 ug/L DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7440-48-4 FebylCP 50 50 u ug/L SGOSS EST AFFORD
Method Reference EPA200 .7 7111/08 7/18/08
7439-95-4 MgbylCP 0 .10 0.68 mg/I.. SGOSS EST AFFORD
Method Reference EPA200.7 7111108 7/18/08
7439-96-5 MnbylCP 10 45 ug/L SGOSS ESTAFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7440-23-4 NabylCP 0.10 89 mg/I.. SGOSS EST AFFORD
Method Reference EPA200.7 7111/08 7/18/08
7440-02-0 NlbylCPMS 10 10 u ug/L DSTANLEY EST AFFORD
Method Reference EPA200.8 7114/08 7/18/08
7439,92-1 PbbylCPMS 10 10 u ugfl.. DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18108
7440-66-6 ZnbylCPMS 10 72 ug/L DSTANLEY EST A F FORD
Method Reference EPA200.8 7114108 7/18/08
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 3of3
GROUNDWATER FIELD/LAB FORM
County_
Quad No
Lat.
Serial No
Long.
SAMPLE TYPE
o Water
❑ Soil
❑ Other
19M
Report To: ARO, FRO, MRO, q�aRO, WIRO, 111 ❑ Chain of Custody
WSRO, Kinston FO, Fed. Trusl,- ttral Off., Other:
Shipped by: Bus, Courier, Uaqnd Del.. ther-
Purpose:
Collector(s)- Date 771 b ? -Time r° a'' Baseline, i
FIELD ANALYSESS' Owner il a, f-cj
pH4W �.+, ;1 Spec. Cond..4 at 250 C Location or site
Temp.,, D °C . Odor .l! �J Description of sampling point
Appearance - -- Sampling Method
Field Analysis By: Q, Cy Remarks
LABQE1&MBY _ _NALYS E_a
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY - GROUNDWATER SEC1
Lab Number 0 U U I r
Date Received 1110- Q b Time C)
Rec'd by:_!�^ From: Bus, Courier, Hand Del.,
Other:
Data Entry By: _
Date Reported:
Ck:
Compliance LUSaT, Pesticide Study, Federal True �m'>_
Sample Interval
8OD 310 RIOA
Diss. Solids 7099 mco
A - Silver 46566 u
Or anochlorine Pesticides
COD High 340 mgA
Flouride 051
AI - AMuminum 46567
Organophosphorus Pesticides
COD Low 335Hardness:
T m I
As - Arsenic 46551
Nitr en Pesticides
Coliform: MF Fecal 31616 1100ml
Hardness non-carb 902
Be - Barium 46SU u
Acid herbicides
Conform: MF Total 315U 1100mi
u
Ca - Calcium 46552 A
PCB's
TOC 680 m
r►
Cd - Cadmium 46559 uall
Tud)idhy 76 NT
Sulfate 945
Cr - Chromium 46560 u
Residue.. Suspended 530 mgA
Sulfide 745 m
Cu - Copper 4&962 UgA
Fe - Iron 46563
Semivolatile Organics
Oil and Grease rn I
if - Mercury719M u
TPH - Diesel Range
pH 403 unitsK
- Potasslum 46555 m
Alkalinity to pH 4.5 410 mgll
M - Ma nesium 46554 m
Alkalinity to pH 8.3 415 mgll
Mn - Manganese 46565
Carbonate 445 mgll
NH. as N 610
Na - Sodium 46556
Volatlie Organics (VOA bottle)
Bicarbonate 440
TPH - Gasoline Range
Carbon dioxide 4U5 M911
ANO-
+ NO as N 630 m
Pb - Lead 46564 u
TPH - STEX Gasoline Range
Chloride 940 mgA
P: Total as P 665 mqA
Se - Selenium u
Chromium: Hex 1032 ugA
Zn - Zinc 46567 ugo
Caior: True 80 CU
r- =� "�
Cyanide 720 mgli
Lab Comments: _ �� r^ l� --r`►r �� r9- )e �F�3 —" !v� 7L �Sk 1.
GW-54 REV.1219 For dissolved Analysis - submit filtered sample and write "D1S" in bl,

County: PERSON
River Basin
Report To RROAP
Collector:
-I GREER
Region.
RR
Sample Matrix:
GROUNDWATER
Loc. Type:
WATER SUPPLY
Emergency YesfNo
CDC Yes1No
VIA Te,
[r� jIa �Qp /cg 40+ 4p
VisitlD
Loc. Descr_: MARGARET LARGE
Sample ID
A832435
PO Number #
8GO874
Date Received:
(1711012008
Time Received:
11:10
Labworks LoginlD
MMATHIS
Date Reported:
7130108
Report Generated: 071SO12008
{ Location ID RROAPNLC Collect Date; 07110f2008 Collect Ttme:: 10:30 Sample Depth
Sampie Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwglab.org under Staff Access
A -Value reported is the average of two or more determinations
Bi-Countable membranes with <24 oolonies; Estimated
82- Counts from all filters Were zero.
B3- Countable membranes with more than 60 or SO colonies; Estimated
84-Filters have counts of both >60 or 80 and c 20; Estimated
B5-Too many colonies were present; too numerous to ccunt (TNTG)
32- Reported value failed to meet QC criteria for either precision or accuracy; Estimated
.f3-The sample matrix interfered with the ability to make any accurate determination; Estimated
.16-The lab analysis was from an unpreserved or impraperly chemically preserved sample; Estimated
Ni -The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
N3-Estimated concentration is c PQL and >MDL
NE -No established PQL
P-Elevated PQL due to matrix interference andfor sample dilution
Q1-Holding time exceeded prior to receipt at lab.
Q2- Holding 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
X1- Sample not analyzed for this compound
R5CEIVED I CENP 1
rli
SEP I91oo$
Laboratory Section}> 1623 Mail Service Center, Raleigh, NC 27899-1623 [phone] Page 1 of

'NC (l)WQ, La6oratory Section <R§sults Sample ID AB32435
Location 'ID: RROAPNLC Collect Date: 07/10/2008
Loe. Descr.: MARGARET LAROE Collect nme:: 10:30
Visit ID
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
Sample temperature at receipt by lab 5.6 ·c HPARKER MMATHIS
Method Reference 7/10/08 7/10/08
MIC
Coliform, MF Fecal In Hquld B2 CFU/100ml PCOTTEN MOVERMAN
Method Reference APHA9222D-20th 7110/08 7/15/08
Colfonn, MFTotal In Rqukf , B2 CFU/100ml PCOTTEN MOVERMAN
Method Reference APHA9222B-20th 7/10/08 7/15/08
Alkalinity to pH 4_5 of liquid _TITLE_ mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 7114/08 7/18/08
AlkaUnlty4.5 160 mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 7/14/08 7118/08
Alkallnlty8.3 1 u mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 7114/08 7/18/08
Bicarbonate 160 mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 7/14/08 7118/08
Carbonate 1 u mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 7/14/08 7/18/08
pH...Alkallnlty 8.07 mg/Las CaC03 NDEO MOVERMAN
Method Reference APHA2320B-20th 7/14/08 7/18/08
WET
Ion Chromatography _TITLE_ mg/I.. MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 7/18/08 7/30/08
Total Dissolved Solids In liquid 12 250 mg/L AWILLIAMS MOVE'RMAN
Method Reference APHA2540C-18TH 7/16/08 7/23/08
Chloride 1 .0 42 mg/L MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 7/18/08 7/30/08
Fluoride 0 .4 0.5 mg/L MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 7/18/08 7/30/08
Sulfate 2 .0 X1 mg/L MIBRAHIM1 MOVERMAN
Method Reference EPA300.0 7/18/08 7/30/08
NUT
NH3 as N In liquid 0 .02 0.10 U,P mg/1..asN MOVERMAN CGREEN
Method Reference Lac10-107-06-1-J 7/10/08 7/15/08
Total Kjeldahl N as N In liquid 0 .2 0.2 u mg/las N GBELK CGREEN
Method Reference Lachat107-06-2-H 7/16/08 7/17/08
N02+N03 as N In liquid 0 .02 0.02 u mg/LasN MOVERMAN CGREEN
Method Reference Lac10-107-04-1-c 7/10/08 7/15/08
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of3
NC <1YWQ, £a6oratory Section CR§su[ts Sample ID AB32435
Location~ID: RROAPNLC Collect Date: 07/10/2008
Loe. Oes,;r.: MARGARET I.JI.ROE Collect Time:: 10:30
'Visit ID
CAS# Analyte Name PQL Result Qualifier Units AnalysVDate Approved By /Date
Phosphorus_total as P In liquid 0.02 0.02 mg/1..asP MAJAYI CGREEN
Method Reference Lac10-115-01-1EF 7/15/08 7/17/08
Nitrate as N In liquid 0.02 0.02 u mg/LasN MOVERMAN CGREEN
Method Reference L.adlat107--04-1-<: 7/15/08 7/15/08
Nltrtle as N In liquid 0.01 0 .0 1 u mg/LasN MAJAYI CG R EE N
Method Reference Lachat107--04-1-c 7/11/08 7/15/08
MET
7440-38-2 AsbylCPMS 5.0 5.0 u ug/L DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7440-70-2 CabylCP 0.10 0.10 u mg/L SGOSS EST AFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7440-43-9 CdbylCPMS 1.0 1.0 u ug/L DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7440-47-3 CrbylCPMS 10 10 u ug/L DSTANLEY EST AFFORD
Method Reference EPA200.8 7/15/08 7118/08
7440-50-8 CUbylCPMS 2.0 4.7 ug/L DSTANLEY ESTAFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7440-48-4 FebylCP 50 50 u ug/L SGOSS ESTAFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7439-95-4 MgbylCP 0.10 0.1 0 u mg/L SGOSS EST AFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7439-96-5 MnbylCP 10 1 0 u ug/L SGOSS EST AFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7440-23-4 NabylCP 0.10 9 8 mg/L SGOSS ESTAFFORD
Method Reference EPA200.7 7/11/08 7/18/08
7440-02-0 NlbylCPMS 10 1 0 u ug/L DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7439-92-1 PbbylCPMS 10 10 u ug/L DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
7440-66-6 2nbylCPMS 10 10 u ug/L DSTANLEY EST AFFORD
Method Reference EPA200.8 7/14/08 7/18/08
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page3of3
North Carolina
GROUNDWATER FIELDILAB FORM Department of Environment and Natural Resources
DIVISION OF WATER DUALITY - GROUNDWATER SECTION
County
Aj
L0 .s 0■ =,-101r■l
Lat.
Long.
i�water
■soil
■ Other
Report To: ARO, FRO, MRCEO WaRO, WiRO,
WSRO, Kinston FO, Fed. Trust Central Of., Other.
Shipped by: Bus, Courier Hand De ; Other
Collector(s): Date -7 ZZ z2 Z��Time.
SAMPLE PRIORITY
Routine
❑ Emergency
❑ Chain of Custody
-�10
F1ELD ANALYSES Owner
pH400 4> , 1 Spec. Cond.94 at 250 C
Temp.ta Asa - � _ oC Odor , N'L, A;�r
Appearance r--
Field Analysis By:
LABORATORY ANALYSES
r`I
Location or site
Description of sar
01
Lab Number-6�00 67
Date Received ' 11 M rr P 'Time Fff "
Rec'd by: 'J11 From: Bus, Courier, Hand Del.,
Other.
Data Entry By:_
Date Reported:
Purpose:
Baseline, Complaint, Compliance�ELLUST Pesticide Study, Federal
point
Ck. - --
Sampling Method Sample Interval
Remarks°a i ��---
(P^iN lime, air [ertp, Bic—)
BCD 310
Diss. Sdids70300 Moa I i
A - Silver 46566 u A
Or anochlodne Pestiddes
COD High 340 m9A
Flouride 961 mo
Ai - Aluminum 465W u
Orgenophosphorus Pesticides
COD Low 335
: Total 9M nW
As - Arsenic 46551 uQA
Nitro en Pesticides
Coliform: MF Fecal 31616 110orrd
Hardness ( non-carb) 902 A
Ba - Barium 46558 u A
Acid Herbicides
Coliform: MF Total 31504 1100mt
Phenols 32730 uaA
Ca - Calcium 46552 mq11
PC81s
TOO 680 m
Cd - Cadmium 46559 u
Turbidity 76 NTU
Sulfate 945 mco
Cr - Chromium 46W ugh
Residue., Suspended 530 mgR
Sulfide 745 mqA
Cu - CoMr 46662 u
Fe - Iron 46563 UgA
Semivolatile Organics
Oil and Grease mgA
H - MerCv 71900 u A
TPH - Diesel Range
pH 403 units
K - Potassium 46555 m
Alkalinity to pH 4.5 410 mgA
>K
M - Ma nesium 46554 MQA
Alkalinity to pH 8.3 415 mgA
Mn - Manganese 46565 uaA
Carbonate 445 moll
NH as N 610 m A
Na - Sodium 46556 m A
Volatile Organics (VOA bathe)
Bicarbonate 440 m_q1I
TPH - Gasoline Range
Carbon dioxide 405 mgA
NO + NO as N 630 rrlqli
Pb - Lead 46564 u A
TPH - STEX Gasoline Range
Chloride 940 mgA
P: Total as P 665 mqA
Se - Selenium u
Chromium: Hex 1032 UgA
Zn . 2; r,c 4&%7 uQA
Color: True 60 CU
Cyanide 72o moll
Lab Comments: e. Oi5.ae-kwy
t- —
GW-84 REV.1218. For Dissolved Analysis - submit filtered sample and write "DIS" in bit

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 07/10/2008 County: Person
To: Aquifer Protection Section Central Office Permittee: Mrs. Margyt Laroe
Central Office Reviewer: Micheal Rovers Project Name: UIC-5A7 OPEN LOOP
Regional Login No: 05 Application No.: W10500186
1. GENER4L INFORMATION
1. This application is (checx all that apply)'® New ❑ Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporationflnfiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Remediation 2 Other Injection Wells (including in situ rernediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a. Date of site visit: 07/10/2008
b. Person contacted and contact information: Mr. Steven Bulard. Ph. # 919451 9943
c. Site visit conducted by: JGreer. RRO-APS
d. Inspection Report Attached: ® Yes or ❑ No.
2. is the following information entered into the DIMS record for this application correct?
E Yes or ❑ No. If no, please complete the following or indicate that it is correct on die current application.
For Treatment Facilities:
a. Location:
b. Driving Directions:
c, USGS Quadrangle Map name and number:
d. Latitude
Longitude:
e. Regulated Activities 1 Type of Wastes (e.g., subdivision, food processing, municipal wastewater): NIA
For DisjLesal and tn'ection 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. Locations): 384 Potluck Farm Road. Rou,kemont NC 27572
b. Driving Directions: Sec M uest:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
If. NEWAND MAJOR MODIFIC4TIONAPPLICATIONS Ithis section_ not needed_ for renewals or minor
modrications, skip to next section)
Description Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification: _
c
r—
Go

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
2. Are the new treatment facilities adequate for the type of waste and disposal system?
D Yes O No D NIA. Ifno, please explain: __
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? D Yes D No D NI A. If no, 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 NI A. If no, 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?)
IIL RENEWAL AND MODIFICATION APPLICATIONS (use previous section fo r new or maior modifi cation
svstems)
Description OfWaste{S) And Facilities
1. Are there appropriately certified ORCs for the facilities? D Yes or D No.
Operator in Charge: __ Certificate#: __
Backup-Operator in Charge: __ Certificate #: __
2. Is the design, maintenance and operation ( e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage, etc) of the treatment facilities adequate for the type of waste and disposal system? D Yes or D No.
If no, please explain: __
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? D Yes or D No. Ifno, please explain: __
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
4. Has the site changed in any way that may affect permit (drainage added, new wells inside the compliance
boundaiy, 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 e:,tjsting 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)? 0 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? 0
Yes or D No. If no, 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
D No D N/A. · Please summarize any findings resulting from this review: __ _
13. Check all that apply: D No compliance issues; D Notice(s) of violation within the last permit cycle; 0
Current enforcement action(s) 0 Currently under SOC; D Currently under JOC; 0 Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments (such as NOV, NOD etc): ____ _
14. Have all compliance dates/conditions in the existing permit, (SOC, JOC, etc.) been complied with? 0 Yes
D No D Not Determined D N/A.. If no, please explain: __
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? 0
Yes or D No ON/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.)
Descrip tion OfWell(S) And Facilities -New, Renewal, And Modification
1. Type of injection system:
L8] Heating/cooling water return flow (5A7)
D Closed-loop heat pump system (5QM/5QW)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5Lf"Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? L8] Yes D No
3. Are there any potential pollution sources that may affect injection? D Yes L8] No
What is/are the pollution source(s)? __ ~-_Wh~at~is ___ th=e ~di=·s=tan~ce ......... of ___ th=---e --in...,je.._.c=ti=o=n ~w~e=ll"'"'(s'"'")~fr'""'o=m"'""th=e .. o-=-o=11u=tl=·o=n
source(s)? ft.
4. What. is the minimum distance of proposed injection wells from the property boundary? 100 ft.
5. Quality of drainage at site: L8] Good D Adequate D Poor
6. Flooding potential of site: L8] 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: N/ A
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? L8] 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.
In jection Well Permit Renewal And Modification Only :
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation ( e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes ~ No . 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 g roundwater remediation permits (of any typ e), will
continued/additional/modified in jections have an adverse impact on mi gr ation of the plume or manag ement of
the contamination incident? D Yes D No. If yes , explain: N/ A
4. Drilling contractor: Name: ACME Well Co. Inc.
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address: 7990 NC H wy . 751, Durham NC 27703
Att: Mr. Charles Carter
Certification nwnber: 2949
5. Complete and attach Well Construction Data Sheet.
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V EVALUATION AND RECOMMENDATIONS
1, Provide any additional narrative regarding your review of the application..
2. Attach Well Construction Data Sheet - if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? ❑ 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:
Reas4
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:
Reason
6, List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Mahe sure that you provide a reason for each special condition:
Condition
Reason
7 Recornmeadation: ❑ 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:
S. Signature of report preparers):
Signature of APS regional sr
Date:
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
New SystemO

Pennlt: V\110500186
SOC:
County: Person
Region: Raleigh
Effective:
Effective:
Contact Person: Margaret Laroe
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Pennits:
Inspection Date: 07/10/2008
Primary Inspector: Jimmie W Greer
Secondary lnspector(s):
Reason for Inspection: Routine
Compliance Inspection Report
Expiration:
Expiration:
Title:
Owner: Margaret Laroe
Facility: Margaret Laroe SRF
384 Potluck Farm Rd
Rougemont NC 27572
Phone: [phone]
Certification: Phone:
Entry Time: 09:30 AM Exit Time: 10:30 AM
Phone: [phone]
Inspection Type: Compliance Sampling
Permit Inspection Type: Injection Heating/Cooling Water Return Well (5A7)
Facility Status: ■ Compliant O Not Compliant
Question Areas:
■Wells
(See attachment summary)
J--:r H-Pl"-e.>-1+ .J-CFFI 1,t.,f!>/1 ..
7 /1-0 / PrS-~.4._·
Page: 1
Permit: WI0500186
Inspection Date: 07/10/2008
Inspection Summary:
owner -Facility: Margaret Laroe
Inspection Type: Compliance Sampling
New System no problems as of this date ...
Reason for Visit: Routine
Page: 2
Page 2 of ,3
INJECTION FACILITY INSPECTION REPORT -FORM B (CONTINUED)
WELL CONSTRUCTION
Date constructed.
Drilling contractor: Name
AtiClreSS —� /1,'►Vi rJ[ c3 7 7@ 3
Certification number c=? !2 4 ! _
Total depth of well V_7��vy Total depth of source well 1-e-
rif applicable)
Inspection point Measurement Meets minimum standards Comments
Yes No
Casing
Depth
Diameter
Height (A.L.S.)
Grout
Depth
Screens
Depth(s)
Length(s)
I.D. Plate
Static water level
Well yield
Enclosure
Enclosure floor
(concrete)
Sampling port
(labeled)
Water tight pipe entry
Well enclosure entry
Vent
43 / 2._�
&
AV.
FM
c.�
C -4 i/ -
Functioning of heat pump system (Determine froin the owner ifhe.a tt pump functio'nsjproperlv)
9 6 AA
r { �►
GW/MC-2 March 29, 2001

Page 1 of 3
North Carolina Department of Environment and Natural Resources
Division of Water Quality - Groundwater Section
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PERMIT NO. WI DATE , 7
NAME OF OWNER
ADDRESS OF OWNER
(Streeil road or lot and subdivision, county, town)
J
LOCATION OF INJECTION WELL (and source wells), if applicable) �I-
— -; r-k
(Streetl road or lot
Potential pollution source 1"z"C Distance from well 5-V
Potential pol lutioll soul -cc_ r am; _ t , Distance from �vel l '
Potential pollution source .'_ T�ec_ Distance from well
M1111mum distance of Weil from propeny boundary ,-Wa j'
Quality a tnaae at site
C!gyoqgXdequate.poorj
GPS Data:
Latitude:
Flooding potential of site
(high.moderat ow
Longitude:
arion orr site)
DRAW SKETCH OF SIxTE (Showpropern! bowidaries, buildings, iuells. potential pollution sources, roads. e npproxhnate s•cizie. and
north arrom)
t =____i
Ol `
' DF RISE INJECTION SYSTEM (vertical closed loop, encased borehole or cased waxer well,- sepaivie saterce wel/ and
ye : ivelI, combination sow-ce and injection well; or other description as applicable)
N 1
r
1 C-2 Mauch 28, 2001

~INSPECTO , ~ -d,,,, __.Q& t Office __ ~f2.~12~i-'---------, __ J~A-~<>~:'.S ____ _ • ~ Page 3 of 3
I
WITNESS ___________ Address ___________ _
WITNESS Address -----------------------
GW/UIC -2 March 28, 2001
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A QUIFER PROTECTION SECTION
APPLICATION REVIEW RE QUEST FORM
Date: June 25, 2008
To: 0 Landon Davidson, ARO-APS
□ Art Barnhardt, FRO-APS
0 Andrew Pitner, MRO-APS
[8] Jay Zimmerman, RRO-APS
From: Michael Ro gers Groundwater Protection Unit
Telephone: [phone]
E-Mail: Michael.Ro [e-mail]
A. Permit Number: WI 0500186
B. Owner: Mar garet Laroe
C. Facility/Operation: __
D Proposed [8] Existing
D. Application:
0 David May, WaRO-APS
0 Charlie Stehman, WiRO-APS
□ 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] UIC-5A7 Open Loop
For Residuals: D Land App.
0 503
0 D&M
D 503 Exempt
D Surface Disposal
D Animal
2. Project Type: 1:8] New D Major Mod. D Minor Mod. D Renewal D Renewal w/ Mod.
E. Comments/Other Information: D I would like to accompany you on a site visit.
NOTE:
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 14 calendar days, please take the following actions:
[8] Return a Completed APSARR Form.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
D Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: -------------------Date: _____ _
FORM: APSARR 07/06 Page 1 of 1
0W AERQG Michael F. Easley, Governor
1 William G. Ross Jr., Secretary
v3 North Carolina Department of Environment and Natural Resources
7 y
p -� Coleen H. Sullins Director
Division of Water Quality
June 23, 2008
Margazret Laroe
384 Potluck Farm Road
Rougemotit. NC 27572
Subject: Ackmowledgement of Application No. W10500186
Margaret Laroe S FR
Injection Heating/Cooling Water Return Well (5A7)
Person.
Dear Ms. Laroe:
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit
application and supporting materials on tune 16, 2008. This application package has been assigned the number listed
above and will be reviewed by Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary.
To ensure the maximum efficiency in processing permit applications, the Division requests your assistance in
providing a timely and complete response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final
action by the Divisions. 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
[e-mail]. If the reviewer is unavailable. you may leave a message, and they will respond
promptly. Also note that the Division has reorganized. To review our new organizational chart, go to
httla:llh2o.enr.state.nc.us/docume-ntsldwj ar chart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS
PROJECT.
Sincerely,
t
for Debra J. Watts
Supervisor
cc: Raleigh Regional Office; Aquifer Protection Section
Permit Application File W10500186
Aquifer Protection Section 1636 Mail Service Center
Internet: www.ncwateroualltv_ora Location 2728 Capital Boulevard
An Equal 0ppodunttyfAffrmative Action Employer- 50% Reeycledlt0% Post Consumer Paper
. Carolina
llmilly
Raleigh, NC 27699-1536 Telephone: [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer Service: (877y 623.6748

NORTH CAROLINA
RECEIVED / DENR / DWQ
AQUIFF.R ·PRnTFr.TION SFCTION
JUN 16 2008
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE S-A7 WEL U S} ✓ New Permit Application OR ____ Renewal (check one)
DATE: '-4t\\a • 20n
PERMIT NO. ________ (leave blank ifNEW permit application)
A. PROPERTY OWNER(S)/APP~~CANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative w/authority for signature): ________________ _
M l\'3--G. l\1l x::r L--l\R '.)'i=,
(1) Mailing Address: ___ 2 .... <o ........ ~.....___f_.__~ ..... :n.;~--\)..,_,s,_;,__x.,~___,_F_,,..,..._.,.._~...,c,...b~(l--------..~ ..... ~""'----------
City: ll:,~ ~So\ \..l">' State:>-tS._ Zip Code: L ] 5 1 -Z...... County: ·p ~¼~ N
Home/Office Tele No.: .-3 .... ~!,.._'-g..,.___3"'-\a..,.,__..4 _-'-1 3_· =S_,3=---C=e=ll=N=o_,_,_.: _9:__.__4:.._q_.___.i\....,l._.·?.___=5 _1 ___ :3-'-3_
EMAIL Address: ______________ _
(2) Physical Address of Site (if different than above): ______________ _
City: ________ State: __ Zip Code: ______ County: ____ _
Home/Office Tele No.: ... Cell No.: ------------"'==..,__ ________ _
EMAIL Address: ______________ _
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name: ___________________________ _
ContactPersona...: -------------=E=MAlL=~A=d=dl)=e=ss ..... : _________ _
Address: _____________________________ _
City: ________ State: __ Zip Code: _____ County: ______ _
Office Tele No.: Cell No.:
Website Address of Company, if any: _____________ _
GPU/UIC SA 7 Well Permit Application (Revised 9/2007) Page I
C. WELL DRILLER INFORMATION
Company Name: -Ac. 'W\"L W & "--'-C: ~ i ):\ '-
Well Drilling Contractor's Name: _C.,.'_._H ........ .,,. ... ~...,.'-..:-=--:y;::~.S.=-' __ C___,a.,_"-...-_::r:,t"L....<::.......c;b-=-. __________ _
NC Contractor Certification No.: __ 2'_5: ......... -\ .... ~--'---------------------
Contact Person: C:~~j.,.',,,,)'.: S
Address: 1. ~ ~ S) :1'\~
c:: ~ "j. ::n::: ,.____
t\'V") ... , 5 l
EMAIL Address:
City: D'-l.1-,.)¼ ~'hh. Zip Code: :N, S... County: ~\:\ )i.'"7~ ~M
Office Tele No.: "\-, \C\ S A4 \"' 4 S) Cell No.: ~ l ~ 2...) 5 $'.9::5"]
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: Evii-N,c<..1$-r-~f',(.Vf C.(~ Co
Contact Person: S, t<. CV/4 111 G tt>c. 1 <;-r EMAIL Address:
Address: /1 17 &47Cffet..Otf. ,&Ao
•
City: A?t''I' ZipCode: 27 fZ~ County: _C_H_l'FT"ff __ "'_"" _______ _
OfficeTeleNo.: qr'J-36Z-?Q/o CellNo.: ________ _
E. STATUS OF APPLICANT
Private: 'l
State:
Federal:
Municipal: __
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
fff:4-,-11116 I Ccoc.~ fo I ~ l"fe"c."t-c (.
G. WELL USE WilJ 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 le NO ___ _
H. WELL CONSTRUCTION DATA (Skip to Section I if this is a Permit RENEWAL)
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.
(1)
X EXISTING Well(s) being proposed for use as an injection well. Provide the data in (I) through
(7) below to the best of your knowledge. Attach a copy of Form GW-1 (Well Construction
Record) if available.
Date to be constructed: _______ Number of borings: ___ _
Approximate depth of each boring (feet): _______ _
(2) WelJ casing. Is the welJ(s) cased? (check either (a.) YES!!! (b.) NO below)
(a) YES ✓ If yes, then provide the casing information below.
Type: Galvanized steel_L Black steel __ Plastic __ Other (specify) ______ _
Casing thickness:~ diameter (inches): ~depth: from O to 4--3 ft. (reference to land surface)
11 Ii Casing extends above ground -~~~-inches
GPU/UIC SA7 Well Permit Application (Revised 9/2007) Page2
(b) NO
(3) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement__ Bentonite Other (specify) <:.x::M:E:N )"):SJ S ~~
(b) Grouted surfilce and grout depth (reference to land surface):
__ Around closed-loop piping; from ___ to __ (feet).
~Around well casing; from <:> to 4S) (feet).
(4) Well(s) Screen Information
Depth of Screen: From Nb );) :Ce to ___ feet below land surface
(5) N.C. State Regulations (Title 15A 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.JL_ 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: 3 4<:::i Formation: C'K}'N ,:;,:g:__ Rock/sediment unit: \:...~l'\.SS;,.\.,;;., ~~"'5"~-0
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR PROPOSED WELLS IF
THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
I. OPERATINGDATA
(1) Injection rate:
(2) Injection Volume:
(3)
(4)
Injection Pressure:
Injection Temperature:
J. INJECTION-RELATED EQUIPMENT
Average (daily) 6 gallons per minute (gpm).
Average (daily)/ 72. gallons per day (gpd).
Average (daily) _!IQ_ pounds/square inch (psi).
Average (January) 5'f ° F, Average (July) 6S"o F.
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
K. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(1) Include a site map (can be drawn) showing: buildings, property lines, surface water bodies, potential sources
of groundwater contamination and the orientation of and distances between the proposed well(s) and any
existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet oftbe
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 SA 7 Well Pennit Application (Revised 9/2007) Page3
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
a]! related appurtenances in accordance with the approved specifications and conditions, AA the Permit."
Ir �
Signature of Property OwnerlAppli
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]
GPUMIC tiA7 Well Permit Applicalim (Rffvised 9/2007) Page 4

IECEivslo I DENR l L)WU
A'au4p vRnTFr.T?nt+ti s,=rmog
�� ENVISION RESIDENTIAL INSTALLATION MANURE
Closed Loop Ground Source Systems
Note: For closed loop systems with antifreeze protections, set SW2-2 to the "loop" position {see table on page 28).
Once piping is completed between the unit, pumps and the ground loop (see figure below), final purging and charging
of the loop is required. A flush cart (or a 1,5 HP pump minimum) is needed to achieve adequate flow velocity in the loop
to purge air and dirt particles from the loop itself. Antifreeze solution is used in most areas to prevent freezing. Flush the
system adequately to remove as much air as possible then pressurize the loop to a static pressure of 40-50 PSI (summer)
or 50-75 PSI (winter)_ This is normally adequate for good system operation. Loop static pressure will fluctuate with the
seasons. Pressures will be higher in the winter months than during the cooling season. This fluctuation is normal and should
be considered when initially charging the system.
After pressurization, be sure to open the plug 1 turn in the end of the loop pump motor(s) (if applicable) to allow trapped
air to be discharged and to ensure that the motor housing has been flooded. Ensure that the loop pumps provide adequate
flow through the unit(s) by checking the pressure drop across the heat exchanger and comparing it to the unit capacity data
in the specification catalog. 2.5 to 3 GPM of flow per ton of cooling capacity is recommended in earth loop applications.
Figure 7: Closed Loop Ground Source Application
Vibration At? aFbing Pad
Multiple Units on
One Flaw Center
When two units are connected to
one loop pumping system, pump control is
automatically achieved by connecting the
SL terminals on connector P2 in both units
with 2-wire thermostat wire_ These terminals
are polarity dependant (see Figure 8). The
loop pump(s) may be powered from either
unit, whichever is more convenient. If either-
unit calls, the loop pump(s) will automati-
cally start. The use of two units on one flow
center is generally limited to a total of 24
GPM capacity.
TO
LOOP
Note: Additional information can be tound
in Flow Center installation manual (IM1961)
and Flush Cart manual (WFS302)_
Figure 8: PrimarylSecondary Hook-up
Envision to Envision
Envision to Envision
Ernrision to
Microprocessor Units
Microprocessor Units
Electrornechanical Units
Dual Capacity
Single Speed
Envision Unit 01
Envi W Unit tP1
Envision Jrtit #1
IA.4 SO SL1
In C 4
5tm Ll SL1
C C
r&C G M SL1 _Ill
ae.a
yr
o a
%W-d toURHI
Niedruni 1
Wl+pump-
9wl Puna
uMz
urs
M OuT
gprn M 171i
Envision unk 02
Envi9ion Unit #2
To Etectromei thanical Unit
Mot CapecKy
Single Speed
N

04VISION RESIDENTIAL INSTALLATION MANUAL
Desuperheater Connections
To maximize the benefits of the desuperheater a minimum 50-gallon water heater is recommended. For higher
demand applications, use an 80-gallon water heater or two 50-gallon water heaters connected in a series as shown
below. Electric water heaters are recommended. Make sure all Local electrical and plumbing codes are met for installing
a desuperheater. Residential units with desuperheaters contain an internal circulator and fittings.
Note: Under certain conditions, Envision dual capacity units operate with very low refrigerant discharge temperatures,
producing little or no water heating capability_ This scenario occurs when the unit is operating with cold entering source
water (loop or well). Allowing the desuperheater pump to operate during these conditions actually removes heat from the
DHW circulating through the unit. To overcome this, Envision unit microprocessors have been programmed to disengage
the desuperheater pump during such conditions. (During low capacity cooling operation, the pump will operate only if
the DHW temperature entering the unit is less than the liquid line temperature plus 35' F ❑uring high capacity cooling
operation, the pump will operate only if the ❑HW temperature is less than the liquid line temperature plus 600 F ) Using
a preheat tank, as shown in Figure 12, will maximize desuperheater capabilities.
Water Tank Preparation
To install a unit with desuperheater, follow these installation guidelines.
1. Turn off the power to the water heater.
2_ Attach a water hose to the water tank drain connection and run the other end of the hose to an open drain or
outdoors.
3. Close the cold water inlet valve to the water heater tank.
4. Drain the tank by opening the valve on the bottom of the tank, then open the pressure relief valve or hot water
faucet.
5. Flush the tank by opening the cold water inlet valve to the water heater to free the tank of sediments. Close when
draining water is clear.
6. Disconnect the garden hose and remove the drain valve from the water treater.
7. Refer to Plumbing Installation and Desuperheater Startup on page 12.
I, 1 CAUTION: Elements will burn out if energized dry.
Figure 11: Typical Desuperheater Installation
314x314x112tee
venting Waste
Value w vent
Couprvrg
0"
Water In
cosh Hot
L'Ya1 er I� IIV3ier OuS
�1
Pit Row
Valve
In
I
Drain Valve
Figure 12. Desuperheater Installation In preheat Tank
Venting Waste Valve
or Vent Coupling _
314`u314"k 112' cdd
tee .� Water In
DHVd Water In prof Il Valve Crain Valve
Hot
Ter Cut
Nate: This canFguration maximizes desuperheater capability.
11

ConnectGIS Page I of I
Parcels
0940-00-49-Record Owner's LAROE
PIN: 6516.000 Number: 21645 Name: MARGARETE
TRUSTEE
Billing 1709 AUTUMN City and DURHAM NC Tax Map: A99 97 Address: RIDGE RD State:
D . f POTLUCK AC OR LOT escnp lon: COM/FRM/1/L7/H&L --: A SUBN0_1: 0
OBJECTID: 774
OBJECTID_ 1: 3223868
FTR_CODE: PARCEL
ZIP: 27712
Building 0 Value:
Current 156679 Value:
Plat: 9/85/1
Subno: 7183
ACRE_1: 3.17 PAC: 3
SHAPE_AREA: 137473.572695 SHAPE_LENG: 2020.337086 72
RECN_1: 21645 Sale Year: 107
Townships: 107 Acreage: 3.17
Property 22050 Other 0 Value: Buildings:
Deed Page: 818 Deed Book: 640
Sale value: 0 Calculated 3.15595915342 Acres:
Per son County GIS
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