WI0500220_GEOTHERMAL_20150212

AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Donald R. van der Vaart
Secretary
February 12, 2015
Scott Dyreng
1811 Valley Creek Drive
Hillsborough, NC 27278
Re: Geothermal Permit Renewal Inspection
1811 Valley Creek Drive
Hillsborough, NC-Orange County
Permit #Wl0500220
Dear Mr. Dyreng:
A groundwater sample was collected from your geothermal well system and submitted to the
Division of Water Resources Chemistry Laboratory for analysis on November 4, 2014. Samples were
collected at the influent (sample #AC1421 l) and effluent (sample #AC14212) ports.
The sample analysis report (attached) indicate that that the following substances (but not limited
to) were detected in the samples: Zinc was detected at 80 parts per billion (ug/L) in the influent sample
and 88 ug/L in the effluent sample. Barium was detected at 540 ug/L in the influent sample and 550 ug/L
in the effluent sample. The detections do not exceed the ISA NCAC 02L .0202 groundwater standard for
Zinc and Barium established at 1000 ug/L and 700 ug/L respectively.
A copy of the test results will be sent to the Department of Health and Human Services,
Occupational and Environmental Epidemiology Branch for a drinking water health risk evaluation
regarding the use of the water. A copy of the evaluation will be mailed to you to following receipt of the
report by this office.
Please note that chloride for the effluent sample (AC14212) was not analyzed due to a laboratory
error. If you have any questions regarding the results please contact me at [phone].
c: file
Orange County Health Department
Sincerely,
Eric Rice, Hydrogeologist
Division of Water Resources
Water Quality Regional Operations
Raleigh Regional Office
Central Office-DWR, AFO and Groundwater Protection Branch (Michael Rogers)
Division of Water Resources, Raleigh Regional Office, Water Quality Operations Section http://portal.ncdenr.org/web/wq/aps
1628 Mail Service Center, Raleigh, NC 27699-1628 Phone: [phone]
Location: 3800 Barrett Drive, Raleigh, NC 27609 Fax: [phone]
An Equal Opportunity \ Affirmative Action Employer -Made in part by recycled paper
North Carolina
AQUIFER PROTECTION FIELDSHEET Department orEnvimnment and Natural Resourms
DIVISION OF WATER RESOURCES -AQUIFER PROTECTION SEC nON
Location code
County —ORAL) -
Quad No Serial No_
LaL - Lorig.
❑ Other
Routine
`` ❑ Chain of Custody
Report To: ARO, FRO, MRO, WaRO, WiRO,
WSRO, Kinston FO, Fed. Trust entral Off, Other
Shipped by -.'Bus. Courier, el., Other. Purpose:
Coliector(s): = c Date Z{ Time j -3rr $eseiinc;
FIELD ANALYSES i I Owner _'CST
PH 400 n! Spec. Cond.-at 25*C Location or Site-J&
Temp.,,, JS.1 eC Odor_ N ei[Z _ _ Description of sampling
Appearance C es2<. Sampling Method f
Field Analysis By: ci. _ Remarks i
LABORATORY ANALYSES
BOD 3I0 mg1L
COD Higit 340 mg1L
COI} Lair 335 MA
Conform: MF Feral 31616 1100ml
Coliform: MF Total 315M ll00ml
TOC 680 mgfL
Twbidity T6 NTU
Residue, Total Suspended 330 rur)L
pH 403 untYs
Alkalinity to pH 4,5 410 mgll.
Alkalinity to pH 93 415 mgtL
Carbnnatc445 mglL
Bicarbonate 440 mgR.
n dioxide 405 rnWL
Cl
Chloride 940 M1#L
Chromium: Hex 1032 U91L
Color: Tree 90 CU
Cyanide 720 mg&
Lab Comments
Diss. Solids 70300 MV
Fluoride 9% mg/L
Hardness: Total 900 MgIL
Hardncas (non-ewb) 902 cnWL
Phenols 32730 UO
Spetiftt CDad. 95 trmhoocm
Sulfate 945 mglL
Sulfide 745 rng/L
Oil and Dream mglL
1�.
NH,A as N 610 m;IL
TXN m N 625 mg/L
NO, + NO, = N 630 maft,
P: Totrt1 as P 665 mWL
trtrate (NO)SI M 620 mg/L
Nitrite (NO2 as N) 615 tnlgfl
OW 54 REV. 9013 For Dissolved Analysis -submit filtered sample and write "DIS" in black
Lab Number
Date Received Time: f�• v�
q (DRec'd By: uB
us, Courier, and
Other:
Data Entry By: _ Ck:
Date Reported: -
Cor j�nce, LUST, Pesticide Study, Federal Trust, Othcr:
rAhA9 6- (Cards one)
- - — —=y
Sample Interval
(Pum" lime. airNmp., etc)
Ag Silver 4
566 u
Al -Aluminum 46557 OWL
'AS-Arseme 46551 OWL
lla-Barium 46553 u JVL
C&Calcium 46552 m IrL
CdCadtnium 46559 u
C.-Chromium 46559 a gIL
cwr_ per 46562
Fa -Iron 46563 ILWL
H&Mertuq 719M ROL
K-Powssiam 46555 m
Mg-Magpesium 46554 MWL
mn-manganrae 46563 y
Na-Sodium 46556 m
PIFLwd 46564
5e-Selenium u
•2n•7inc 46567 u
Or hlorise Pesticides
h arta Pesticides
Nitrogen Pesticides
Acid Herbicides
PCBs
Semivolatile sniea
TPH-Diesel Ilap
Volatile Or anies VOA houlc
TPH-Gasolim Range
TPH•BTEXCramfine c
LAB-USE�L
Temperature on arrival M:

AC14211 :N'C (l)~ 'Water Sciences Section-Chemistry £a6oratory r.R#su(ts
County: ORANGE Sample ID: AC14211
River Basin DWR PO Number# 14G0433
Report To R~O Dat.e Received: .. 11/04/2014
Collector: ~ lime Received: 15:00
Region: RROAP Division of Water Resouic.e, Labworks LoglnlD TASCENZO1
Final Report Cate: 2/11/15 Sample M11trlx: GRQUNDWATER
Final Re port Report Print Date: 02/11/2015 Loe. Type: WATER SUPPLY
Emergency Yes/No VisitlD
COC Yes/No ,.J
Loe. Descr.: 1811 VALLEY CREEK DRIV !; ,_
I Location ID : SP68WI0500220 I Collect Date: 11/04/2014. I Collect Time: 13:15 I Sample D~pth I
If this report Is labeled preliminary repo_rt, the results have not been validated. Do not use for Regulatory purposes.
CAS#
LAB
WET
7782-49~2
NUT
MET
7440-22-4
7429-90-5
7440-38-2
7440-38-3
7440-70-2
7440-43-9
7440-47-3
7440-50-8
7439-89-6
7439-97-6
7440-09-7
7439-95-4
7439-96-5
7440-23-5
7440-02-0
7439-92-1
7782-49,2
7440-66-6
Anal yt e Name PQL Result/ Units Method ·Analysis
aualjfier Reference Date
Sample temperature at receipt by lab 2.3 ·c 11/5/14
Ion Chromatography _TITLE ... mg/L EPA 300.0 rev2. 1 11/13/1'
Fluoride 0.4 0.4U mg/L EPA 300 .0 rev2.1 11/13/1'
Chloride 1.0 8.5 mg/L EPA 300.o rev2.1 11/13/1'
Bromide 1.0 1.0U mg/L EPA 300.0 rev2. 1 11/13/1l
Sulfate 2.0 2.0 U mg/L EPA 300.0 rev2.1 11/13/1l
NO2+NO3 as N in liquid 0.02 0.02 mg/Las N EPA 353.2 REV 2 11/5/14
Ag by ICPMS 1.0 1.0 U ug/L EPA200.8 11/25/1'
Al by ICP 50 sou ug/L EPA200.7 12/2/14
As bylCPMS 2.0 2.7 ug/L EPA200.8 11/25/1'
Ba by ICP 10 540 ug/L EPA200.7 12/2/14
Ca by ICP 0.10 37 mg/L EPA200.7 12/2/14
Cd by ICPMS 0.50 0.50U ug/L EPA200.8 11/25/1,
Crby ICPMS 10 10 U ug/L EPA200.8 11/25/1t
Cu by ICPMS · 2.0 12 ug/L EPA200.8 11/25/1l
Fe by ICP 50 56 ug/L EPA200.7 12/2/14
Hg 245.1 Dissolved 0.2 0.20U ug/L EPA245.1 1111111,
K by ICP 0.10 0.67 mg/L EPA200.7 12/2/14
Mg by ICP 0.10 10 mg/L EPA200.7 12/2/14
Mn by ICP 10 11 ug/L EPA200.7 12/2/14
Na by ICP 0.10 16 mg/L EPA200.7 12/2/14
Ni by ICPMS 2.0 2.0 U ug/L EPA200.8 11/25/1'
Pb by ICPMS 2.0 2.0 U ug/L EPA200.8 11/25/1,
Se by ICPMS 5.0 5.0 U ug/L EPA200.8 11/25/1'
Zn by ICPMS 10 80 ug/L EPA200.8 11/25/1'
WSS Chemistry Laboratory» 1623 Mall Service Center, Raleigh, NC 27699>1623 [phone]
For a delailed descrictlon of lhe ouallfier codes refer lo <htto :/ /oortal.ncdenr.onz/web/wa/oos/methods-and-oals>
Page 1 of 1
Validated by
RBYRD
CGREEN
CGREEN
CGREEN
CGREEN
CGREEN
CGREEN
ESTAFFORD1
ESTAFFORO1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
I Nonh Carolina
AQUIFER PROTECTION FIELDSHEET I Department of Environment and Natural Resources
I DIVISION OF WATER RESOURCES-AQUIFER PROTECTION SECTION
Location code SP, 8 ~IOS I')(\ 1,:~ 0 §AMPLE TYPE ·-._ ~,J.e'PRIQBJTY 0 l'i~uJ,3'{ Jr
County O~bt; ~r Routi~ Lab Num er /Jet'( --J.-
Quad No Serial No. 0 Soil □.-Emergenc; · DateReceived \ • ~-\~ Time: ) 5 : DU D Other Rec'd By: ~ From:Bus, Courier,~., Lat. Long. .
D Chain of Custody Other:
Report To: ARO. FRO, MRO, ~ WaRO, WiRO, Data Entry By: Ck:
WSRO, Kinston FO, J:ed. Trust, entral Off., Other: 1': Date Reported:
Shipped by : Bus, Courier, ~1., Other: . ~ Pu n se: f
aint, Co~ce, LUST, Pesticide Study, Federal Trust, Other: Collector(s): E , /1.:L.ciS . Date lVrd~Time 45"'"" Baseline, ,Comp
FIELD ANALYSES Owner g coT , · _f) YR c"".N G' (cin:lit one>
pH 400 -J .S''t Spec. Cond.~ ILO. at 25°C . Location or Site IK/1 111iUJ >--V C l<CL~ f"),R--,.,_1,,_ H ..1LLS &ve /JI.At:. H
Temp.10 /S-,, oc Odor AJ ta ·~ Description of sampling<Goint (J .,. I.\.~,._)... ?,?~F
Appearance (. .l~c.r-Sampling Me~ l"'"r.l • Sample Interval
Field Analysis By: ~. g;u£ . Remarks :~.,;,,..ri,..k-I .-i.mo. -•·• OU:. I
LABORATORY ANALYSES (Pumping time, ait tamp . etc )
B0D310 mg/L Diss. Solids 70300 mg/L, r _, ...-Ag-Silva-4( ,S66 ug/L Or.-..n ochlorine Pesticides
COD High 340 mg/L Fluoride 951 mg/L Al-Aluminum 46557 u2/L Organoohosohorus Pcstieidcs
CODLow33S mg/L Hardness: Total !)OD mg/L As-Arsenic 46SS I ug/L Nitro gen Pesticides
Colifonn: MF F~l 31616 /IOOml Hardness (non-earl>) 902 mg/L Ba-Barium 46558 uo/1 Acid Herhicidcs
Colifonn: MF Total 31 SD4 /IDOml Phenols 32730 ug/1 Ca-Calcium 46SS2 mg/L PCBs
TOC680 mg/L Specific Cond. 95 µMhos/cm Cd-Cadmium 46559 uo/1
Turbidity 76 NTU Sulfate945 mg/L Cr-Chromium 46559 . ue/L
Residue. Total Suspended 530 mg/L Sullide74S mg/L Cu-Copper 46562 u!!ll.
Fe-Iron 46563 u!!ll. Scmivolatilc O,unics
Oil and Grease mg/L Hg-Mcn:uiy 71900 ue/L TPH-Diescl Ran ge
pH403 units K-Potassium 46SSS mg/L
Alkalinity to pH 4.5410 mg/L Mg-Magnesium 465S4 m oll.
Alkalinity to pH 8.3 415 mg/L Mn-Manganese 46565 uo/1 Volatile Orun ics /V OA bonle)
Carbonate 44S mg/L NH,asN6ID mg/L Na-Sodium 46S56 mg/L -TI'H-Gasoline Ran ge
Bicarbonate 440 mg/L TKNasN625 mg/L Ni-Nickel ue.11.. TPH-BTEX Gasoline Ran i:e
s;«rt,o n dioxide 405 mg/L u NO,+ NO, as N 630 mg/L Pb--Lcad46564 ue/L
{/ Chloride94D mg/L P: Total as P 665 mg/L Sr,-Selcnium uo/1
Chromium: Hex 1032 ug/L Nitrate (NO1 as N) 620 mg/L J Zn-Zinc 46567 uo/1.
Color: True 80 cu Nitrite (N02 as N) 615 mg/L LAB U~EONLY ~.3 Cyanidc720 mg/I. Temperature on arrival ("C):
Lab Comments ________________________________________________________ _
GW-54 REV . 8/2013 For Dissolved Analysis-submit filtered sample and write "DIS~ in block.
AC14212 !NC ©W1( Water Sciences Section-Chemistry £a6oratory <:R§su[ts
County:
River Basin
Report To
Collector:
ORANGE
RRO
ERICE
Region: .!IBQAe
Sample Matrix: GROUNDWATER
Loe. Type : WATER SUPPLY
Emergency Yes/No
COC Yes/No
I Location ID : 5P68WI0500220
DWR
Division of Water Resources
Final Re p ort
VisitlD
Loe. Descr.: 1811 VALLEY CREEK DRIVE
I Collect Date: 11/05/2014
Sample ID:
PO Number#
Date Received:
Time Received:
Labworks LoginlD
Final Report Date:
Report Print Date:
I Collect Time: 13:45
AC14212
14G0434
11/05/2014
15:00
TASCENZO1
2/11/15
02/11/2015
I Sample Depth I
If this report Is labeled preliminary report, the results have not b°eeh validated. Do not use for Regulatory purposes.
CAS#
LAB
NUT
MET
Anal yte Name
Sample temperature at receipt by lab
N02+N03 as N in liquid
7440-22-4 Ag by ICPMS
7429-90-5 Al by ICP
7440-38-2 As by ICPMS
7440-38-3 Ba by ICP
7440-70-2 Ca by ICP
7440-43-9 Cd by ICPMS
7440-47-3 Cr by ICPMS
7440-50-8 Cu by ICPMS
7439-89-6 Fe by ICP
7439-97-6 Hg 245.1 Dissolved
7440-09-7 K by ICP
7439-95-4 Mg by ICP
743.9-96-5 Mn by ICP
7440-23-5 Na by ICP
7440-02-0 Ni by ICPMS
7439-92-1 Pb by ICPMS
7782-49-2 Se by ICPMS
7440-66-6 Zn by ICPMS
0.02
1.0
50
2.0
10
0.10
0.50
10
2.0
50
0.2
0.10
0.10
10
0.10
2.0
2.0
5.0
10
Result/
Qualifier
2.3
0.02
1.0U
sou
2.7
550
38
o.sou .
10U
15
sou
0.20U
0.66
10
10
17
2.0 U
2.0 U
5.0 U
88
Units
·c
mg/Las N
ug/L
ug/L
ug/L
ug/L
mg/L
ug/L
ug/L
ug/L
ug/L
ug/L
mg/L
mg/L
ug/L
mg/L
ug/L
ug/L
ug/L
ug/L
Method
Reference
Anal ysis Validated by
Date
11/5/14 RBYRD
EPA 353.2 REV 2 11/5/14 CGREEN
EPA200.8 11/25/14 ESTAFFORD1
EPA200.7 12/2/14 ESTAFFORD1
EPA200.8 11/25/14 ESTAFFORD1
EPA200.7 12/2/14 ESTAFFORD1
EPA200.7 12/2/14 ESTAFFORD1
EPA200.8 11/25/14 ESTAFFORD1
EPA200.8 11/25/14 ESTAFFORD1
EPA200.8 11/25/14 ESTAFFORD1
EPA200.7 12/2/14 ESTAFFORD1
EPA245.1 11/17/14 ESTAFFORD1
EPA200.7 12/2/14 ESTAFFORD1
EPA200.7 12/2/14 ESTAFFORD1
EPA200.7 12/2/14 ESTAFFORD1
EPA200.7 12/2/14 ESTAFFORD1
EPA200.8 11/25/1, ESTAFFORD1
EPA200 .8 11/25/1, ESTAFFORD1
EPA200.8 11/25/14 ESTAFFORD1
EPA200.8 11/25/14 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a delailed description of the aualifier codes refer lo <htto://oortal.ncdenr.onr/web/wa/oos/methods-and-oals>
Page 1 of 1
Permit Number
Program Category
Ground Water
Permit Type
WI0500220
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SWRule
Permitted Flow
Facility
Facility Name
Scott and Chelsea Dyreng SFR
Location Address
1811 Vly Creek Dr
Hillsborough
Owner
OwnerName
Scott
Dates/Events
NC
Orig Issue
1/21/2010
App Received
9/23/2014
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
27278
Dyreng
Draft Initiated
'
Scheduled
Issuance Public Notice
Central Files: APS SWP
11/17/2014
Permit Tracking Slip
Status
In review
Version
Project Type
Renewal
Permit Classification
Individual
Permit Cont.act Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Scott Dyreng
1811 Valley Creek Dr
Hillsborough
Region
Raleigh
County
Orange
NC
Issue Effective
27278
Expiration
Requested /Received Events
RO staff report received
RO staff report requested
Additional information requested
Additional information received
Streamlndex Number Current Class
11/10/14
10/8/14
9/26/14
10/7/14
Subbasin
AVA
HCDEMR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Scott and Chelsea Dyreng
1811 Valley Creek Drive
Hillsborough, NC 27278
November 21, 2014
Re: Issuance of Injection Well Permit
Permit No. WI0500220
Geothermal Heating/Cooling Water Return Well
Orange County
Dear Mr. and Mrs. Dyreng:
John E. Skvarla, Ill
Secretary
In accordance with your permit renewal application request received September 23, 2014, and
additional information received October 7, 2014, I am forwarding Permit No. WI0500220 for the
continued operation of geothermal heating/cooling water return well(s) located at the above
referenced address. Please note that this renewed permit shall become effective on January 1, 2015,
(i.e., the day after the expiration date of the existing permit), which may differ from the date of this
letter. This permit shall be effective from January 1, 2015, until December 31, 2019, and shall be
subject to the conditions and limitations stated therein.
Please Note: The Raleigh Regional Office (RRO) collected samples from your geothermal
well system on November 4, 2014. Laboratory analytical results will be forwarded to you
when it becomes available.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit 120 days prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water Resources. If you have any questions regarding your permit or the Underground
Injection Control Program please call me at [phone].
Best Regards,
/Uu4 r2~-
Michael Rogers, P.G. (NC & l
Hydrogeologist
Water Quality Regional Operations Section
Division of Water Resources, NCDENR
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: [phone]\ Internet: www.ncdenr.gov
An Equal Opportunity\ Affirmative Action Employer -Made in part by recycled paper
Scott and Chelsea Dyreng
cc: Danny Smith and Rick Bolich, Raleigh Regional Office
Central Office File, WI0500220
Orange County Environmental Health Department
Page 2 of2
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMNUSSIFON
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE 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
Scott and Chelsea Dyreng
FOR THE CONTINUED OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER
RETURN WELLS), defined in Title 15A North Carolina Administrative Code 02C .0224(a), which wilt be
used for the injection of heat pump effluent. The injection well(s) located at 1811 Valley Creek Drive,
Hillsborough, Orange County, NC 27278, will be operated in accordance with the application submitted
September 23, 2014, and conformity with the specifications and supporting data received October 7, 2014, all of
which are filed with the Department of Environment and Natural Resources and are considered a part of this
permit.
This permit is for continued operation of an injection well shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from January 1, 2015, (i-e., the day after the expiration date of
the existing permit) until December 31, 2019, and shall be subject to the specified conditions and limitations set
forth in this permit.
Permit issued this the 21st day of November 2014
Thomas A. Reeder, Director
Division of Water Resources
By Authority of the Environmental Management Commission.
Permit#W10504220 MOW Page 1 of
ver. 0912014

PART I -PERMIT GENERAL CONDITIONS
1. The Permittee shall 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). Noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [15A NCAC 02C .021 l(a)].
3. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data [15A NCAC 02C .0211(1)].
4. This permit is not transferable without prior notice and approval. In the event there is a desire for the
facility to change ownership, or there is a name change of the Permittee, a formal permit amendment
request must be submitted, including any supporting materials as may be appropriate, at least 30 days
prior to the date of the change [15A NCAC 02C .021 l(q)].
5. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met [15A NCAC 02C .0203].
PART II -WELL CONSTRUCTION GENERAL CONDITIONS
1. The well supplying water for the geothermal heating and cooling system shall be constructed m
accordance with the requirements of rule 15A NCAC 02C .0107.
2. If a separate injection well is used then it shall also be constructed in accordance with the requirements of
Rule . 0107 of this Subchapter except that the entire length of the casing shall be grouted from the top of
the gravel pack to the land surface in such a way that there is no interconnection of aquifers or zones
having differences in water quality that would result in degradation of any aquifer or zone [15A NCAC
02C .0224(d)(2)].
3. Bentonite grout shall not be used to seal any water-bearing zone with a chloride concentration equal to or
greater than 1,500 milligrams per liter. In areas where elevated chloride levels are known to exist or are
probable, such as coastal areas, chloride levels shall be verified in the field to determine existing conditions.
[15A NCAC .0225(g)(8)].
4. For open-end wells, the casing shall be grouted from the bottom of the casing to the land surface in such a
way that there is no interconnection of aquifers or zones having differences in water quality that would
result in degradation of any aquifer or zone [15A NCAC 02C .0224(d)(3)].
5. The injection well system shall be constructed such that a sampling tap or other collection equipment
approved by the Director provides a functional source of water when the system is operational. Such
equipment shall provide the means to collect a water sample immediately after emerging from the water
supply well and immediately prior to injection into the return well [15A NCAC 02C .0224(d)(4)].
6. Each well shall be secured to reasonably insure against unauthorized access and use and shall be sealed
with a watertight cap or well seal as defined in G.S. 87-85(16).
Permit #WI0500220 UIC/5A7
ver. 09/2014
Page 2 of5
7. Each well shall have permanently affixed an identification plate [15A NCAC .01070)(2)].
8. A completed Well Construction Record (Form GW-1) shall be submitted as described in Part Vl.5 of this
permit.
PART III-OPERATION AND USE CONDITIONS
1. 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 [15A NCAC 02C .021 lG)].
2. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface
water or groundwater resulting from the operation of this facility [15A NCAC 02C .0206].
• 3. The injection facility shall be properly maintained and operated at all times to achieve compliance with
the conditions of this permit and the rules of 15A NCAC 02C .0200, even if compliance requires a
reduction or elimination of the permitted activity [15A NCAC 02C .021 lG)].
4. 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 talce immediate
corrective actions that may be required, such as the repair, modification, or abandonment of the injection
facility [15A NCAC 02C .0206].
PART IV -INSPECTIONS [15A NCAC 02C .021 l(k)]
1. Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable time for the purpose of dete:rmining 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. DWR representatives shall have reasonable access for purposes of inspection, observation, and sampling
associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary samples of the injection facility's activities.
PART V -MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction, repair, or abandonment shall be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on-site and available for inspection [15A NCAC
02C .0224(f)(4)].
2. Monitoring of any well may be ·required to ensure protection of the groundwater resources of the State
and compliance with the groundwater quality standards specified in 15A NCAC 02L [15A NCAC 02C
.0224(f)(l )] .
3. The Permittee shall report any monitoring or other information that indicates noncomplia1.1ce with a
specific permit condition, that a contaminant may cause a violation of applicable groundwater quality
Permit #WI0500220 ..-UIC/5A7
ver. 09/2014
Page 3 of5
standards, or that a malfunction of the injection system may cause the injected fluids to migrate outside
the approved injection zone or area. As specified in rule 15A NCAC 02C .0211(r), noncompliance
notification shall be as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence, to the Raleigh Regional Office, telephone number 919-791-4200.
(B) Written notification shall be made within five days of the occurrence and submitted to the
addresses in Item #5 below.
(C) The written notification shall contain a description of the noncompliance and its cause; the period
of noncompliance, including dates and times; if the noncompliance has not been corrected, the
anticipated time it is expected to continue; and any steps taken or planned to reduce, eliminate, and
prevent reoccurrence of the noncompliance.
4. 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 [15A NCAC 02C
.021 l(b )].
5. All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff
Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Water Quality Regional Operations Section
DWR Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699
PART VI-PERMIT RENEWAL [15ANCAC 02C .0224(c)]
As required by rule an application for permit renewal shall be made at least 120 days prior to the
expiration date of the permit. This permit condition does not apply if the permittee chooses to discontinue
operation of the well for injection of effluent from the geothermal heating and cooling system associated
with this permit.
Permit #WI0500220 UIC/5A7
ver. 09/2014
Page4 of5
PART VII-CHANGE OF WELL STATUS [15A NCAC 02C .0240]
1. The Permittee shall provide written notification withln 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(l), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Pennittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part VII (1) and (2) (G) shall be submitted to the addresses
specified in Part VII.5 above.
Permit#WI0500220 UIC/5A7
ver. 09/2014
Page 5 of5
Pat McCrory
Governor
A.VA
NCDENR
North Carolina Department of Environment and Natural Resources
November 6, 2014
John E. Skvarla, Ill
Secretary
Memorandum
To: Michael Rogers
WQROS, Animal Feeding Operations and Groundwater Protection Branch
From: EricRice ~
Water Quality Regional Operations, Raleigh Regional Office
Through: Rick Bolich, Assistant Regional Superviso~
Water Quality Regional Operations, Raleigli Regional Office
Subject: Geothermal Water Return-Renewal
Scott & Chelsea Dyreng SFR
1811 Valley Creek Drive
Hillsborough, N.C.-Orange County
Permit # WI0500220
Enclosed is the regional staff report regarding the submittal of a permit renewal application
for a geothermal water return system at the above listed site in Hillsborough, N.C. Please contact
me at [phone] if you have any questions about the staff report.
cc: file
Attachment: WQROS form
1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Phone: [phone]\ Internet: www.ncdenr.gov
An Equal Opportunity I Affirmafive Action Employer -Made in part by recycled paper
RECElVEOJDENR/DWR
NOV l O 2014
Water Quality Regional
Operations Section
WATER QUALITY REGIONAL OPERATIONS STAFF REPORT
Date: November 6, 2014
To: WQROS AFO-GPB
CO Reviewer: Michael Rogers
Regional Office Inspector: Etic Rice
L GENERAL INFORMATION
County: Orange
Permittee: Scott Dyreng
Facility Name: Scott & Chelsea Dyreng SFR
Permit # WI0500220
1. This application is (check all that apply): D New 12] 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 12] Geothermal Water Return
Was a site visit conducted in order to prepare this report? ~ Yes or D No.
a . Date of site visit: November 4, 2014
b. Person contacted and contact information: Chelsea Dyreng
c. Site visit conducted by: E. Rice
d . Inspection Report Attached: D Yes or ~ No.
2. Is the following information entered into the BIMS record for this application correct?
D Yes or ~ No. If no, please complete the following or indicate that it is correct on the current application .
Note that total well depth in BIMS is not correct. Total depth is 460 feet.
For Dis posal and In jection Sites:
(If multi ple sites either indicate which sites the information a pp lies to. co py and paste a new section into the
document for each site, or attach additional pa ges for each site)
a. Loeation(s):
b. Latirnde: Longitude:
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.)
Descri ption Of Well(S) And Facilities -New, Renewal, And Modification
1. Type of injection system:
12] Heating/cooling water return flow
D Closed-loop heat pump system
D In situ remediation (SI)
D Closed-loop groundwater remediation effluent injection (5L/''Non-Discharge")
FORM: WI0500031 1
WATER QUALITY REGIONAL OPERATIONS STAFF REPORT
D Other (Specify: _ __,_)
2. Does system use same well for water source and injection? [gl Yes D No
3. Are there any potential pollution sources that may affect injection? D Yes [g] No
What is/are the pollution source(s)? What is the distance of the injection well(s) from the
pollution source(s)?
4. Quality of drainage at site: [g] Good
5. Flooding potential of site: [g] Low
D Adequate D Poor
D Moderate D High
V. EVALUATION AND RECOMMENDATIONS
l. Provide any additional narrative regarding your review of the application.: Permit is for a one well system.
The well is used as a potable water source. Total well depth is four hundred sixty ( 460) feet. Sixty three (63)
feet of six (6) inch steel casing installed. Yield is two (2) gpm. Installed in 2000 by Hudson Well Drilling.
Influent and effluent samples collected for chloride, metals, and NO2+NO3 as N. Well operation appears to be
compliant.
2. Do you foresee any problems with issuance/renewal of this permit? D Yes [g] No. If yes, please explain
briefly. __ .
3. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
4. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
5. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
FORM: WI050003 l 2
WATER QUALITY REGIONAL OPERATIONS STAFF REPORT
G. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information;
Issue- sample results pending; ❑ Deny. If deny, please state reasons:
7_ Signature of report preparer(s):
Signature of APS regional supervisor:
Date:
Attachments:
FORM: WI0500031

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW RE QUEST FORM
Date: October 8, 2014
To: RRO-WQROS: Rick Bolich / Danny Smith
From: Michael Rogers, WQROS -Animal Feeding Operations and Groundwater Protection Branch
A.
B.
C.
D.
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
Permit Number: WI0500220
Applicant: Dyreng
Facility Name:
Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal
E. Comments/Other Information:
D I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action . Within 30 calendar days, please return a com pleted W OROS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact
person listed above.
I
RO-WQROS Reviewer: __________________ Date: _____ _
COMMENTS:
NOTE: Thanks!
FORM: WQROS-ARR ver. 092614 Page I of I
Ro gers, Michael
From:
Sent:
To:
Scott Dyreng [scott.dyreng@duke .edu]
Tuesday, October 07, 2014 4:36 PM
Rogers, Michael
Subject:
Attachments:
RE : WI0500220 Dyreng Geothermal Well Permit
DOC .PDF
Here you go.
Scott
-----Original Message-----
From: Rogers, Michael [mailto:[e-mail]]
Sent: Friday, September 26, 2014 5:09 PM
To: Scott Dyreng
Subject: FW: WI0500220 Dyreng Geothermal Well Permit
Mr. Dyreng-
We received your permit renewal application for your geothermal water return well. Thank
you.
However, Please find attached the signature page of the application. Please have Chelsea
also sign and return, and we will continue to process the renewal. Both property owners must
sign the application. You can sign, scan, and send back in reply to this email if you wish.
Thank you for your cooperation.
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
NCDENR -DWR
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699
Direct No. 919-807-6406
-----Original Message-----
From: Michael Rogers [mailto:[e-mail]]
Sent: Friday, September 26, 2014 1:13 PM
To: Rogers, Michael
Subject:
This E-mail was sent from "RNPAC7DD0" (Aficio 2075).
Scan Date: 09.26.2014 13:12:37 (-0400)
Queries to: robin.markha m@ ncdenr.gov
1
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Govemor
September 26. 2014
Scott and Chelsea Dyreng
1811 Valley Creek Drive
Hillsborough, NC 27278
Dear Mr. and Mrs. Dyreng_
John E. Skvarla, III
Secretary
Subject: Acknowledgement of
Application No. W10500220
Geothermal Heating and
Cooling Water Return Well
Orange County
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your permit
application and supporting documentation received on Septe>,nber 23, 2014- Your application package
has been assigned the number listed above, and the primary reviewer is Michael Rogers.
The 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 and/or to arrange a site
inspection. To ensure maximum efficiency in processing permit applications, the Water Quality Regional
Operations Section (WQROS) requests your assistance in providing a timely and complete response to
any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Michael Rogers at [phone] or a [e-mail].
Sincerely,
r'
or Debra J. Watts, Su ry
.� e
F
Division of Water Resources
cc: Raleigh Regional Off -ice. WQROS
Permit File W10500220
1636 Wil Service Center, Raleigh, North Carolina 27599-1636
Phone:91M07-fi4641lntemet: htkpJiWr1a1.nadenr.amlweWwg
An Equal [Opportunity 1 ASfamalive Action Emplayer - Wde in pact with recycled paper

Orange County Interactive GIS
Page I of 1
GIS Data Currency Dates Help County Home Page IT/GIS Home Page
Orange County NC Interactive GIS
Print Suffer Task Export Results scale xr
1 inch = 400 feet
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Search Results Map Layers
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f=1 IJi Search Results (1)
d [j Parcei Search - [PIN in ('9852231950')j - 1 parcels fci
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P 0 9852231960(DYRENG)
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Select chi•• Parcel Only
PIN 9862231960
PINSTATUS ACTIVE
L6
OWNER TYPE
INTEREST OWNERS
OWNERI DYRENG SCOTT D
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OWNER2 DYRENG CHELSEA B
ADDRESS1 1811 VALLEY CREEK
DR
ADDRESS2
CITY HILLSBOROUGH
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STATE NC
ZIPCODE 27278
TOWNSHIP 7
TOWNSHIP NAME CHAPEL HILL
SIZE 0,92A
CALCULATED 0.94 A
ACRES
SUBCODE 2270
#45 SEC 2 PH D
LEGAL_DESC NEW HOPE SPRINGS
P83/104 '
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http://server2.co.orange.nc.us/OrangeNCGIS/default.aspx 9/26/2014

pri
DATE:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELLS
These wells inject groundwater directly into the subsurface as part of a geothermal beating and cooling system
(check one) New Application Renewal* Modification
* For renewals complete Parts A-C and the signature page. 1
to the Address on the Last Paize, Illecihle Applications Will Be Relurned As Incomph
20
ste.
PERMIT NO. 01 '7}f'
5 i� � �- {leave blank if New Application}
Water quality Regional
A. STATUS OF APPLICANT (choose one) Operalions Section
Nan -Government: Individual Residence w"� Business/Organization
Government: State Municipal County Federal
B. WELL OWNERIPERMIT APPLICANT — For individual residences, list owner(s) on property deed. For all
others, list name of entity and name of person delegated authority to sign on behalf of the business or agency:
"M 1�f'�t i6_ 1 ('it�L, ..--
MailinT'A-A"r-'-44
ress: I-V� i��f re& _
City: State: & Zip Cade: County: O."A it
Day Tele No, ; Q F 33 W i % Cell No.: _
EMAIL Address: ! t .Fax No.:
C. WELL OPERATOR (If different from well owner) — For individual residences, list owner(s) on property
deed. For all others, list name of entity and name of person delegated authority to sign on behalf of the
business or agency: —
Mailing Address: �Jf� � z)r
__ --- --
City: ,& _fI►i,6I, State: � 4 Zip Code: County:
Day Tele No.: _-- �p��% Cell No.:
EMAIL Address: Fax No.;
D. LOCATION OF WELL SITE — Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site:
(2) Physical Address (if different than mailing address):
County:
City: State: NC Zip Code:
OPU/UIC 5A7 Permit Application (Revised 818/2013)
Page i

E. WELL DRILLER INFORMATION
Well Drilling Contractor's Name:
NC Well Drilling Contractor Certification No.: _____________________ _
Company Name: ________________________________ _
Contact Person,_: _______________ EMAIL Address: ___________ _
Address :------------------------------------
City: __________ Zip Code:· _____ State: __ County: _________ _
Office Tele No .: _________ Cell No.: _________ Fax No.: ________ _
F. HV AC CONTRACTOR INFORMATION (if different than driller)
G.
HVAC Contractor's Name: ____________________________ _
NC HV AC Contractor License No.: _________________________ _
Company Name: ________________________________ _
Contact Person.,,_: _______________ EMAIL Address: ___________ _
Address: ___________________________________ _
City: Zip Code: _____ State: __ County:
Office Tele No.: _________ Cell No.: __________ Fax No.: _______ _
' .
WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES __ _ ·NO· ___ _
YES ----NO ___ _
H. WELL CONSTRUCTION REQUIREMENTS-As specified in 15A NCAC 02C .0224 (d ):
( 1) The water supply well shall be constructed in accordance with the water supply well requirements of
15A NCAC 02C .0107 .
(2) If a separate well is used to inject the heat pump effluent, then the injection well shall be constructed
in accordance with the water supply well requirements of 15A NCAC 02C .0107, except that:
(a) For screen and gravel-packed wells, the entire length of casing shall be grouted from the top
of the gravel pack to land surface; ·. · .. ·
(b) For open-end wells without screen, ~he casing shall be grouted from the bottom of the casing
to land surface.
(3) A sampling tap or other approved collection equipment shall provide afonctional source of water
•• during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection. . ·'· ·
GPU/UIC 5A 7 Pe rm it Appl ication (Re vised 8/8/20 13 ) Page 2
I. WELL CONSTRUCTION SPECIFICATIONS
J.
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
______ *.EXISTING WELLS PROPOSED WELLS ------
*For existing wells, please attach a copy of the Well Construction Record (Fonn GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
( c) Casing depth below land surface
(d) Casing height "stickup" above land surface
(e) Grout material(s) surrounding casing and depth below land surface
Note: .b<;ntonite grouts are prohibited for sealing water-bearing zones with 1500
mg/L chioride or greater.per 15A NCAC 02C .0107(0(8 )
(t) Length of well screen or open borehole and depth below land surface
(g) Length of sand or gravel packing around well screen and depth below land surface
OPERATING DATA
(1) Injection Rate: Average (daily) gallons per minute (gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average (daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) __ ° F.
K. SITE MAP -As specified in 15A NCAC 02C .0224 (b )( 4 l, attach a site-specific map that is scaled or otherwise
accurately indicates distances and orientations of the specified features from the injection well(s). The site map
shall include the following:
( 1) All water supply wells, surface water bodies, and septic systems including drain field, waste
application area, and repair area located within 250 feet of the injection well(s).
(2) Any other potential sources of contamination listed in 15A NCAC 02C .0107 (a )(2) located within 250
feet of the proposed injection well(s).
(3) Property boundaries located within 250 feet of the parcel on which the proposed injection well(s) are
to be located.
(4) An arrow orienting the site to one of the cardinal directions (north, south, west, or east)
NOTE: In most cases an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be draw11 i11 by lu11ul. Also, " 'layer' can be selected s/rowiug topographic colltours or
elevation data.
GPU/UIC 5A7 Permit Application (Revised 8/8/2013) Page 3
L. CERTFFICATICN (to be signed as required below or by that person's authorized agent)
15ANCAC 02C A211fe1 requires that all permit applications shall be signed as follows:
1. for a corporation. by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively:
3. for a municipality or a state, federal, or other public agency: by either a principal executive
Officer or ranking publicly elected official;
4. for all others: by the well owner (person(s) listed on the property deed).
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that 1 have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. 1 am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. l agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accord cc with t ie approved specifications and conditions of
the Permit_ ' 7
Applicant
Print or Type Full Naive
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
DWR - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/LJIC 5A7 Permit Application (Revised W8120131 Page 4

L. CERTMCATION (to be signed as required below or by that person's authorized agent)
e req=es W FLU permit appEcRions SrUaIll.+l�e s�gz�� as i`ollvws:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively,
3. for a municipality or a state, fe&erral, or aiher pudic agency: by eii er a pt Ec_ic pal executive
offices' or raging publicly elected official;
4. for ail others_ by the well owner (person(s) listed on the property deed).
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I Hereby certify, under penalty or law, that I ha"Ve 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, iixludbig the possibility of fines and imprisoosnent,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in acco"ce Frith t, a approved specifications and conditions of
the Permit."
Applicant
Print or Type Full Name
Signature of Proprty Owned6Rlllicant
.Print or Type Full Name r
Signature of Authorized Agent, if any
Print or Type Full "Dame
S�ubrnit two copies of the completed application package to:
DWR - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
OPOAt1IC'-A7 ?r rnii April catm [Rt rued SM2_913j PInC q

&9A
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
July 31, 2014
CERTIFIED MAIL# 7010 0780 0001 7057 «-14 ~LeCf? ~
RETURN RECEIPT REQUESTED
Scott Dyreng
1811 Valley Creek Dri-ve
Hillsborough, NC 27278
Subject: Notice of Expira,tion (NOE)
5A7 Geothermal Open-Loop Injection Well
Permit No. WI0500220
Orange County
Dear Mr. Dyreng:
John E. Skvarla, Ill
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of North
Carolina, and is responsible for the regulation of injection well construction and operation activities
within the state. Our records indicate that the above-referenced operating permit for the geothermal
injection well system located on your property at 1811 Valley Creek Drive in Hillsborough, NC,
which was issued to you on January 21, 2010, and expires on December 31, 2014, is soon due for
renewal. If you wish to keep this permit and operate the injection well system, the permit must be
renewed and issued in your name.
If Your Injection Well is Currently Active:
In order to comply with the regulatory requirements listed under North Carolina Administrative Code
(NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit the enclosed renewal application
(Application for a Permit to Construct or Operate Injection Wells -Open Loop Geothermal Injection
Wells) within 120 calendar days of the expiration of your permit. The form is also available on-line
at our website http ://portal.ncdenr.org/web/wg/a ps/gwpro/permit-a pp lications. According to our
records, you must submit your permit renewal by September 2 , 2014.
If Your Injection Well is Currently Inactive:
If you have a separate injection well and it is no longer being used for any purpose, it must be
permanently abandoned according to the regulatory requirements listed under NCAC Title 15A,
Subchapter 2C, Section .0214. When the well is plugged and abandoned, a well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted. You do not have to renew your permit but you must submit a "Status of Injection Well
System" form.
Similarly, if you have a multi-purpose well that is used for both water supply and injection but are no
longer injecting into the well, you do not have to renew your permit but you must submit a "Status of
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: [phone] I Internet: www .ncdenr.gov
An Equal Opportunity\ Affirmative Action Employer-Made in part by recycled paper
Injection Well System" form. These forms are not enclosed but can be found at the website listed
above.
If There has been a Chan ge of Ownershi p of the Pro perty :
If there has been a change of ownership of the property, an "Injection Well Permit Name/Ownership
Change " Form must also be submitted. This form is not enclosed but can be found at the website
listed above.
Please submit the applicable forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms in a timely manner may result in the assessment of civil
penalties in accordance with North Carolina General Statute 87-94.
Thank you in advance for your cooperation and timely response. If you have any questions, please
contact me by phone at [phone] or by email at eric.g,[e-mail].
Sincerely,
~c!J-~
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Raleigh Regional Office -WQROS w/o enclosures
Central Files -Permit No . WI0500220 w/o enclosures
2
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t%or delivery Information visit our website at www.usps.com
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■ Complete Items 1, 2, and 3. Also complete
Item 4 If Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to yau.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Arficle Addressed tm
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Geri fled Mall U Fnxess Mall
13 Registered C] Ratum Ramipt for Merchandise
❑ Insured Mail El C.D.D.
4. Restricted WiVer7R PBttre Faej ❑ Yes
Article Number 7010 0780 0001 7057 3668
{Transfer from seMca label}
Farm 3811, February 2004 Darneetlo Return Rex" 10ft5-02-M-IW

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North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
July 31, 2014
CERTIFIED MAIL # 7010 0780 0001 7057 4474
RETURN RECEIPT REQUESTED
Scott Dyreng
1811 Valley Creek Drive
Hillsborough, NC 27278
Subject: Notice of Expiration (NOE)
5A7 Geothermal Open-Loop Injection Well
Permit No. WI0500220
Orange County
Dear Mr. Dyreng:
John E. Skvarla, Ill
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of North
Carolina, and is responsible for the regulation of injection well construction and operation activities
within the state. Our records indicate that the above-referenced operating permit for the geothermal
injection well system located on your property at 1811 Valley Creek Drive in Hillsborough, NC,
which was issued to you on January 21, 2010, and expires on December 31, 2014, is soon due for
renewal. If you wish to keep this permit and operate the injection well system, the permit must be
renewed and issued in your name.
If Your In jection Well is Currently Active:
In order to comply with the regulatory requirements listed under North Carolina Administrative Code
(NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit the enclosed renewal application
(Application for a Permit to Construct or Operate Injection Wells -Open Loop Geothermal Injection
Wells) within 120 calendar days of the expiration of your permit. The form is also available on-line
at our website http://portal.ncdenr.org/web/wq/aps/gwpro/permit-applications. According to our
records, you must submit your permit renewal by September 2 , 2014. ·
If Your In jection Well is Currently Inactive:
If you have a separate injection well and it is no longer being used for any purpose, it must be
permanently abandoned according to the regulatory requirements listed under NCAC Title 15A,
Subchapter 2C, Section .0214. When the well is plugged and abandoned, a well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted. You do not have to renew your permit but you must submit a "Status of Injection Well
System" form.
Similarly, if you have a multi-purpose well that is used for both water supply and injection but are no
longer injecting into the well, you do not have to renew your permit but you must submit a "Status of
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: [phone] \ Internet: www.ncdenr.gov
An Equal Opportunity I Affinnalive Action Employer-Made in part by recycled paper
Injection Well System" form. These forms are not enclosed but can be found at the website listed
above.
If There has been a Change of Ownershi p of the Property:
If there has been a change of ownership of the property, an "Injection Well Permit Name/Ownership
Change" Form must also be submitted. This form is not enclosed but can be found at the website
listed above.
Please submit the applicable forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms in a timely manner may result in the assessment of civil
penalties in accordance with North Carolina General Statute 87-94 .
Thank you in advance for your cooperation and timely response. If you have any questions, please
contact me by phone at [phone] or by email at [e-mail].
Sincerely,
t¾c!J-~--
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Raleigh Regional Office -WQROS w/o enclosures
Central Files -Permit No. WI0500220 w/o enclosures
2
Permit Number WI0500220
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Scott and Chelsea Dyreng SFR
Location Address
1811 Vly Creek Dr
Hillsborough
Owner
Owner Name
Scott
Dates/Events
NC 27278
Dyreng
Orig Issue
01/21/10
App Received Draft Initiated
09/09/09
Scheduled
Issuance
Central Files : APS_ SWP_
02/04/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Scott Dyreng
1811 Valley Creek Dr
Hillsborough
Major/Minor
Minor
Region
Raleigh
County
Orange
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Scott Dyreng
1811 Valley Creek Dr
Hillsborough
NC
NC
Public Notice Issue
01/21/10
Effective
01/21/10
27278
27278
Expiration
12/31/14
_R_e~g~u_la_t_e_d_A_c_t_iv_i_ti_e_s ________________ Re quested/Received Events
Heat Pump Injection RO staff report requested
Outfall NULL
Waterbody Name
Additional information requested
RO staff report received
Additional information received
Stream Index Number Current Class
09/16/09
09/16/09
01/07/10
01/07/10
Subbasin
Permit Number W10500220
Program Category
Ground Water
permit 'type
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael.rogers
Coastal 5W Rule
Permitted Flow
Facility Name
Scott and Chelsea Dyreng SFR
Location Address
1811 Vly Creek Dr
Hillsborough NC 27278
❑wner
Central Files- APS SWP
01/16/10
Permit Tracking Slip
Status Project Type
In review New Project
Version Permit Classification
tndividual
Permit Contact Affiliation
Scott Dyreng
1811 Vly Creek Dr
Hillsborough
MajorlMinor Region
Minor Raleigh
County
Orange
Facillty Contact Affiliation
NC 27278
Owner fame
Owner Type
Individual
Scott Dyreng
Owner Affiliation
Scott Dyreng
1811 Vly Creek ❑r
Hillsborough NC
27278
I]: es Events
Scheduled
Orig Issue App Receiver) Draft Initiated Issuance
09/09/09
public Not}ce Issu Effective
EmirPon
�J� J+L[ f
Re elated Activities
Re-uestedlRerceived Events
Heat Pump injeclion
RQ staff report requested
09/16/09
Addlt]onal information requested
09116/09
RC staff report received
01 /07/10
Adttt anal information received
01/07/10
❑utfall NU'__.
Waterbody Name Stream fndex Number Current Class Subbasin

NCDENR
North Carolina Department at Environment and Natural Resources
Beverly Eaves Perdue
Governor
Scott and Chelsea Dyreng
1811 Valley Creep Drive
Hillshoraugh, NC 27278
Re: Issuance of Injection Well Permit
Permit No. W10500220
Issued to Scott and Chelsea Dyreng
Orange County
Dear Mr. and Mrs. Dyreng:
Division of Water Quality
Coleen H. Sullins
Director
January 21, 7010
Dee Freeman
Secretary
In accordance with your application received September 9, 2009, I am forwarding Permit No. WIO-500�20 for
the operation of a 5A7 geothermal underground injection control (C]IC) well heat pump system located at the
above referenced address. This permit shall be effective from the date of issuance until December 31, 2014,
and shall be subject to the conditions and limitations stated therein.
Also attached is a summary of the laboratory sampling results from water samples collected from your
geothermal well on October 6 and November- 3. 2009. Laboratory analytical results of both the influent and
effluent samples collected on October 6 indicate exceedances in the maximum contamination level (MCL) or
elevated levels for the following parameter(s):
Parameter i Units MCL Restilts
Total Coliform CFU1100ml 1 3 (effluent)
I
Aluminum 4g1L 1 No standard 120 (influent)
Iron µglL 300 1 1900 (influent)
790 (effluent)
Manganese n/L 50 63 ('influent)
57 (effluent)
Lead µg1L 15 16 (influent)
j Zinc µg'L 1000 1300 (influent)
The source or cause of these exceedances is unknown. It is recommended before using water from this well for
personal consumption that you consult with the Orange County Environmental Health Department.
AOUIFER PROTECTi44 SECTION
106 Mail Service Center, Ratel h, No* Carolina 27099.163E
Location: 2726 Capital Boulevard, Raleigh. North Carolina 27604
Phone: 919-733,3221 l FAX 1: 915.715-4568; FAX 2: 919-715.61548 I Customer Seroce:1-877-623.6748
Internet: www.rxwaterouaCstv.om
An Equal Opparnunity r Atfirm0we Action Emp"r
Qtie
aAbCarolina
NaWralllf

In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an application
to renew the permit four months prior to its expiration date. As indicated in the permit, this permit is not
transferable to any person without prior notice to, and approval by, the Director of the Division of Water
Quality. If you have any questions regarding your permit or the Underground Injection Control Program please
call me at [phone] .
Best Regards ,
,' -iU~ ~~-----
Michael Rogers, P.G. (NC~ FL)
Environmental Specialist
cc: Jay Zimmennan -Ralei gh Regional Office
Central Office File -WI0500220
Orange County Environmental Health Dept.
Attachment(s)
NC DIVISION OF WATER QUALITY
LABORATORY ANALYTICAL RESULTS
5A7 GEOTHERMAL UNDERGROUND INJECTION CONTROL (UIC) WELL
PERMIT NO .: WI0500220
PERMITTEE(S): Scott and Chelsea Dyreng
SAMPLE COLLECTION DATE: 10/6/09
Parameter Fecal Coliform Total Coliform
units CFUl100ml CFU/100ml
NC MCL and/or EPA Standard NC MCL= 1 NC MCL = 1
Influent Sample Results <1 < 1
Effluent Sample Results <1 3.
Parameter Nitrate + Nitrite Silver, Ag
units mg/Las N µg/L
NC MCL and/or EPA Standard NC MCL = 10 NC MCL=20
EPAPDWS= 10 EPA SOWS= 100
influent Samp le Results <.02 na
Effluent Sample Results <,02 na
Parameter Cadmium, Cd Chromium, Cr
units µg/L µgfl
NC MCL and/or EPA Standard NC MCL=2.0 NCMCL=10
EPA PDWS = 5.0 EPA PDWS = 100
Influent Sample Results na < 10
Effluent Sample Results na < 10
Parameter Manganese, Mn Sodium, Na
units µg/L mgfl
NC MCL and/or EPA Standard NC MCL= 50 NS
EPASDWS= 50
Influent Sample Results M. 17
Effluent Sample Results .57 · 17
Parameter pH (field)
units units
NC MCL and/or EPA Standard NC MCL = 6.5-8.5
EPA SOWS = 6.5 to 8.5
Influent Sample Results 7.00
Effluent Sample Results 7.00
NC MCL = North Carolina Maximum Contamination Limits per 15A NCAC 2L .D20D
EPA PDWS = Env~onmental Protection Agency Primary Drinking Water Standards
EPA SOWS = Environmental Protection Agency Secondary Drinking Water Standards
NA = Not analyzed
NS = No standard
Total Dissolved Solids Chloride, Cl
mg/L mg/L
NC MCL = 500 NC MCL =250
EPA SOWS = 500 EPA SOWS = 250
158 4.5
160 5.3
Aluminum, Al Arsenic, As
µg/L µg/L
NS NC MCL = 10
EPA SOWS= 50 to 200 EPAPOWS= 10
.. ,120 na
< 50 na
Copper, Cu Iron, Fe
µg/L µg/L
NC MCL = 1000 NC MCL=300
EPA SOWS= 1000; POWS = 1300 EPA SOWS= 300
150 ··• 1900
90 79()
Nlckel, Ni Lead, Pb
µg/L µg/L
NC MCL = 100 NCMCL=15
EPAPOWS=15
< 10 16
< 10 < 10
Fluoride, FL
mg/L
NC MCL = 2.0
EPA PDWS = 4.0
<0.4
<0.4
Barium, Ba
µg/L
NC MCL = 700
EPA POWS = 2000
na
na
Potassium, K
mg/L
NS
0.73
0.75
Selenium, Se
µgfl
NC MCL =20
EPAPOWS= 50
na
na
Sulfate, S04
mg/L
NC MCL = 250.0
EPA SDWS = 250
<2.0
<2.0
Calcium, Ca
mg/L
NS
35
35
Magnesium, Mg
mg/L
NS
9.7
9 .8
Zinc, Zn
µg/L
NC MCL = 1000
EPA SDWS = 5000
1300
na
Parameter
units
NC MCL and/or EPA Standard
Influent Sample Results
Effluent Sample Results
NC DIVISION OF WATER QUALITY
LABORATORY ANALYTICAL RESULTS
5A7 GEOTHERMAL UNDERGROUND INJECTION CONTROL (UIC) WELL
PERM"rr NO.: WI0500220
PERMITTEE(S): Scott and Chelsea Dyreng
SAMPLE COLLECTION DATE: 11/3/09
Iron, Fe Zinc, Zn pH (field)
11g/L 11g/L units
NC MCL = 300 NC MCL = 1000 NC MCL = 6.5-8.5
EPA SOWS= 300 EPA SOWS = 5000 EPA SOWS = 6.5 to 8.5
<50 830 7.00
61 850 7.00
NC MCL = North Carolina Maximum Contamination Limits per 15A NCAC 2L .0200
EPA PDWS = Environmental Protection Agency Primary Drinking Water Standards
EPA SOWS= Environmental Protection Agency Secondary Drinking Water Standards
NA = Not analyzed
NS = No standard
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 97; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Scott and Chelsea Dvreng
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL, defined in Title 15A North Carolina
Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat pump effluent. This
injection well is located at 1911 Valley Creek Drive. Hillsborough. Orange County, NC 2 72 78, and will be
constructed and operated in accordance with the application September 9, 2009, 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 pen -nit is for Operation of an injection well shall be in cormplian.ce 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 December 31, 2014, and shall
be subject to the specified conditions and limitations set forth in Parts I through VIII hereof.
N�
Permit issued this the day of , 201 o.
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
W10500220

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 (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 injection well shall have permanently affixed an identification plate according to 2C
.0213(g).
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to:
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section-Raleigh Regional Office
3 800 Barrett Drive
Raleigh. NC 27609
[phone]
GW-1 s must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
PART II-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting 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.
WI0500220 2
3. The issuancJ of this permit shall not relieve the Pennittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
4. Continued operation of the injection system will be contingent upon the effluent not impacting
groundwater quality. The water quality of the effluent cannot be that of a lower quality than the influent,
which results in a degrading of water quality of the aquifer.
PART III-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
·requires a reduction or elimination of the permitted activity :
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART IV -OPERATIONS AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
PART V -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
WI0500220 3
PART VI -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Raleigh Regional Office, telephone number [phone], any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VII -PERMIT RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
PART VIII-CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(l), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
.Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to the following:
(A)
(B)
(C)
WI0500220
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.
The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
4
' (D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which • extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurfa~e cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
WI0500220
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
5
I
Routing Slip for SA 7 Well
Laboratory Review
Date: J/l¥J-o
Permit No. U O S--0 6.?J.:o
Permittee(s): [) y t,.cd6-
I have reviewed the attached laboratory analytical
results and have made any comments below.
44/ Initial
'/l'f/b/P Date
A11,lvs :~ 1>e1./h -P,.,-•"rt,°1r1t-k. t ,.,-.J,.;,k ''
l!lwsf: 4P ./-e.>c o.c«cl. /P"'f,-/4 ..P,r //C. ,,..,,,,,,,J,.,-J,.,-
or-E PA PDW S . C ~ s""""'4') s: l,.u! .. -f ::f,,..
141,.-Mry a r111 l 1 ./-,tc,.,f ,.,su /1:r~)
S:\UIC\GPU Routing Slip for 5A7 Well(s).doc
, .
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 01-06-2010 County: Oran ge
Permittee: Scott D yren g
Project Name: UIC-5A7
Application No.: WI0500220
To: A quifer Protection Section Central Office
Central Office Reviewer: Michael Ro gers
Regional Login No: __ _
I. GENERAL INFORMATION
1. This application is (check all that appl y): 1:8] New D Renewa
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Recycle D High Rate fufiltration D Evaporation/fufiltration Lagoon
D Land Application of Residuals
D Distribution of Residuals
D Attachment B included
D Surface Disposal
D 503 regulated D 503 exempt
D Closed-loop Groundwater Remediation 1:8] Other fujection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? 1:8] Yes or D No.
a. Date of site visit: 10-06-2009 and 11-03-2009
b . Person contacted and contact information: Scott D yreng, 919-933-9667
c . Site visit conducted by: Lin McCartney
d. fuspection Report Attached: 1:8] Yes or D No.
2. Is the following information entered into the BIMS record for this application correct?
1:8] 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 Dis posal and In jection Sites:
(If multi ple sites either indicate which sites the information a pp lies to , co py and p aste a new section into the
document for each site . or attach additional pages for each site)
a. Location(s): 1811 Vallev Creek Dr .. Hillsboroueh . NC 27278
b. Driving Directions: Take I-40 W for 27 miles . take Exit 261 toward Hillsboroul!h . turn left onto NC-86.
Turn ri ght onto Davis Rd., turn left onto Hope Valle y Dr., turn left onto New Hop e S orin g Dr., turn ri ght
onto Valley Creek Dr.
c . USGS Quadrangle Map name and number: __
d . Latitude: 36-0-50 Longitude: 79-7-42
IL NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed fo r renewals or minor
modifications, skip to next section )
Description OfWaste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification: __
FORM: Staff.Report-Scott.Dyreng
RECr:IVf:0 I DEN,~ I DVvQ
AQUIFfR PRnTFrTnN t;FCTION
JAN O 7 20;J
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description Of Well(S) And Facilities-New, Renewal , And Modification
1. Type of injection system:
!ZI 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? rgj Yes D No
3. Are there any potential pollution sources that may affect injection? rgj Yes D No
What is/are the pollution source(s)? Septic Tank What is the distance of the injection well(s) from the pollution
source (s)? 134 ft.
4. What is the minimum distance of proposed injection wells from the property boundary? 34 ft.
5. Quality of drainage at site: rgj Good D Adequate D Poor
6. Flooding potential of site: rgj Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? rgj 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.
Injection 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 D No. If yes, exp lain:
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 y es . explain:
3. For renewal or modification of groundwater remediation permits ( of any ryp e ), will
continued/additional/modified in jections have an adverse imp act on mi gration of the plume or mana gement of
the contamination incident? D Yes D No. If y es . explain:
4. Drilling contractor: Name: Hudson Well Co.
FORM: Staff.Report-Scott.Dyreng 4
i
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address: 2316 Cathran Rd. Rou gemont . NC 27572
Certification number: __
5. Complete and attach Well Construction Data Sheet.
FORM: Staff.Report-Scott.Dyreng 5
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATIONAND REECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application..
2. Attach Well Construction Data Sheet - if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yes, please explain
briefly.
4, List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
a. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
7, Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information;
Issue; ❑ Deny. If deny, please state reasons:
8. Signature of report preparer{s}: ! rr
Signature of i\PS regional supervisor.
Date:
�.�
ADDITIONAL REGIONAL STAFF AEVIEW ITEMS
The sam ling was conducted in two separated times because on the first time it did not cover all the parameters
which were required.
FORM: Staff.Report-Scott.Dyreng 6

Permit: WI0500220
SOC:
County: Orange
Region: Raleigh
Effective:
Effective:
Contact Person: Scott Dyreng
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 11/03/2009
Primary Inspector: Lin McCartney
Secondary lnspector(s):
Reason for Inspection: Routine
Compliance Inspection Report
Expiration:
Expiration:
Title:
Owner: Scott Dyreng
Facility: Valley Creek 5A7
1811 Vly Creek Dr
Hillsborough NC 27278
Phone: [phone]
Certification: Phone:
Entry Time: 11 :00 AM Exit Time: 12:30 PM
Phone: [phone]
Ext.4243
Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Heating/Cooling Water Return Well (5A7)
Facility Status: ■ Compliant O Not Compliant
Question Areas:
■Wells
(See attachment summary)
Page: 1
Permit: WI0500220
SOC:
County: Orange
Region: Raleigh
Effective:
Effective:
Contact Person: Scott Dyreng
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 10/06/2009
Primary Inspector: Lin McCartney
Secondary lnspector(s):
Reason for Inspection: Routine
Compliance Inspection Report
Expiration:
Expiration:
Title:
Owner: Scott Dyreng
Facility: Valley Creek 5A7
1811 Vly Creek Dr
Hillsborough NC 27278
Phone: [phone]
Certification: Phone:
Entry Time: 11 :00 AM Exit Time: 01 :00 PM
Phone: [phone]
Ext.4243
Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Heating/Cooling Water Return Well (5A7)
Facility Status: ■ Compliant O Not Compliant
Question Areas:
■Wells
(See attachment summary)
Page: 1
Courtly:
ORANGE
River Basin
Report To
RRQAP
Cdlecior_
L MCCARTNE
Region:
RRO
Sample Matrix:
GROUNDWATER
Lac, Type:
WATER SUPPLY
Emargancy Yes/No
COC YeafNo
�( • DWU Laboratory Section Wesults
Sample tD7
AB60228
WA7yrR
PO Number k
9G1176
p
,M1V
pale Received:
10/06/2009
y
Time Received:
12:30
R '
Labwarks Loginl❑
SUATHIS
Date Reported:
10/21/09
Report Generated
10l2112039
Visitlt]
Loc. DaScr.: SCOTT QYRENG
Locadon IA: SP088W OSD02204 1 Collect Date: 1010W2009 1 Cotlect Time:: 11A0 1 Sample Depth I
Sample Qualifiers and Comments
Routine Qualifiers
- f
-
j
For a more detailed description of these qualifier codes refer to www.dwgtab.org under Staff Access
-�
LJ
A -Value reported is the average of two or more determinations
81-Countable membranes with 40 colonies; Estimated
N3-Estimated concentration is < POL and aMOL
82- Counts from all filters were zero.
NE -No established PCIL
t
P-Elevated POL due to matrix interference andlor sampte dfluSior. _
�?
$3- Countable membranes with more than 60 or 80 colonies; Estimated
Ol-Hold ing lime exceeded prwrto receipt at lab-
BR -Filters have cqunts of both a60 or80 and < 20; Estimated
02- Holding time exceeded following receipt by lab
B5-Too many colonies were present; too numerous to count (TNTC)
POL- Practical Quantitadon Limit -subject to change due to instrument sensitivity
J2• Reported Halos failed to mast t}C criteria for either precision or accuracy; Estimated
U- Samples analyzed for this Compound but not datected
J3-The samplematrix interfered with the ability to make any accurate determination',Estimated
x1- Sample not analyzed for this compound
J6-The fah analysis was from an unpreserved ar impmperty chemically preserved sample; Estimated
Ni-The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
Laboratory Section» 1623 Matt Service Center, Raleigh, NC 27699-1623 (9191 733•3908 Page 1 of 3

'
:NC ©WQ_ £a6oratory Section (J?Jsu[ts Sampl11 ID AB50228
L0<,ation ID : 5PD68WID50D22D-l Collect Date: 10/06/2009
Loe. Dascr.: . SCOTT DYRENG conect nme:: 11:00
Visit ID
CAS# Analyte Name PQL Result Qualifier Units Analysl/Oate Approved By /Date
Sample temperature at receipt by lab 2.2 ·c HPARKER SMATHIS
Method Reference 10/6/09 10/6/09
MIC
Collform, MF Fecal In liquid 82 CFU/100ml BSWANSON CGREEN
Method Reference APHA9222D-20th 10/6/09 10/12109
Coliform, MF T 0181 In lquld B2 CFUl100ml BSWANSON CGREEN
Method Reference APHA92228-20lh 10/6/09 10121/09
WET
Ion Chromatography _TITLE_ mg/L MIBRAHIM1 CGREEN
Method Reference EPA300.0 10/6/09 10/14/09
Total Dissolved Solids In Hquid 12 158 mglL JSTALEY CGREEN
Method Reference APHA2540C-18TH 10/8/09 10/14/09
Chloride 4.5 mg/L MIBRAHIM1 CGREEN
Method Reference EPA300.0 10/6/09 10/14109
Fluoride 0.4 0.4 u mg/L MIBRAHIM1 CGREEN
Method Reference EPA300.0 10/6/09 10/14/09
Sulfate 2 2.0 u mg/L MIBRAHIM1 CGREEN
Method Reference EPA300.0 10/6/09 10114/09
NUT
NO2+NO3 as N In llquld 0.02 0.02 u mg/1.asN MAJAYI MOVERMAN
Method Reference Lac10-107-D4-1-c 10/7109 10/15109
MET
7429-90-5 Al bylCP 50 120 ug/L · JJURGEVICH ESTAFFORO
Method Reference EPA.200.7 10/13/09 10/19/09
7440-70-2 CabylCP 0.1 35 mg/L JJURGEVICH ESTAFFORD
Method Reference EPA.200.7 10/13/09 10/19'09
7440-"17-3 CrbylCPMS 10 10 u ug/L OSTANLEY ESTAFFORD
Method Reference EPA200.8 10/12/09 10119109
7440-50-8 Cu bylCPMS 2 150 ug/L DSTANLEY ESTAFFORD
Method Reference EPA200.8 10/12/09 10/19/09
7439-89-6 FebYICP 50 1900 ug/L JJURGEVICH ESTAFFORD
Method Reference EPA200.7 10/13/09 10/19109
7440-09-7 KbylCP 0.1 0.73 mg/L JJURGEVICH ESTAFFORD
Method Reference EPA200.7 10/13/09 10/19/09
7439-95-4 Mg bylCP 0.1 9.7 mg/L JJURGEVICH ESTAFFOAD
Method Reference EPA200.7 10/13/09 10/19109
7439-96-5 MnbylCP 10 63 ug/L JJURGEVICH EST AFFORD
Method Reference EPA200.7 10/13/09 10/19/09
Laboratory Section>> 1623 Mall Service·center, Raleigh, NC 27699-1623 [phone] Page 2 of 3
Location ID:
Loe. Descr.:
Visit ID
5P068WI0500220-I
SCOTT DYRENG
CAS# Analyte Name
7440-23-5 NabylCP
Method ·Reference EPA200.7
7440-02-0 NlbylCPMS
Melhod Reference EPA200.8
7439-92-1 PbbylCPMS
Method Reference EPA200.8
7440-66-6 ZnbylCPMS
Method Reference EPA200;8
¾C (l)'WQ_ La6oratory Section ~sufts
PQL Result Qualifier
0 .1 17
10 10 u
10 16
10 1300
Laboratory Section» 1623 Mail Servlce'Center, Raleigh, NC 27699-1623 {919) 733-3908
Units
mg/I.
ug/L
ug/L
ug/L
Sample ID
Collect Date:
Collect Time::
Analyst/Date
JJURGEVICH
10/13/09
DSTANLEY
10112/09
BSKINNER
10/16/09
DSTANLEY
10/12/09
Page 3 of 3
AB50228
1010612009
11:00
Approved By /Date
ESTAFFORD
10/19/09
ESTAFFORD
1Dl19JO!I
ESTAFFORD
10/19109
ESTAFFORD
10/19JO!I
North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
Location codta_�i� Lr 7 0 1 L) � AS MPLE TYPE
County rC. n [3 ce Water
Quad No Serial No. ❑ soil
Lat. Long. ❑ Other
SAMPLE PRIORITY
Routine
Emergency
11 ❑ Chain of Custody
Report To: ARO, FRO, MRO, RRO WaRO, WiRO,
WSRO, Kinston FO, Fed. Trust Central Off., Other:
Shipped by: Bus, Courier, and De Other: Purpose:
Collectors sj: L• ct s Date _ Time t 0 0 1
r.. FIELD ANALYSES -6 —0 Owner S f c�
PH 4DO _ ,�-2 Spec. Cond:94 at 250C Location or Sil
Temp.lo le", i A oC Odor A' so F1 .0 Description of
� m
La Numberber
Date Received D — _0 Time:
Reed By: From:Bus, Courier, Hand Del.,
Other:
= Entry By. Ck:
Date Reported:
Complaink CGm� plianc�Je,{LLUUS , Pesticide Study, Federal Trust, Other.
,irrrY,5
Appearance
Field
LABORATORY
Cj < ,- . tr
Analysis By: /9 CC
ANALYSES
BOA 310
COD High 340
COD Low 335
Conform: MF Fecal 31616
Conform: MFTotal 31504
TOC 630
Turbidity 76
Residue, Total Suspended 530
pH 403
Alkalinity to pH 4.5 410
Alkalinity to pH 8.3 415
CA 4 f-�k�y(
mg&
mglL
mg1L
110omt
MOW
mgrL
NTU
mgfL
units
mglL
mglL
Biss. Solids 70300
Fluoride951
Hardness: Total 900
Hardness (non-carb) 902
Phenols 32730
Specific Cond. 95
Sulfate 945
Sulfide 745
Od and Grease
Sampling Method
Remarks
mglL
mgA_
mgA-
mWL
ugll
pMhoskm
mg&
mD&
mg1L
7j
X
& rr~ b -�
Ag-Sover 46M
AI Aluml um 48557
As-Arserdc 46551
Ba-Barium 46556
Ca -Calcium 46552
Cd-Cadmlum 46559
Cr-Chromium 46&%
Cu�Copper 46562
Fe -Iron 46663
Hg-Mercury 71 goo
K Potasslum 46555
Mg -Magnesium 46554
MwManganese 46565
����
Pun6wni
u lL
u
URIL
m lL
wolt.
u2IL
u gIL
WL
m L
m OIL
4L
](
Carbonate 445
mull.
NH6 as N 610
mg1L
Na Sodium 46558
mull.
Bicarbonate 440
mglL
TKN as N 525
mglL
ISIMIckel
UgVL
Carbon dioxide 405
mglL
N%+ NO, as N 630
mg/L
}(
Ph -Lead 46564
ugJL
Chloride 940
mg&
P: Total as P 665
mg1L
Se-seienlum
L
Chromlum: Hex 1032
uglL
Nltrale (N%as N) 020
mglL
Zn-Tiny 4&%7
uqJL
Color. True 80
Cu
Nitrite (NO2 as N) 615
mgn-
Cyanide 720
mgfL
Lab Comments
GW-54 REV, 7103 For Dlssakred Analysts -submit filtered sample and write "DIS" in black.
Sample Interval
Mxk al WV., etc.]
anoeWorine Pesticides
OrganophospktM Res#cides
NftMen Pesticides
Add Herbicides
PCBs
Semimlatile Organkm
TPH-Diesel Range
VoWle Or2 arks JVQA bottle
TPH-Gasoline Range
TPH-BTEX Gasoline Range
LAB USE ONLY
Temperature on arrival (IC): 02. R

County:
❑RANGE
River Basin
Report To
RROAP
CaRxtar.
L MCCARTNEY
Region;
RRO
Sample Matrix:
GROUNDWATER
Loc. Type:
WATER SUPPLY
Emergency Ye31No
COC YesrNo
Location10: _ 5p068W10500220-EFF
G
VisitID
Lor:, Descr.: l3COTT OYRt=NG
Collect date: 1010612009 Collect Time:: 111:40
Sample Qualifiers and Comments
Sample IO:
AB50229
PO Number #
9G11T7
Date Received'
1010612009
Time Received:
12:30
Labworks LoginlD
SMATHIS
Date Reported:
t a121109
Report Generated 10121t2aag
IfA I0 �' �12 q
Sarnple Depth
Routine Qualifiers
For a m❑re detailed description of these qualifier codes refer to www.dwglab.arg under Staff Access
A -Value reported is the average of two or more determinations
N3-Estinsated canceniration is c POL and aMOL
B1-Countable membranes with 40 colonies; Estimated
_ NE-Na established PO
S2- Counts from all filters ware zero.
B3- Countable membranes with more than 60 or 80 colonies; Estimated P-Elevaled POL due to matrix interference andlor sample dilution
84-FRem have counts of baM >60 or 80 and c 20; Estimated Qf-Hold ing time exceeded prior to receipt at lab.
85 Too many cnlonles were present too numerous to count (TNTC) ❑2- Natding time exceeded following receipt by lab
POL- Practical Qoantitativn Limit -subject to change due to instrum enl sensitivity
12- Reported value failed to meet OC criteria for either precision or accuracy; Estimated
U-Samples analyzed for this cgmpeund but not detected
J3-The sample matrix interfered with the ability to make any accurate determination; Estimated
x1-Sample not analyzed for this oompmund
.i6-The lab analysis was from an unpreserved or improperly chemically preserved sample; Estimated
N1-The component has been tentatively identified based on mass spectrat library search and has an estimated value
LAB
Laboratory Section>a 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone]
Page 1 of 3

'
:NC <DWQ £a6oratory Section <R§sufts Sample ID AB50229
location ID: 5P068WI0500220-EFF Collect Date: 10/0&l2009
Loe:. Oe$Cr.: SCOTT DYRENG Collect Time:: 11:40
Visit ID
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
Sample temperature at receipt by lab 2.2 ·c HPARKER SMATHIS
Method Reference 10/6/09 1016/0!1
MIC
Coliform, MF Fecal In llquld 82 CFU/100ml BSWANSON CGREEN
Method Reference APHA92220-20th 10/6/09 10/12/09
Coliform, MF Total In llquld 3 CFU/100ml BSWANSON CGREEN
Method Reference APHA9222B-20th 10/6/09 10/21109
WET
Ion Chromatography _TlTLE_ mglL MIBRAHIM1 CGREEN
Method Reference EPA 300.0 10/6/09 10/14/09
Total Dissolved Solids In liquid 12 160 mg/L JSTALEY CGREEN
Method Reference APHA2540C-18TH 10/8/09 10/14109
Chloride 5.3 mg/L MIBRAHIM1 CGREEN
Method Reference EPA300.0 10/6/09 10114/09
Fluoride 0 .4 0 .4 u mglL MIBRAHIM1 CGREEN
Method Reference EPA300.0 10/6109 10/14/09
Sulfate 2 2.0 u mg/L MIBRAHIM1 CGREEN
Method Reference EPA300.0 10/6/09 10114/09
NUT
N02+N03 as N In llquld 0.02 0.02 u mg/lasN MAJAYI MOVERMAN
Method Reference Lac10-107-04-1-c 10/7/09 10/15/09
MET
7429-90-5 Al bylCP 50 50 u ug/L JJURGEVICH ESTAFFORD
Method Reference EPA200.7 10/13109 10/19/09
7440-70-2 CabylCP 0.1 35 mglL JJURGEVICH ESTAFFORO
Method Reference EPA200.7 10/13/09 10/19109
7440-47.3 CrbylCPMS 10 10 u Ug/L OSTANLEY ESTAFFORD
Method Reference EPA200.8 10/12/09 10/19/09
7440-50-8 CubylCPMS 2 90 Ug/L BSKINNER EST AFFORD
Method Reference EPA200.8 10/16109 10/19/09
7439-89-6 FebylCP 50 790 ug/L JJURGEVICH EST AFFORD
Method Reference EPA200.7 10/13109 10/19109
7440-09-7 KbylCP 0.1 0.75 mg/L JJURGEVICH EST AFFORD
Method Reference EPA200.7 10/13109 10119/09
7439-95-4 MgbylCP 0.1 9 .8 mg/L JJURGEVICH EST AFFORD
Method Reference EPA200.7 10/13109 10119/09
7439-96-5 Mn bylCP 10 57 ug/l JJURGEVICH ESTAFFORO
Method Reference EPA 200 .7 10/13/09 10/19/09
Laboratory Section» 1623 Mall Service-Center, Raleigh, NC 27699-1623 [phone] Page 2 of 3
L~tionlO:
Loe. Descr.:
Visit ID
5P068WI0500220-EFF
SCOTT DYRENG
CAS# Analyte Name
7440-23-5 NabylCP
Method Reference EPA200.7
7440-02-0 NlbylCPMS
Method Reference EPA200.8
7439-92-1 PbbylCPMS
Method Reference EPA200.8
:NC ©WQ La6otatory Section ~su[ts
PQL Result Qualifier
0.1 17
10 10 u
10 10 u
Laboratory Section>> 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone]
Unit$
mg/I.
ug/1..
ug/1...
Sample ID
CoHec:t Date:
Collect Time::
Analyst/Date
JJURGEVICH
10/13/09
OSTANLEY
10/12/09
OSTANLEY
10/12/09
Page 3 of 3
AB50229
10/06/2009
11:40
Approved By /Date
EST AFFORD
10/19/09
ESTAFFORD
10/19109
EST AFFORD
10/19A'.l9
GROUNDWATER FIELD/LAB FORM
Location
l,'i
County _ O rco -%s e
Quad No Serial No.
Let. Lang_
Report To: ARO, FRO, MRO, RO, aRO, WiRO,
WSRO, Kinston FO, Fed. st tral Off., Other:
Shipped by, Bus, Courier Hand Delt Other_
SAMPLE TYPE
Water
❑ Soil
❑ Other
❑ Chain of Custody
�auecwrtsy: r74-e j;jjo.�_■ uare - i rme � i -
FIELD ANALYSES �/p G- 6q Owner Ico
pH 400 Spec. Cond.s4_6I at 25°C Location or Sil
Temp.la °C Odor .,p- _ Description of
Appearance Sampring Met
Field Analysis By: L r Remarks_
I ARORATORY ANAL YSF:S
BOO 310 mglL
COD High 340 mg1L
COD Low 335 mglL
ColHorm: MF Fecal 31618 1100m1
Collform: MF Total 31504 1100m1
TOC 680 mg1L
Turbidity 76 NTt1
Residue, Total Suspended 530 mg1L
pH 403 units
Alkalinity to pH 4.5 41a mglL
Alkalinity to pH 83 415 M91L
Carbonate 445 mg1L
Blcarbonale 440 mg1L
Carbon dioxide 405 mg1L
Chloride 940 "V&
-25
Chromium: Hex 1032 U91
Color. True 80 Cu
Cyanide 720 mglL
Lab
North Carolina
Department of Environment and Natural Resources
DMSION OF WATER QUALITY -GROUNDWATER SECTION
SAMPLE PRIORITY Tq
0 Routine Lab Number
❑ Emergency Date Received &-L32T Time:
Re(Yd By: From:Bus; Courier, jfand Del
Other. lk
Data Entry B : Ck:
� U e J11) 4- Date Reported:
LM e, Complaint, Com liance LUST, Pesticide Study, Federal Trust, Other.
-J+ i7 v Y P :-I L� (drde one)
hiss. Solids 70300
mg1L
AgSWer 46586
U91L
Fluoride 951
mgA-
jr,
AI -Aluminum 46557
Hardness. Total 900
mglL
As -Arsenic 46551
uq1L
Hardness (non-carb) 902
mglL
Ba-Barium 46556
LIWL
Phenols 32730
refill
Ca -Calcium 46552
mg1L
Specinc Cond. 95
IjMhos/cm
Cd-Cadmlum 46559
1L
Sulfate 945
mg1L
Cr-Chromium 465%
/L
Sulfide 745
mg1L
'
Cu-Copper 46562
1L
Fe -Iron 46563
1L
Oil and Grease
mglL
Hg-Mercury 71900
uQIL
K-Potassium 46555
m rL
Mg -Magnesium 46554
nVk
Mn-Mangenese 46505
LWL
WW as N 610
m911-
X
Na-Sodium 46558
TKN as N 625
mg1L
pE
Ni-Nickel
LKVL
N%+ NOS as N 630
mglL
Pb-Lead 46564
n,
P: Total as P 665
m91L
SeSeleniurn
WIL
Nitrate (NOD as N) 020
mg1L
7n-7Anc 46567
Nitrite (NOS as N) 615
mg1L
GW-54 REV. 7iO3 For Dissolved Avmlysis-submit BNered sample and wrile 'CIS' In block.
Or anacMorine Pesticides
Or honk Pesticides
Ntmo en Pestlrldes
Acid HeWddes
PCBs
5rmivalaWe Qr Dolts
TPH-Diesel Ranoe
Volatile Organics OA bottle)
TPH-Gasoiwre Range
TPH-BTEx Gasoline Range
L6D U$E_ONLY
Temperature on arrival (1%
J

1.1 Labaratonr N
esults
County:
CRANGE
River Basin
Report To
RROAP
Collector.
L MCCARTNEY
Region:
RRO
sample Matrix:
GROUNOWATER
Lac. Type:
WLUENT
Emergency YeslNo
COC YeslNo
Location ID: 512068WI05002201N
VisitID
Lne. Deser.: 1#11 VALLEY CREEK DRIVE
Collect Date: 111031TA09 collect Time: 11:15
Sample Qualifiers and Comments
Sample !D: ABS1302
PO Number # 9G1250
❑ate Received. 11103120139
Time Received- 12:45
Labworks LoginID HPARKER
pate Reported: 12(7109
Report Generated: 12/0712009
13 )l o .
Sample Depth
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www,dwglab.org under Staff Actress
A -Value reported is the average bf two or more determinations
N3-Estimated concentration is c POL and �MDL
B1-Countable. membranes with <20 colonies; Eslimated
NE -No established POL
82- counts from all ihars were zero.
83- Countable membranes wish more than 60 or 80 colonies, Estimated P-Elevated POL due to rnWx Interference and/or sample dilution
+j1-Holding time exceeded pnor to receipt at lab.
84-Filters have mounts of both?60 or 80 and � 29; Estimated
p2- Holding time exceeded fallowing receipt by lab
B&Tao many colonies were present; too numerous to count (TNTG)
POI.- Practicat OuanVtaticn Limit -Subject to change due to instrument sensitivity
J2-Reported value Faded to meet CC criteria for either precision or accuracy; Estimated
J3-T)se sample mavix interfered with the ability to make any accurate determinatVon: Eslimaled U- Samples analyzed for this compound but not detected
.]G-The Is analysis was from an unpraserved or improperly chemically preserved sample; Estimated X1- Sample not analyzed for this compound
N1-The component has been tenlativeiy identified based on mass spectral library search and has an estimated valua
LAB
taboratory Sactlonat� 1623 Malt Service Center, Raleigh, NC 27699.1623 j919] 733-39t16 Page 1 of 2

Location 10: 5P068WI05002201N
WC (l)WQ La6oratory Section CJ?.gsufrs Sample ID AB51302
Collect Date: 11/03/2009
Loe. Descr.: 1811 VALLEY CREEK DRIVE Collect Time :: 11:15
Visit ID
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
Sample temperature at receipt by lab 1.7 ·c HPARKER SMATHIS
Method Reference 11/3109 11/5109
MET
7439-89-6 FebylCP 50 50 U Ug/L SGOSS EST AFFORD
Method Reference EPA200.7 11/10/09 11/1-8/09
7440-66-6 Zn bylCP 10 830 ug/L SGOSS ESTAFFORD
Method Reference EPA200.7 11/10/09 11/18/09
Laboratory Section» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone] Page 2of 2
North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
Location code [ rt7 IUI 0 ; tv0 :X A1j —2+7 SAMPLE TYPE SAMPLE PRIORITY
County dr ' Water 14 'Routine Lab Number f f Ab 51,3v �j
Quad No Serial No. S❑'I El Emergency T Date Received I -�� Time• 7J
Lat. Lang. El Other By: From:Bus
❑ Chain of Custody Other:_
Report 7a: ARO, FRO, MRO, RD WaRO, WiRD, G�� Data Entry BY: Ck:
WSRO, Kinston FO, Fed- Trust, Central Off„ Other. Date Reported:__
Shipped by: Sus. Courier, and De . Other. Purpose:
Collector(s}: c ¢ Data !I - - u Time ' 1 t P' Baseline, Complai Compliance LIST, Pesticide Study, Federal Trust, Other
FIELD ANALYSES owner e-- °r`1eone3
pH 40o a Spec. Cond.94_ R at 25GC Location or Site j j h Valel ��-� le i7
Temp.lo °C Odor �'J t9_J j e- ❑escripbon of sampling point — fir, ' .
Appearance f J ez r Sampling Method Sample interval rs ,
Field Analysis By: Z_ '7 '-6 ; L,r f
LABORATORY ANALYSES
E10D 310 rng1L
COD High 340 mg1L
COI) Low 335 mg1L
Coliform: MF Fecal 31616 1100ml
Colirorm: MF Total 31504 1100m1
TOG 684 m91L
'turbidity 76 NTU
Resldue, Total Suspended 530 mg1L
1
pH 403 , units
Alkalinity to pH 4.5 410 mg/L
Alkalinity to pH 6.3 416 m91L
Carbonate 445 mg/L
Bicarbonate 440 mg1L
Carbon dioxide 405 m91L
Chloride 940 mglL
Chromium: Hex 1032 ug/L
Color. True 80 Cu
Cyanide 720 mgiL
Lab
Diss. Solids 7030D mg1L
Fluoride 951 "401
Hardness: Total 900 rnA
Hardness (noracar6) 992 moo.
Phenols 32730 ugll
Specific Cond. 95 uMhos(crn
Sulfate 945 mg/L
Sulfide 745 rng1L
Oil and Grease mglL
NHa as N 610 mg/L
TKN as N 625 mg/L
ND� + NQ3 as N 630 mg/L
P: Total as P 665 mg/L
Nitrate (Nfl3 as H) 620 mg/L
Nitrite (NCB, as N) 615 mg/L
GW-64 REV. 7103 For Dissolved Analysis-submft filtered sample and write "DIS" In block.
Ag$gver 46586 u /L
AI-AEuminum 46557 LV
As -Arsenic 46551 WL
SaZarium 46558 u L
Ca -Calcium 46552 m 4_
Cd-Cadmlurn 46559 uqA.
Cr-Chromium 46559
Cu-Copper 46562 uglL
Fe -Iron 45563 tNIL
Hg•Meraury 719M ugIL
K-Potassium 46555 m
Mg -Magnesium 46554 m
Mn-Manganese 46565 L
Na-Sodium 46550
Ni-Nicket u 1L
Pb-Lead 46564
Se 5elernum /L
Zn Zinc 46567 U91
Gme, air temp., etc.]

' County.
ORANG
Sample 0Q
AB51303
River Basin
f ��k7�`�
PC Number#
9Gi251
��
~ ��
Report To
RROAP
Date Received:
1110212009
jr
Time Received.
12:45
Collector,
LL MCCAftjN§Y
D '<
Labwarks LoglrilD
HPARKER
Region:
RRO
Date Reported;
t2171a9
Sample Matrix:
GROUNDWATER
Lae. Type
EFFLt1Et}T
Report Generated'
17J07MO9
Emergency Yea/No
COC YeslNo
Visi1lD
Lac. Descr.: 11111 VALLEY CREEK l]RNE
Location IQ'
SP068MI3500220EFF
Collect Rate: 11I03)2009 Collect Time:: 11:45
Sample Qepth
Sample Qualifiers and Cammenis
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
91-Counisbte membranes with 417 colonies; Estimated
IY3-Estimated concentration is < PQL and �MDL
62- Counts from all tillers were zero_
NE -No established PQL
P-Elevated PQL due to matrix interference endlar sample dilution
B3- Countable membranes wish more than 60 or 80 colonies; Estimated
01-Hoiding tlrra exceeded prior to receipt at lab.
94-Filters have counts of both >60 or 86 and r 20; Estimated
Q2- Molding dme exceeded following receipt by lab
65-Too many Colonies were present, toe numerous to taunt ['f NTC)
PQL- Practical 0uantitation Limitaubjeet to change due to instrument sensitivity
J2- Reported value sailed to meet QC Criteria for either precision or accuracy; Estimated
5amplea analyzed for this compound but notdetected
J3-The sample matrix interfered with the ability to make any accurate determination; Estimatedl1-
7C1- Sam pie not analyzed for this Gmpourid
d6-The lab analysis was from an unpreserved or imprapedy chemically preserved sample; Estimated
N1-The component has been tentatively identified Rased on mass spectral librarysearch and has an estimated value
LAB
Laboratory Section» 1623 Mail Service Center, Raleigh, NO 21699.1623 1919) 733-3900 Page 1 02

" Location JD : SP068WI0500220EFF
¾C '1YWQ £a6oratory Section CJ?.gsu{ts Sample ID AB51303
Collect Date: 11/03/2009
-Loe. Descr.: 1811 VALLEY CREEK DRIVE Collect Time:: 11:45
Visit ID
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
Sample temperature at receipt by lab 1.7 °C HPARKER SMATHIS
Method Reference 11/3109 11/5/09
MET
7439-89-6 FebylCP 50 6 1 Ug/L SGOSS ESTAFFORD
Method Reference E?A200.7 11/10/09 11/18/09
7440-66-6 ZnbylCP 10 850 ug/L SGOSS ESTAFFORD
Method Reference E?A200.7 11110/09 11/18/09
Laboratory Section>> 1623 Mali Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of 2
North Carolina
I-GR.O'UNDWATER FIELD/LAB FORM DepartmentofEnAronmentartdNatural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
Location code J? C? 6 y _L21� �13 _,X4� SAMPLE TYPE A� MPLE FRIORITY r
County anr $4 Water ] Routine LabImber
Quad No Ij Serial No. ❑ Soil ❑ Emergency -2 pate Received I J _�i - Time:
Lat. Long. ❑ Other Rec'd By: From:Bus, Courier, and Del.,
❑ Chain of Custody Other:
Report To: ARO, FRO, MRO,9!Eg WaRO, WiRO, Data Entry By: Ck:
WSRO, Kinston FO, Fed. Trust, Central Off., Other: U e Date Reported:
Shipped by: Bus, Courier, hand Del., Other: Purposeiyj
Collector(S): I rl (:a,r Ih f( _ Date�� Time I ' 4 Baseline, Complain Cnm fiance LUST, Pesticide Study, Federal Trust, Other.
FIELD ANALYSES Owner r ,-, (ardevne)
pH 4oc 1.0 Spec. Cond.94 3,� _ �at 25°C Location t7r Site_1� j ll i��l Ile r-�� Dr.
Temp -,a �(d 5 �°C Odor ,��1�/a r� _ Description of sampling point U1,,y I� :.r•I — Tr�F1 it �. -17` -
Appearance r I eI a t�� Sampling Method w— Sample Interval ) 4 o r.,
Field Analysis sy: f. i44!'�•,��, �a.1 Remarks J,�,r•yr,.;l 1 �{ f .'e - -20 -,-
LABORATORY ANALYSES tPuiriping lime, air temp., etc.]
SOD 310 m1311.
COS] High 340 mglL
COD Low 335 mg1L
CcIform: MF Fecal31616 1100MI
Coltforn: MFTotal 31504 1100MI
TOC 680 mglt
Turbidity 76 NT1J
Residue, Total Suspended 530 mg/1_
PH 403 units
Alkalinity to pH 4.5 410 mgk
Alkalinity to pH 8.3 415 mglL
Carbonate 445 mg1L
Bicarbonate 440 mg1L
Carbon dioxide 405 mg1L
Chloride 940 mg1L
ChTomlum: Hex 1032 41L
Color: True 80 Cu
Cyanide 720 mg1L
Lab
hiss. Sands 70300 mg1L
Ag•SIIver 45566 u IL
Fluoride 951 mglL
Al-Alurninum 45557 u 1L
Hardness: Total 900 mg1L
As -Arsenic 46551 ugIL
Hardness (non-carh) 902 mglL
Sa-Barium 46558 IL
Phenols 32730 ugA
Ca -Calcium 46552 m 1L
Specific Cond. 95 pmhoslcm
Cd-Cadmium 46559 u
Sulfate 946 mglL
Cr-Chromium 46559 u 1L
Sulflde 745 mg1L
Cu-Copper 46562 1L
Fe -Iron 46563 L
Oil and Grease mg1L
Hg-Mercury 71900 u L
K-Potasslum 46555 m fL
Mg-Magneslum 46554 m 1L
MrrManganese 46565 ugtL
NH, as N 610 mg1L
Na-Sodium 46556 m IL
TKN as N 625 mglL
Ni-Nickel L
NDZ + NO$ as N 630 mglL
Ph -Lead 46564 uWL
P: Total as P 665 mg1L
Se -selenium ugIL
Nitrate (ND, as N) 820 moo-
Pn,7Jnc 485137 4L
Nitrite (NO2 as N) 615 mg1L
GW 54 REV. 7103 For DissolYed Analysis -submit filtered sampie and write 'DIS' in block.
Ofganochlorine Pesticides
O ano hos horus Pesticides
_Nitrogen Peskides
Acid Herbicides
PCBs
Sernlvolatile Or ank s
TPH-Diesel Raq2e
Volatile Oroanics VOA hvttie'
TPH-Gasoline Range
TPH-STEX Gasoline Range
LAB USE ON
Temperature on arrival (°C): r

Ro gers, Michael
From:
Sent:
To:
Subject:
Attachments:
Dear Michael,
Scott Dyreng [[e-mail]]
Wednesday, September 09, 2009 12:58 PM
Rogers, Michael
FW : Scott Dyreng 5A7 Permit Application
Dyreng 5A7 Application.pdf; DyrengWellPermit.PDF
I searched through the documents that I was given by the previous home-owner and came across the attached Well
Permit/Application form. I believe this is what you are after, although I can't see the form number. Please let me know
if this will work.
Regards,
Scott
From: Scott Dyreng
Sent: Tuesday, September 08, 2009 2:25 PM
To: [e-mail]
Subject: Scott Dyreng 5A7 Permit Application
Dear Michael,
Thank you for your help via the telephone earlier today. I have attached a completed Form SA7. As I mentioned on the
phone, there was a mis-communication between my contractor and I. The contract said that all permits were included.
I assumed this meant the SA7. He informed me that he had not filed this application and so I am making sure to send it
with all due haste. The geothermal system is currently functioning, but the return line to the well has not yet been
buried . It is on top of the lawn. Please let me know if you need additional information.
Regards,
Scott Dyreng
919-933-9667 h
919-660-8004 w
1
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: Se ptember 16, 2009
To: D Landon Davidson, ARO-APS
0 Art Barnhardt, FRO-APS
0 Andrew Pitner, MRO-APS
C8J Jay Zimmerman, RRO-APS
0 David May, W aRO-APS
0 Charlie Stehman, WiRO-APS
0 Sherri Knight, W-SRO-APS
From: Michael Ro gers Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Mail: Michael.Ro [e-mail]
A. Permit Number: WI 0500220
B. Owner: Scott Dvreng
C. Facility/Operation: ._· _.
D Proposed C8J Existing 0 Facility D Operation
D. Application:
1. Permit Type: D Animal O SFR-Surface Irrigation□ Reuse D H-R Infiltration
D Recycle O I/E Lagoon D GW Remediation (ND)
C8J UIC -SA 7 Geothermal well
For Residuals: □ Land App. 0 D&M
D 503 D 503 Exempt
D Surface Disposal
D Animal
2. Project_Type: C8J New D MajorMod. D Minor Mod. D Renewal D Renewal w/Mod.
E. Comments/Other Information: C8J I would like to accompany you on a site visit.
NOTE: This well is already being used as an injection well, but does not have a permit. I obtained a GW-1
from the driller but it is not signed. I will need to go out on the inspection w/your staff as they will probably
!!et a NOV for iniection w/out a permit. Also. FYI. the inspection mav show violations in well construction.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within, please take the following actions:
C8J Return a Completed APSARR Form and attach laboratory analytical results, if applicable.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
D Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: -------------------Date: _____ _
FORM: APSARR 07/06 Page 1 of 1
Beverly craves Perdue
Governor
Scott Dyreng
1811 Valley C=k Dr.
Hillsborough. NC 27278
HCDEHR
North Carolina Department of Environment and
Division of Water Quality
Coleen H. Sullins
Director
Subject: Acknowledgement of Application No. W10500220
Valley Creek 5A7
Injection Heating/Cooling Water Return Well (5A7)
Orange
Dear Mr. Dyneng:
Natural Resources
September 15, 2009
Dee Freeman
Se:rotary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on September 9, 2009. This application package has been assigned the number listed above and will be reviewed
by Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 - 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 now that the Division has reorganized. To
review our new organizational chart, go to httr://h2a.enr.state.nc.us/documents/dw(i Q=hart.odf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER '%VHFN MAKING INQUIRMS ON THIS PROJECT.
Sincer,y,
for Debra J.6atts
Supervisor
cc: Raleigh Regional Office, Aquifer Protection Section
Steve Bowman (Bowman Mechanical, 145 Technical Ct., Garner, NC 27529)
Permit Application File W10500220
AQUIFER. PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location, 272R Capital 5oulevrir;3, Raisaigh, North Carolina 27604
Phone: 9*73M2211 FAX 1:919-715-0588; FAX 2: 919-715-fiO4B 1 Gustoraer Service: 1.877-6Z-6748
Internet v wvw,ncwateraualikv.orn
One
North Carolina
An Eq.;al Opponun } l Afdrrn�L,ivra Ac: ran EmpKMr

NORTH CARDLINA k}o4vo5 UL%Q)�d 1Wi�d
4 03-
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A
WELL(S) FOR INJECTION WITH A HEAT PUMP SYSTEM
Type 5A7 and 5QM Wells
In Accordance with the provisions ofNCAC Title 15A: 02C.02110
Complete application and mail to address on the back page.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: 1 .lu1V , 2009
A. SYSTEM CLASSIFICATION Please check column which matches proposed system.
(1) X Type 5A7 wells inject water used to provide heating or cooling for structures.
(2) Type 5QM wells contain a subsurface system of continuous piping, that is
isolated from the environment and circulates a fluid other than potable water.
This includes systems that circulate additives such as antifreezes and/or corrosion
inhibitors.
(3) Type 5QW wells contain a subsurface system of continuous piping, that is
isolated from the environment and only circulates potable water. If you selected
this well type, then complete form GW-57. CL, Notification Of Intent To
Constract A Closed -Loop Geothermal -Water Only Injection Well System.
B. PERMIT APPLICANT
Name: Scott Dyrene
Address: 1811 Valley Creek Dr -
City: Hillsborough State: NC Zip Code: 27278 County: Orange
Telephone. [phone] lI �n �. l�C-�+-� — 1'4
C. PROPERTY OWNER (if different from applicant)
Name:
Address:
City:
Telephone:
D. STATUS OF APPLICANT
Private: X Federal:
State:
Sate
Municipal
Zip Code: County:
Commercial:
Native American Lands:
Revised 5105 GW/MC-57 HP Page 1 of 4

E. FACILITY (SITE) DATA
(Fill out ONLY if the Status of Owner is Federal, State, Municipal or Commercial).
Name of Business or Facility: ___________________ _
Address: ___________________________ _
City: _________ Zip Code: ____ County:
Telephone: __________ Contact Person: __________ _
F. HEAT PUMP CONTRACTOR DATA
Name: Bowman Mechanical
Address: 145 Technical Ct
City: Garner Zip Code: 27529 County: _W_a_k_e ____ _
Telephone: [phone] Contact Person: Steve Bowman
G. INJECTION PROCEDURE (Briefly describe how the injection well(s) will be used.)
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES X ----NO __ _
YES ~X~-NO ___ _
I. CONSTRUCTION DATA (check one)
X EXISTING WELL being proposed for use as an injection well. Provide the data in
(1) through (7) below to the best of your knowledge. Attach a copy of Form GW-
1 (Well Construction Record) if available.
PROPOSED WELL to be constructed for use as an injection well. Provide the
data in (1) through (7) below as PROPOSED construction specifications. Submit
Form GW -1 after construction.
(1) Well Drilling Contractor's Name: _H_ud_s_o_n_W_e_ll_D_n_._ll_in~g~----------
NC Contractor Certification number:
(2) Date to be constructed: 1-4-2000 Number of borings: ___ _
Approximate depth of each boring (feet): ________ _
(3) Well casing: Is the well(s) cased?
(a) YES X If yes, then provide the casing information below.
Type: Galvanized steel_K__ Black steel __ Plastic __ Other (specify)
Casing depth: From O to 63 ft. (reference to land surface)
Casing extends above ground _1_8 __ inches
(b) NO __
Revised 5/05 GW/UIC-57 HP
-------
Page 2 of4
( 4) Grout (material surrounding well casing and/or piping):
(a)
(b)
Grout type: Cement __ Bentonite Other (specify) ______ _
Grouted surface and grout depth (reference to land surface):
__ around closed loop piping; from ___ to ___ (feet).
__ around well casing; from __ to __ (feet).
(5) Screens (for Type 5A7 wells)
(a) Depth: From _O_ to ~ feet below ground surface.
(6) N.C. State Regulations (Title 15A NCAC 2C .0200) require the permittee to make provisions
for monitoring wellhead processes. A faucet on both influent (fluid entering heat pump) and
effluent (fluid being injected into the well) lines is required. Will there be a faucet on:
(a) the influent line? yes __ no__ (b) the effluent line? yes__x_ no __
(7) SOURCE WELL CONSTRUCTION INFORMATION (if different from injection well).
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-1 is not available,
provide the data in part K ( 1) of this application form to the best of your knowledge.
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
J . PROPOSED OPERATING DATA (for Type 5A7 wells)
(1) Injection rate: Average (daily) 8 oallons per minute (gpm).
(2) Injection Volume: Average (daily) 2,400 gallons per day (gpd).
(3) Injection Pressure: Average (daily) 30 pounds/square inch (psi).
(4) Injection Temperature: Average (January) 48 ___ ° F, Average (July)~° F.
K. INJECTION FLUID DATA
(1) Fluid source (for Type 5A7 wells) If underground, from what depth, formation and type of
rock/sediment unit will the fluid be drawn (e.g., granite, limestone, sand, etc.).
Depth: 300 Formation: granite pluton Rock/sediment unit: granite
(2) Chemical Analysis of Source Fluid (for Type 5QM wells)
Provide a complete listing of all chemicals added to the circulating heat transfer fluid:
L. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the injection equipment and exterior piping/tubing
associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
M. LOCATION OF WELL(S) Attach two maps.
Revised 5/05 GW/UIC-57 HP Page 3 of4
(1) include a site map (can be drawn) showing: buildings, property lines, surface water bodies,
potential sources of groundwater contamination and the orientation of and distances between
the proposed well(s) and any existing well(s) or waste disposal facilities such as septic tanks or
drain fields located within 1000 feet of the geothermal heat pump well system. Label all
features clearly and include a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
N. PERMIT LIST: Attach a list of all pen -nits or construction approvals that are related to the site.
Examples include:
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non -Discharge permits
(3) Sewage Treatment and disposal Permits
O. CERTIFICATION
"i hereby certify, under penalty of law, that I have personally examined and am familiar with the
information submitted in this document and all attachments thereto and that, based on my inquiry of
those individuals immediately responsible for obtaining said information, I believe that the
information is true, accurate and complete. I am aware that there are significant penalties, including
the possibility of fines and imprisonment, for submitting false information. I agree to construct,
operate, maintain, repair, and if applicable, abandon the injection well and all related appurtenances in
accordance with the approved specifications and conditions of the Permit."
(Signature of Well 1 •ner or Au rized Agent)
If authorized agent is acting an behalf of the well owner,
please supply a letter signed by the owner authorizing the above agent
P. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property
Tights in the well being constructed. A well is real property and its construction on land rests
ownership in the landowner in the absence of contrary agreement in writing.)
If the property is owned by someone other than the applicant, the property owner hereby consents to
allow the applicant to construct each injection well as outlined in this application and that it shall be
the responsibility of the applicant to ensure that the injection well(s) conforms to the Well
Construction Standards (Title 15A NCAC 2C .0200)
(Signature Of Property Owner If Different From Applicant)
Please return two copies of the completed Application package to:
UIC Program
Aquifer Protection Section
North Carolina DENR DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Reviscd 5105 GWIUIC-57 HP Page 4 of

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94/1712900 11, 03 SIS6443906 ORAMEE CO ENV HLTH PAGE 93
WELL PERMIT
& APPLICATION
AfH7RESS �%BG T 11�
PHONE NUMBER
DIRECTIONS I LC
FZ
Clrenge Counly HoWth Department
Emhcnrnurtal HaaMh D1vlyion
P.O. Box 8101, 3084 Revwe Road
Hllkbmw t6 NC 2rm
PRONE 7TIUlff1 967-0251 $36.733I W-2031
EXTENSION ZW FA]C p l l `
-MSL ! t7[
LOT SIZE =AFL SUBOi"SION! LOTO
Is TM. - WELL ❑ REPLAGEME Nt WELL © WELL AOAta=lWEnNY ❑ WELL LINER OPERMIT Re"AL
� E OR 0%U-gl TWS8I9MER (PLRAWQrrSo ,9El
F CC WASTEWA FMC SYSTEFA PUSuC SEV.FR OTHER
IF YOU HAVE AFRUFOUEO LOCATION FOR THE PROPOREG WEI,L PLEASE INDICATE BY SKETCKING A SITE PLAN ON THE BACK
SHOWING ANY LX19171NG STRVGTUF=. SEP`DG SYSTEMS, UNDERORpUN7 STORAGE TANKS M.
_ PAYMENT &FIST REIRCLNDM K M 7WS APPUCA77a7N TO CDMPLM'tHE S�ERWI;E&
aVE PE-T QIT FEE 3140.00
c�G— 7WEEOWnhV AND ANY PROIP450) PROPM YLIAMI CORNM dlrJST nE CLEARLY MARKED
�.�' 7'TI$ WEIJ, PERMriAI'fiST 8E IBSUF,D $E!"ORE CDN87lzUCFTON flPTTfE WELL BI=GINS
1U-- A HAIL CONSTRUCTION INSPECTION MUST BE CONPUCTM AND ±FIE WELL APPROVED iY 7NE oCNl7 BFFwm
PtACMFGViC WELL XTO USE.
I HAVE READ MSAPPLZAnON AND AITF1 MZC THE OCHD TO ENTER 71*- PROPERTYANG PERJWM TYE SEFMCEI4,EOt1MTSD.
OWh1E V TCNANT : ,e�, GATF
THIS PERMIT SHALL BE VALV FOR A AEMOD Of I YEAR FROM TfrDATE OF ISSUANCE
OTHER PERMJT CONOMONS
REFERVO THE ATTACFIED SITE PLAN SHOWING THEWELL ELL AND FACLOYLOCATTONS AND OTHER SKCIFICAVONS. THE WELL SHALL
BE LOCATED AND COFISTR MD EN AGCOROANCE WITH 4RANGE GGWNIY GRQUN0WATEfI RE8%&M . THE WELLCONTRACTOR
SMALL BE RWIST'EITED TO CONTlMCT WELLS IN ORMIll COUNTY. UNLESS QTHtRWISE SPECIFIED, THE FOLLOWING MINIMUM
SETBACK DISTANCES SHALL OF MAINTAINED:
SEPTIC SVST'EM 108FT
BUILDING FOUNDATIONt. WATER-nGHT SEWER LINF'S, OR OTHER SOURCES OF CONTAWMATION OFT
PROPI K" LINES 46Fr
THE WELL VIE MKWATED IS ILAS'W ON SETBACK OTSTANG0 FROM KNOWN FF ATURES AND DOES NOT INDICATE NOR GUARANTEE
THAT ANY QUAHT(p OR QUALM QrF�wgrFiFe Wrs6 BE F'FiDVFDED BY THE WELL
DEPTH CASING DF- 1,3 . STATIC WATER
YIELDS Z ,WATEq ` -- rr TY+x
WELLDRILiEWCOMTRACTOR A �»3.J ,11 O. '
y—Y -fo_
DATE HEALTH S 1 ST
OCHD 07108

�04/11 ;2008 1103, 9195443906
pRq�iC,E Co E114 IILTH
w� S,
PAGE 04 _
r
_� L�Rht1A�t
��z

Page 1 of 1
I This Pa ge Printed Wednesda t , Se Qtember 16, 2009 1 :53 Qm I
Parcels Current Thru August 4, 2009. Owner Information Current
Thru Au g ust 26, 2009
!SUMMARY INFORMATION I
PIN 19862231960 lrTMBL 7.11 .. 42
Owner IDYRENG SCOTT D IDeed
Ref. 1980/370
10wner2 I& CHELSEA B Deed 06/06/2008 Date
Mailing Addr. 1811 VALLEY CREEK DR Rate 10 Code
c·t st I z· IHILLSBOROUGH, NC, 1 Y, a e, ip 27278 :stam ps
IRev 670.00
!V aluation 11$298215 lirract# 760585
Legal Desc. ~~f ~5s2 PH D NEW HOPE IILot Size If 0.92
I
Legal Desc.
,IP83/104 I 2
http://gis.co.orange.nc.us/W ebsiteN ouCountGIS/asp/dataprintpage.asp?Summary=on&pin... 9/16/2009
Orange County, North Carolina - Address Inquiry
Y
Page 1 of i
j
0R ANGE i.OITNT7" 1 NO RTI1 G-%R01INA
Address Record for PIN 9862231960
For questions about 2009 property values, please go to the Revaluation
Pag.f-!.
Property Summary Pane
GIS Map
2009 Property Values
2009 Total Market Value: $298215
2009 Total Use Value: $0
TMBL
7.11-42
Street Address
1811 VALLEY
CREEK ❑R
Place
NEW HOPE
SPRINGS
Building/Unit
Number
Zip Code
27278
Township
7 - Chapel Hill
Address
Jurisdiction
OC
Lot
45
Address Status
Tax Rate
Code
10 - County Tax + Orange Grove Fire Tax
Current
Owner
DYRENG SCOTT D
Comments
bttp:Hserver2.co.orange.nc.us/Addresses/AddTessDetail.asp?AddrID=1139 9/16/2009

You Count In Orange County
Page 1 of 2
Orange County N.C. CIS Ma
1 [
+ 3
This map contains parcels prepared for the inventory of real property within orange County,
and is compiled from recorded deeds, plats, and other public records and data. Users of
his map are hereby notified that the aforementioned public primary information sources
should be consulted for verification of the information contained on this map. The county
and its mapping companies assume no legal responsibility for the information contained on
his map.
This Page Printed Wednesday, September 16, 2009 1:53 pm
Parcels Current Thru 81412009. Owner Information Current Thru
8/26/2009
Parcel Identification Number: 9862231960
r Summary r- Building rr Land r Documents T- Prior Owners
http:llgis, co. orange.ne,uslservletleom, esri. esrimap. Esrimap?S erviceh ame=YouCountGIS... 911 G12009

You Count In Orange County Page 2 of2
Create Print Data Page
http://gis.co.orange.nc.us/scrvlet/com.esri.esrimap.Esrimap?ServiceName=YouCountGIS... 9/16/2009