WI0500271_GEOTHERMAL_20200430

*G"
L. North Carolina Department of Environmental Qualit
y ty —Division of Water Resources
PQ
Q.ok
Ge
'LICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELL(S)
In Accordance With the Provisions of 15A NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELL(S)
These well(s) inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
CHECK ONE OF THE FOLLOWING:
New Application y Renewal* Modification Permit Rescission Request*
*For Permit Renewals or Rescission Request, complete Sections A thru E. and M (signature page) only
Print or TypepInformation and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: Iq F r;\ Z-3 , 20 Z(U PERMIT NO. WI OSOo 2? i (leave blank if New Application)
A. CURRENT WELL USE & OWNERSHIP STATUS (Leave Blank if New Well/Permit Application)
1. Current Use of Well
a. I wish to continueto use the well as [ Geothermal Well ❑ Drinking Water Supply Well
❑ Other Water Supply Use- Indicate use (i.e., irrigation, etc.)
b. Terminate Use: If the well is no longer being used as a geothermal injection well and you wish to
rescind the permit, check the box below. If abandoned, attach a copy of the Well Abandonment
Record (GW-30).
❑ Yes, I wish to rescind the permit
2. Current Ownership Status
Has there been a change of ownership since permit last issued? ❑ YES NO
If yes, indicate New Owner's contact information:
Name(s)
Mailing Address:
City: _ State: Zip Code: County:
Day Tele No.: Email Address.:
B. STATUS OF APPLICANT (choose one) /
Non -Government: Individual Residence ✓ Business/Organization
Government: State Municipal County Federal
C. WELL OWNER(S)/PERMIT APPLICANT - For single family residences, list all persons listed on the
property deed. For all others, list name of business/agency and name of person and title with delegated authority
to sign: kg,. c,r.ci SI►utib,,,. /t Fi'
Y _
Mailing Address:.3 )I i' c2v4.1 ,41 eaLi br. (C
City: J Il s t)er,t, I, State: iv( Zip Code: V17 b' County: Or4,,,
Day Tele No.: I t —ZZot .-4q0 Z. Ce11 No.: q 19 Z&S-N419,1 _
EMAIL Address:grvS 2.2_z C qot , [G;,,' Fax No.:
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 1

D. WELL OPERATOR (if different from well owner) — For single family residences, list all persons listed on
the property deed. For all others, list name business/agency and name of person and title with delegated authority
to sign: A/IA
Mailing Address:
City: State: Zip Code: County:
Day Tele No.: Email Address.:
E. PHYSICAL LOCATION OF WELL(S) SITE
(1) Parcel Identification Number (PIN) of well site: q g 17
(2) Physical Address (if different than mailing address): (Same')
County: Ofelle
City: County Zip Code:
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name:
NC Well Drilling Contractor Certification No.:
Company Name:
Contact Person: EMAIL Address:
Address:
City: Zip Code: State: County:
Office Tele No.: Cell No.: Fax No.:
G. HVAC CONTRACTOR INFORMATION (if different than driller)
HVAC Contractor's Name:
NC HVAC Contractor License No.:
Company Name:
Contact Person: EMAIL Address:
Address:
City: Zip Code: State: County:
Office Tele No.: Cell No.: Fax No.:
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES NO
(2) Personal consumption? YES NO
I. WELL CONSTRUCTION REQUIREMENTS — As specified in 15A NCAC 02C .0224(d]:
(1)
(2)
The water supply well shall be constructed in accordance with the water supply well requirements of
15A NCAC 02C .0107.
If a separate well is used to inject the heat pump effluent, then the injection well shall be constructed
in accordance with the water supply well requirements of 15A NCAC 02C .0107, except that:
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 2

(3)
(a) For screen and gravel -packed wells, the entire length of casing shall be grouted from the top
of the gravel pack to land surface;
(b) For open-end wells without screen, the casing shall be grouted from the bottom of the casing
to land surface.
A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
*EXISTING WELLS PROPOSED WELLS
*For existing wells, please attach a copy of the Well Construction Record (Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
(c) Casing depth below land surface
(d) Casing height "stickup" above land surface
(e) Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited for sealing water -bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .01070(8)
(g)
Length of well screen or open borehole and depth below land surface
Length of sand or gravel packing around well screen and depth below land surface
K. OPERATING DATA
(1) Injection Rate: Average (daily) gallons per minute (gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average (daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) ° F.
L. SITE MAP — As specified in 15A NCAC 02C .0224(b)(4), attach a site -specific map that is scaled or otherwise
accurately indicates distances and orientations of the specified features from the injection well(s). The site map shall
include the following:
(1) All water supply wells, surface water bodies, and septic systems including drainfield, waste
application area, and repair area located within 250 feet of the injection well(s).
(2) Any other potential sources of contamination listed in 15A NCAC 02C .0107(a)(2) located within 250
feet of the proposed injection well(s).
(3) Property boundaries located within 250 feet of the parcel on which the proposed injection well(s) are
to be located.
(4) An arrow orienting the site to one of the cardinal directions (north, south, west, or east)
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 3

NOTE: In most cases an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand. Also, a `layer' can be selected showing topographic contours or elevation
data
M. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .0211(e) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer
or ranking publicly elected official;
4. for all others: by all the persons j listed on the property deed.
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of the
Permit."
Signature of roperty Owner/Applicant
ICON A !N
Print or Typb Full Name and Title
Signature of Property Ow"ned'Applicant
Print or Type Full Name and Title
Signature of Authorized Agent, if any
Print or Type Full Name and Title
Submit two copies of the completed application package to:
Division of Water Resources - UIC
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 4

APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELL(S)
In Accordance With the Provisions of 15A NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELL(S)
These well(s) inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
CHECK ONE OF THE FOLLOWING:
New Application X Renewal* Modification Permit Rescission Request*
*For Permit Renewals or Rescission Request, complete Sections A thru E. and M (signature page) only
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: A r ; ;I 7.3
20 1? PERMIT NO. W IOS€o 2..7 I (leave blank if New Application)
A. CURRENT WELL USE & OWNERSHIP STATUS (Leave Blank if New Well/Permit Application)
1. Current Use of Well
a. I wish to continue to use the well as Ef Geothermal Well ❑ Drinking Water Supply Well
❑ Other Water Supply Use- Indicate use (i.e., irrigation, etc.)
b. Terminate Use: If the well is no longer being used as a geothermal injection well and you wish to
rescind the permit, check the box below. If abandoned, attach a copy of the Well Abandonment
Record (GW-30).
0 Yes, I wish to rescind the permit
2. Current Ownership Status
Has there been a change of ownership since permit last issued? 0 YES LINO
If yes, indicate New Owner's contact information:
Name(s)
Mailing Address:
City: _ _ State: Zip Code: County:
Day Tele No.: Email Address.:
B. STATUS OF APPLICANT (choose one)
Non -Government: Individual Residence / Business/Organization
Government: State Municipal County Federal
C. WELL OWNER(S)/PERM1T APPLICANT — For single family residences, list all persons listed on the
property deed. For all others, list name of business/agency and name of person and title with delegated authority
to sign: ku u ettiii Sit/Am./pod I ,Fi'
Mailing Address: I, )1 ff 49.2,r4,1 M ra[�r.•v D r; r�
City: H iiti3 befrviyh State: /Vs; Zip Code: 1.17 {! County: Orioif
Day Tele No.: q 14 -Zoe, .-4q4 Z Ce11 No.: 419 - Z65--1010
EMAIL Address: & /vS Z2Z , Cann Fax No.:
Geothermal Water Retum Well Permit Application Rev. 4-15-2016 Page 1

D. WELL OPERATOR (if different from well owner) — For single family residences, list all persons listed on
the property deed. For all others, list name business/agency and name of person and title with delegated authority
to sign: &// 4
Mailing Address:
City: State: Zip Code: County:
Day Tele No.: _ Email Address..
E. PHYSICAL LOCATION OF WELL(S) SITE
(1) Parcel Identification Number (PIN) of well site: Qg LI !S9 % County: &m
(2) Physical Address (if different than mailing address): (Sipple)
City:
County Zip Code:
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name:
NC Well Drilling Contractor Certification No.:
Company Name:_
Contact Person: EMAIL Address:
Address:
City: Zip Code: State: County:
Office Tele No.:
Ce11 No.: Fax No.:
G. HVAC CONTRACTOR INFORMATION (if different than driller)
HVAC Contractor's Name:
NC HVAC Contractor License No.:
Company Name:
Contact Person: _ _ _ EMAIL Address:
Address:
City: Zip Code: State: County:
Office Tele No.: Cell No.: Fax No.:
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES NO
(2) Personal consumption? YES NO
L 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:
gitgliwaNINEttosrlIalumA1141101tumittAtmniamticalleam.44155460

(3)
(a) For screen and gravel -packed wells, the entire length of casing shall be grouted from the top
of the gravel pack to land surface;
(b) For open-end wells without screen, the casing shall be grouted from the bottom of the casing
to land surface.
A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
*EXISTING WELLS PROPOSED WELLS
*For existing wells, please attach a copy of the Well Construction Record (Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
(c) Casing depth below land surface
(d) Casing height "stickup" above land surface
(e) Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited for sealing water -bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .01070(8)
(f)
(g)
K. OPERATING DATA
Length of well screen or open borehole and depth below land surface
Length of sand or gravel packing around well screen and depth below land surface
(1) Injection Rate: Average (daily) gallons per minute (gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average (daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) ° F.
L. SITE MAP —As specified in l 5A NCAC 02C .0224111) 41, attach a site -specific map that is scaled or otherwise
accurately indicates distances and orientations of the specified features from the injection well(s). The site map shall
include the following:
(1) All water supply wells, surface water bodies, and septic systems including drainfield, waste
application area, and repair area located within 250 feet of the injection well(s).
(2) Any other potential sources of contamination listed in 15A NCAC 02C .0107( ak 20 located within 250
feet of the proposed injection well(s).
(3) Property boundaries located within 250 feet of the parcel on which the proposed injection well(s) are
to be located.
(4) An arrow orienting the site to one of the cardinal directions (north, south, west, or east)
Geothermal Water Return Well Permit Application Rev. 4-15-2016
Page 3

NOTE: In most cases an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county CIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand Also, a layer' can be selected showing topographic contours or elevation
data
M. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .0211(e) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer,
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer
or ranking publicly elected official;
4. for all others: by all the person(s) listed on the property deed.
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am feuniliar 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 offroperty Owner/Applicant
ICor kv (iu
Print or Typ Full Name and Title
•
Signature of Property Applicant
Print or Type Full Name and Title
Signature of Authorized Agent, if any
Print or Type Full Name and Title
Submit two copies of the completed application package to:
Division of Water Resources - UIC
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 4

ROY COOPER
Governor
MICHAELS. REGAN
Secretary
S. DANIEL SMITH NORTH CAROLINA
Environmental Quality Director
Ronald & Shannon Ryen
3718 Quail Meadow Drive
Hillsborough, NC 27278
April30,2020
RE: Acknowledgement of Application No. WI0500271
Geothermal Heating/Cooling Water Return Well
Orange County
Dear Mr. & Mrs. Ryen:
The Water Quality Regional Operations Section (WQROS) acknowledges receipt
of your permit application and supporting documentation received on April 29, 2020. Your
application package has been assigned the number listed above, and the primary reviewer
is Shristi Shrestha
Central and Raleigh Regional Office staff will perform a detailed review of the
provided application, and may contact you with a request for additional information. To
ensure maximum efficiency in processing permit applications, the Water Quality Regional
Operations Section (WQROS) requests your assistance in providing a timely and complete
response to any additional information requests.
Please note that processing standard review permit applications may take as long
as 60 to 90 days after receipt of a complete application. If you have any questions, please
contact Shristi Shrestha at 919-707-3662 or email at [e-mail].
cc: Raleigh Regional Office, WQROS
Permit File WI0500271
Sincerely,
For Rick Bolich, Chief
Ground Water Resources Section,
NCDEQ Division of Water Resources
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street I 1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919.707.9000
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Direrlor
NORTH CAROLIN
Environmental Quality
April 16, 2020
CERTIFIED MAIL # 7009 2250 0000 8087 1573
RETURN RECEIPT REQUESTED
Ronald & Shannon Ryen
3718 Quail Meadow Dr.
Hillsborough NC 27278
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No. WI0500271
Orange County
Dear Mr. & Mrs. Ryen:
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above -referenced operating permit for the
geothermal injection well system located on your property at the above referenced address was
issued on March 23, 2015, and expires on May 31, 2020. Per permit conditions and requirements
per 15A NCAC 2C .0224(c), the renewal application must be submitted at least 120 calendar days
prior to expiration of the permit if you wish to continue operating the injection well on your
property.
If Your Geothermal Water Return Well is Still Currently Being Used for Injection:
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit the enclosed renewal
application (Application for a Permit to Construct or Operate Injection Wells — Geothermal
Heating/Cooling Water Return Wells). The form is also available on-line at our website
http ://portal. ncdenr.orgLweb/wq/aps/gwpro/permit-applications.
If Your Geothermal Water Return Well is NO LONGER Being Used for Injection:
If the well is no longer being used for injection, you do not have to renew your permit. Check the
box in Part A of the attached renewal application that you wish to rescind the permit and indicate
the current status of the well (i.e., used as water supply well, irrigation well, inactive, plugged and
abandoned, etc.). If it is no longer being used for any purpose, it must be permanently abandoned
according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C,
Section .0240. When the well is plugged and abandoned, a well abandonment record (Form GW-
30) must be submitted to our office to certify that the abandonment was properly conducted.
GDE
North Carolina !Department of Environmental Quality Division of WalUr kesaurnes
S12 North Salisbury Street 1 1636 Mil Service Center 1 Raleigh North Carolina 27699-4.36
119.707.9000

If There has been a Change of Ownership of the Propert►
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change" Form must also be submitted in addition to the renewal application.
This form is not enclosed but can be found at the website listed above. Please submit the applicable
forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms 30 days before the expiration of the permit 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 shristi.shrestha'uncdenr.gov.
Regards,
Shristi Shrestha
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: Raleigh- Regional Office — WQROS w/o enclosures
Central Files - Permit No. W10500271 w/o enclosures

NCDENR
North Carolina Department of Environment and Natural Resources
Pet Mcr v+, r
Governor
Ronald & Shannon Ryen
3718 Quail Meadow Dr.
Hillsborough NC 27278
Dear Mr. and Mrs. Ryen,
April 24, 2015
Mnald R. van der 11aart
Secretary
RECEIVEDIDENRIDWR
APR 2 9 Z?i15
Wafer Quality Regional
Operations 5eiar1
Subject: Permit No.WI0500271
Ronald & Shannon Ryen SFR
Geothermal Heating/Cooling Water Return Well
Orange County
On March 16, 2015, staff of the NC Division of Water Quality, Aquifer Protection Section inspected and
sampled the well for the above facility, in support of permit renewal every five years. We wish to thank
Mr. Ronald Ryen who was present and assisted during the inspection.
On the date of the inspection the wellhead appeared to be well maintained. The water samples have been
analyzed and are attached (samples AC17567 and 17568). These were compared to 15A NCAC 2L
groundwater standards, each other (entry water vs. exit water), and to sample results from 2010.
All parameters analyzed comply with 2L Groundwater Standards and are not even close to exceedance
levels. I neglected to request two parameters, iron and copper but will see if those results are available
from the lab. Iron was at non -detect levels in 2010, and copper was not run at that time either.
The signatures of water entering and leaving your geothermal system are very close and not of concern to
DWR.
There was not much change from 2010 to 2015. Two metals, manganese and zinc were a bit high in 2010
but tested considerably lower in 2015, which is good. Entry and exit numbers below were averaged for
each year, since they were similar.
Parameter Standard 2010 2015 Unit of measure
Manganese (Mn) 50 48 12 ug/L
Zinc (Zn) 1000 715 245 ug/L
PQL numbers are the minimum amounts detectable by the lab. Any result marked by a "U" means it was
at or below detection levels. The unit of measure "mg/1" means milligrams per liter or part per million;
ug/1 means micrograms per liter or parts per billion.
Division of Wetter Resources, Raleigh Regional Office, Water Quality Operations Section
1628 Mail Service Center, Raleigh, NC 27699-1628 Phone: [phone] Fax [phone]
Location: 3800 Barrett Drive, Raleigh, NC 27609 http://portai.ncdenr.org/web/wglregional-oificcslraleigh
An Equal Opportunity 1 Affirmative Action Employer — Made in part by recycled paper

Mr. & Mrs. Ryen, WI050027 l
04 /24 /2015
Page2
Due to good results, these numbers are not being submitted to the Department of Health. However, if you
are using this well for drinking water, it is a good idea to get it tested periodically by your county health
department. Their charges are very reasonable for the work they do.
If you have any questions please feel free to contact me via email at [e-mail] or at
[phone].
Attachment
Sincerely,
~~
J~n Schneier
Environmental Specialist
cc: Raleigh Regional Office, Water Quality Regional Operations Section Files
Mike Rogers, Central Office
.
AC17567 :NC (JJ'WCJ{, Water Sciences Section-Cliemistrv £a6oratorv CR,gsufts
County: ORANGE Sample ID: AC17567
River Basin DWR PO Number# 15G0077
Report To RRO Date Received: 03/16/2015
Collector: J SCHNEIER
Time Received: 15:20
Region: RRO
Labworks Login ID TASCENZO1
Division of Wa.ter Resources Final Report Date: 4/2/15 Sample Matrix: GROUNDWATER
Final Re port Report Print Date: 04/02/2015 Loe. Type: WATER SUPPLY
Emergency Yes/No VisitlD
COC Yes/No
Loe. Descr.: RONALD RYEN
I Location ID: 5P068WI0500271-INF J Collect Date: 03/16/2015 I Collect Time: 13:30 I Sample Depth I
If this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
GAS#
LAB
WET
7439-97-6
NUT
MET
7429-90-5
7440-38-2
7440-70-2
7440-43-9
7440-47-3
7439-95-4
7439-96-5
7440-23-5
7440-02-0
7439-92-1
7440-66-6
Anal yt e Name PQL Result/ Units Method Analysis
Qualifier Reference Date
Sample temperature at receipt by lab 3.9 ·c 3/16/15
Ion Chromatography TITLE_ mg/L EPA 300.0 rev2.1 3/17/15 -
Fluoride 0.4 0.4U mg/L EPA 300.0 rev2.1 3/17/15
Chloride 1.0 3.8 mg/L EPA 300.0 rev2.1 3/17/15
Bromide 0.4 0.4U mg/L EPA 300.0 rev2.1 3/17/15
Sulfate 2.0 4.9 mg/L EPA 300.0 rev2.1 3/17/15
NO2+NO3 as N in liquid 0.02 0.06 mg/Las N EPA 353.2 REV 2 3/18/15
Al by ICP 50 sou ug/L EPA200.7 3/18/15
As by ICPMS 2.0 2.0 U ug/L EPA200.8 3/19/15
Ca by ICP 0.10 41 mg/L EPA200.7 3/18/15
Cd by ICPMS 0.50 0.50 U ug/L EPA200.8 3/19/15
Cr by ICPMS 10 10 U ug/L EPA200.8 3/19/15
Mg by ICP 0.10 9.1 mg/L EPA200.7 3/18/15
Mn by ICP 10 12 ug/L EPA200.7 3/18/15
Na by ICP 0.10 16 mg/L EPA200.7 3/18/15
Ni by ICPMS 2.0 4.2 ug/L EPA200.8 3/19/15
Pb by ICPMS 2.0 2.0 U ug/L EPA200.8 3/19/15
Zn by ICPMS 10 230 ug/L EPA200.8 3/19/15
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed descriotion of the oualifier codes refer lo <htto:/ /nortal.ncdenr .onz./web/wa/ ons/methods-and-oals>
Page 1 of 1
Validated by
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ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
l< 0a 77
AQUIFER PROTECTION FIELD SHEET
Location codeg P06/9 w to o Q7 - 1:41l‘'
County O�
Quad No Serial No.
Lat. Long.
Report To: ARO, FRO, MROSEDWaRO, WiRO,
WSRO, Kinston FO, Fed. Tnt Central Ott, Other
Shipped by: Bus, Courier, 1:&-dDelj, Other.
Collector(s): tSchfie; er
FIELD ANALYSES
PH aw—i. Spec. Cot d.aa aq7 at 25 C
Temp.to OLD
Appearance NAY" -
Field Analyses By: -3- f
North Carolina
Department of Envirotunent and Natural Resources
owls ION OF WATER RESOURCES -AQUIFER PROTECTION SECTION
SAMPLE TYPE
ist Water
❑ Soil
0 Other
❑ Chairs of Custody
SAMPLE PRSORITY
Rouline
0 Emergency
LABORATORY ANALYSES
13013 310-
umJIL
COD High 340
COD Lem 335
weL
Coli1bna MF Face 31616
II00ml
Calrorm: NSF Toed 31504
n 00m1
TDC 680
ire -
Turbidity 76
NW
Residue. Tone Suspended 530
mg/L
pH 403
Wait*
Alkalinity to pH 4S 410
mglt.
Alkalinity to pH S 3 415
mgit
Carbonate 445
eng1L
Bicarbonale 440
mg/L
Catboat dioxide 405
mg/L
..)4;
Clakuide 940
ms t-
Chramiva4 Hec1032
tiJL
Colot;Tree 80
CU
Cyanidc720
nlii.
Lab Comments
°c Odor no-e-
Date
Lab Number
Date Received 3— /c at c—
Rec'd By:.��
Other.
Time: 6 G1)
From:Bus, Courier, Hand Del.,
Data Entry By: Ck
Date Reported:
Purpose:
p„I 16 W015 Time Q 13 e O Baseline, Complaint, omplian LU�Pesticide Study, Federal Trust, Outer:
reel
Owner (YOl Ryya°
Location orSite_l�3 ojPteedrfi-; vs 620 W -M7g
Description ion of sam ling
Sampling Method
Remarks
Dim. Solids 70300
mg/L
Fluoride 95l
en el.
Hardness: Total 900
iiardacss(nc -earb) 902
Phenols 32730
Specific Cond 95
µMbonrun
Siasic 945
met
Sulfide 745
mg)L
Oil and Qreaae
NH1. a N610
my1L
TS:14 as N 625
NO1+ NO1 as N 630
P_ Total as P 665
mg/L
Mimic (l4Oj as N) 620
mall
Nitrite(Ndses N)615
Ag•Stiva 46566
Al•Almt iawn 46557
uFIL
aIJL
A, M cnic 46551
ea-BarWm 46$5s
Le-
){ Ca-Calcium46552
y Cd-Cadmium 46559
X Cr-Cbmminm 46559
Cu-Copper46562
ugIL
urJL
uglL
*")[ Po-bon46563
uc/L
lag -Mercury 71900
u&L
K•Potassium 46555
X g-ldagncsium 46554
K M -Manganese 46565
j[ Na-Sodium46556
)444k,ke
.Pb-Lead 46564
Se -Selenium
)Zn•Zine 46567
ng[L
van-
up/L
Sample Interval
time
8rgar✓icblan,ur Pessicidca
OrgarwPbospburm Pesticides
Nitrogen Pesticides
Acid Herbicides
PCHs
Semi volatile Orrnnies
-MB-Diesel Range
Vafalik Organics (VOA bottkl
TPH-Oesotinc Raw
TPH-BTE7C GISOLIIC Rannc
LAB USE ONLY
Temperature on arrival ['Cy
39
GW-54 REV_ ]tft013
Fa Dissdlvcd Aralysessabmit filtered sample and write "D15" in block
1

• 'AC17568 :NC <1YW'1{, Water Sciences Section-Cliemistry La6oratory ~su[ts
County:
River Basin
Report To
ORANGE
RRO
Collector: J SCHNEIER
Region: RRO
Sample Matrix: GROUNDWATER
Loe. Type: WATER SUPPLY
Emergency Yes/No
COC Yes/No
I Location ID: 5P068WI0500271-EFF
DWR
Division of Water Resources
Final Report
VisitlD
Loe. Descr.: RONALD RYEN
[ Collect Date: 03/16/2015
Sample ID:
PO Number#
Date Received:
Time Received:
Labworks Login ID
Final Report Date:
Report Print Date:
I Collect Time: 13:45
AC17568
1500078
03/16/2015
15:20
TASCENZO1
4/2/15
04/02/2015
l Sample Depth I
If this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
CAS#
LAB
WET
NUT
MET
Analyte Name
Sample temperature at receipt by lab
Ion Chromatography
Fluoride
Chloride
Bromide
Sulfate
N02+N03 as N in liquid
7429-90-5 Al by ICP
7440-38-2 As by furnace
7440-70-2 Ca by ICP
7440-43-9 Cd by ICPMS
7440-47-3 Cr by ICPMS
7439-95-4 Mg by ICP
7439-96-5 Mn by ICP
7440-23-5 Na by ICP
7440-02-0 Ni by ICPMS
7439-92-1 Pb by ICPMS
7440-66-6 Zn by ICPMS
0.4
1.0
0.4
2.0
0.02
50
2.0
0.10
0.50
10
0.10
10
0.10
2.0
2.0
10
Result/
Qualifier
3.9
_TITLE_
0.4U
3.8
0.4U
4.9
0.06
.SOU
2.0 U
41
0.50 U
10 U
9.3
12
16
4.7
5.7
260
Units
·c
mg/L
mg/L
mg/L
mg/L
mg/L
mg/Las N
ug/L
ug/L
mg/L
ug/L
ug/L
mg/L
ug/L
mg/L
ug/L
ug/L
ug/L
Method
Reference
EPA 300.0 rev2.1
EPA 300.0 rev2.1
EPA 300.0 rev2.1
EPA 300.0 rev2.1
EPA 300.0 rev2.1
Analysis Validated by
Date
3/16/15 RBYRD
3/17/15 CGREEN
3/17/15 CGREEN
3/17/15 CGREEN
3/17/15 CGREEN
3/17/15 CGREEN
EPA 353.2 REV 2 3/18/15 CGREEN
EPA200.7 3/18/15 ESTAFFORD1
EPA200.9 3/20/15 ESTAFFORD1
EPA200.7 3/18/15 ESTAFFORD1
EPA200.8 3/19/15 ESTAFFORD1
EPA200.8 3/19/15 ESTAFFORD1
EPA200.7 3/18/15 ESTAFFORD1
EPA200.7 3/18/15 ESTAFFORD1
EPA200.7 3/18/15 ESTAFFORD1
EPA200.8 3/19/15 ESTAFFORD1
EPA200.8 3/19/15 ESTAFFORD1
EPA200.8 3/19/15 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed descriotion of the oualifier codes refer to <htto ://oortal.ncdenr.orn/web/wa/oos/methods-and-oals>
Page 1 of 1
/SSG` o0 76P
AQUIFER PROTECTION FIELDSHEET
Luca lion codes PODS VIXt0'dj 00 W? f ^ Of
County
Quad No Serial No_
Lat. Long.
Report To: ARO, FRO, MRO,)WaRO, WiRO,
WSRO, Kinston FO, Fed. Tru Central Off, Other:
Shipped by: Bus, Courier, d ❑e , Other:
Collector(s): t�c of
FIELD ANALYSES
pH aw * LH
Spec. Candy, 3 00
Temp. tq i (1 "C Odor Ole_
Appearance_CAppy
Field Analysis By: T. Scht j�?/'
LABORATORY ANALYSES
BOD 310
mg/L
COD High 340
mglL
COD Law 335
mg/L
Coliforrn; MF Fecal31616
/100m!
Califrrue MF Total31.504
1100rn1
IOC 600
mzJL
Tluhidity 76
Nail
Residue, Total Suspended 530
rngJL
—
pH 403
units
Alkalinity to pH 43 410
min -
Alkalinity to pH 0..3 05
man -
Carbonate 445
mgll.
Bicardurate 440
mglL
Carbon dioxide 405
mg1L
Chloride 946
me,
Chromium: Hen 1032
ugll.
Color: True BO
CU
Cyanide 720
rgJI,
Lab Comments
SAMPLE TYPE
Er Water
❑ Soil
❑ Other
0 Chain of Custody
SAMPLE PRIORJTY
a- Routine
0 Emergency
Purpose:
Date 63)151 og01S Time , Baseline, Complaint,
Owner 1m e
at 25°C Location or Site 'NV
Description of sam . ling point
Sampling Method
�
Remarks
Deb Solids 70300
mg1L
Fluoride 951
mg/L
Hardness: Total900
mglL
Hardness (noncarb) 902
mg/L
Phenols 32730
ugh
Spec i&e Cord- 95
pint koshers
Sulfate 945
mg/L
Svlidr 745
mglL
Oil and Grease
mgAL
NU, as N 610
sngIL
TKN as N 625
niglL
%
NOr + NOr as N 630
mg/L
Y_Tcta1 m P 665
mgll-
Nitnflc (Nods N) 620
mg/L
Nitrite (1402 as N) 615
mg/L
North Carolina
Department of Environmcet and Natural Resources
DIVISION OF WATER RESOURCES-AQUIFF�L PROTECTION SECTION
Lab Number V /'7
gi
Date Received g Time: 1. t
Rec'd By: -- From:Bus, Courier, Hand Del„
Other
Data Entry By: _ Ck:
Date Reported:
LUST Pesticide Study, Federal Trust, Other:
Idrei'e anal
. felt/Alt—
(Pumping lime, of temp., ale.)
AgSilver 46566
uC1 L
%
Al-Ahrminum 46557
wt.
As -Arsenic 4655I
'C__,
Bo-aariam 4655E
VI -
Ca -Calcium 46552
ry_
C jm46559
uF/L
X
Cr-Chrottuam 46559
up/L
Cu-Copper 46562
u ,
X
FeArun46563
'
Hg-Mercury 71900
t iL
K
K-Potanhun 46555
Fn-
Mg-Magnesium46554
me_
X
Mn•Mangancse 46565
uglL
Na-Sodium 46556
mg/1_
]tit -Nickel
ng/L
•
Pli-Lead 46564
u�_
Se -Selenium
ujI/L
Za Zine 46567
0
Sample Interval
Orauochtorm! Pesticides
Orraranhuspbmus Pesticides
Nitrogen Pesticides
Acid Herbicides
PCBs
Scmivolalile Orpuics
TPH-Diasel Range
Volatile Organics (VOA bottle!
TPH-ramt ie Range
TPH-BTIFX Gasoline Range
LAB USE ONLY
Temperature on arrival (9C):
GW-54 REY. 012011
For Dissolver Analysis -submit filleted sample and write"DfS" in block.

Permit Number
Program Category
Ground Water
Permit Type
WI0500271
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael. rogers
Coastal SWRule
Permitted Flow
Facility
Facility Name
Ronald and Shannon Ryen SFR
Location Address
3718 Quail Meadow Dr
Hillsborough NC
Owner
Owner Name
Ronald
Dates/Events
Orig Issue
6/30/2010
App Received
2/23/2015
Reg ulated Activities
Heat Pump Injection
Outfall
Waterbody Name
27278
Ryen
Draft Initiated
Scheduled
Issuance
..
Central Files: APS SWP
3/23/2015
Permit Tracking Slip
Status
In review
Version
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Ronald Ryen
3718 Quail Meadow Dr
Hillsborough
Region
Raleigh
County
Orange
NC 27278
Public Notice Issue Effective Expiration
Requested /Received Events
RO staff report requested
RO staff report received
3/2/15
3/20/15
Streamlndex Number Current Class Subbasln
. .tr'A
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Ronald and Shannon Ryen
3 718 Quail Meadow Drive
Hillsborough, NC 27278
Re: Issuance of Injection Well Permit
Permit No. WJ:0500271
March 30, 2015
Geothermal Heating/Cooling Water Return Well
Orange County
Dear Mr. and Mrs. Ryen:
Donald R. van der Vaart
Secretary
In accordance with your permit application/renewal application and change of ownership request
received February 23, 2015, I am forwarding Permit No. WI05002 71 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 June 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 June 1, 2015, until May 31, 2020, 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 March 16, 2015. Laboratory analytical results will be fonvarded 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,
~4;v---
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
Division of Water Resources, NCDENR
Water Quality Regional Operations Section
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: [phone] \ Internet: http://www.ncwater.org
An Equal Opportunity\ Affirmative Action Employer -Made in part by recycled paper
cc: Danny Smith & Rick Bolich, Raleigh Regional Office
Central Office File, WI0500271
Orange County Environmental Health Department
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
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
Ronald and Shannon Ryen
FOR THE OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER RETURN WELL(S),
defined in Title 15A North Carolina Administrative Code 02C .0224(a), which will be used for the injection of
heat pump effluent. The injection well(s) located at 3718 Quail Meadow Drive, Hillsborough, Orange County,
NC 27278 will be operated in accordance with the application submitted February 23, 2015, and conformity
with the specifications and supporting data, all of which are filed with the Department of Environment and
Natural Resources and are considered a part of this permit.
This permit is for operation of an injection well shall be in compliance with Title 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 June 1, 2015, (i.e., the day after the expiration date of the
existing permit) until May 31, 2020, and shall be subject to the specified conditions and limitations set forth in
this permit.
Permit issued this the 23rd day of March 2015
S. Jay Zimmerman, Director
Division of Water Resources
By Authority of the Environmental Management Commission.
Permit #WI0500271 UIC/5A7
ver. 01/15/2015
Page 1 of5
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 [I SA 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 (l)].
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).
Pennit #WI0500271 UIC/5A7
ver. 01/15/2015
Page 2 of5
7. Each well 'shall have permanently affixed an identification plate [lSA 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 [lSA 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 1 SA NCAC 02C .0200, even if compliance requires a
reduction or elimination of the permitted activity [lSA NCAC 02C .021 l(j)].
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 take immediate
corrective actions that may be required, such as the repair, modification, or abandonment of the injection
facility [lSA NCAC 02C .0206].
PART IV-INSPECTIONS[lSANCAC 02C .0211(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 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 o,btain 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 [ISA NCAC
02C .0224(±)(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 ISA NCAC 02L [ISA NCAC 02C
.0224(f)(l )] .
3. The Permittee shall report any monitoring or other information that indicates noncompliance with a
specific permit condition, that a contaminant may cause a violation of applicable groundwater quality
Permit #WI050027 l UIC/5A 7 Page 3 of 5
ver. 01/15/2015
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 ISA NCAC 02C .02ll(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 Staff at 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 [ISA NCAC 02C
.0211(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 [15A NCAC 02C .0224(c)]
As required by rule an application for permit renewal shall be made at least 120 days prior to the
expiration date of the permit. This permit condition does not apply if the permittee chooses to discontinue
operation of the well for injection of effluent from the geothermal heating and cooling system associated
with this permit.
PART VII -CHANGE OF WELL STATUS [ISA NCAC 02C .0240]
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 ISA 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 ISA NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
Permit #WI0500271 UIC/5A7
ver. 01/15/2015
Page 4 of5
(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 #WI0500271 UIC/5A7
ver. 01/15/2015
Page 5 of5
WATER QUALITY REGIONAL STAFF REPORT
Date: 0311$12015
To: DWR WQROS AFO/GPB Central Office
Central Office Reviewer: Michael Rogers
Regional Office Inspector: Joan Schneier
County: Orange
Pernnittee: Ronald & Shannon Ryen
Project Name: Geothermal
Heating/Cooling Water Return Well
RECENEDIDENRIDWR
L GENERAL .INFORMATION
1. This application is (check all that apply): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/InfiltratfWM
❑ Land Application of Residuals ❑ Attachment 13 included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Remediation ® Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
MAR 20ZO5
Water a', aiiry Regional
Sect:on
a. Date of site visit: 03/16/2015
b. Person contacted and contact information: Ron Ryen
c. Site visit conducted by: J. Schneier
d. Inspection Report Attached: ® Yes or LI No.
2. Is the following information entered into the BIMS record for this application correct?
❑ Yes or ® No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
e. Regulated Activities / Type of Wastes (e.g., subdivision, food processing, municipal wastewater):
For Disposal and Injection Sites:
(If multiple sites either indicate which sites the information applies to. copy and paste a new section into the
document for each site, or attach additional pages for each site)
a, Location(s): Correct
b. Driving Directions: From 1-85 west of Durham, Exit 170. Bus 70 west, short distance. Rt on Pleasant
Green/Schley Rd, 7.7 mi. Rt on Quail Meadow Dr, 0.6 mi. House on left. [former directions were correct,
just an alternate route]
c. USGS Quadrangle Map name and number: Correct quad, did not check #
d, Facility Location Latitude: 36.144786 Longitude: -79.016245 Accuracy 0.1 second [updated on current
BIMS facility page]. Well Location (assumed from Google Earth) 36.144639,-79.015940. , Accuracy 1
second. This may not be exact but is a lot closer than the current well location in BIMS, about 500 ft away.
FORM: WI0500271 _Ryen_Staff Rep_06_ 17 2015.doc 1

WATER QUALITY 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.)
Descri ption OfWell(S) And Facilities -New, Renewal , And Modification
I. Type of injection system:
~ Heating/cooling water return flow ( SA 7)
D Closed-loop heat pump system (5QM/5QW)
D In situ remediation (SI)
D Closed-loop groundwater remediation effluent injection (SL/''Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? ~ Yes D No
3. Are there any potential pollution sources that may affect injection?~ Yes D No
What is/are the pollution source(s)? Septic system What is the distance of the injection well(s)
from the pollution source(s)? Greater than 120 ft , probabl y not u pgradient.
4. What is the minimum distance of proposed injection wells from the property boundary? Not checked on
ground, Google Earth shows about 112 ft from the road edge (nearest property boundary).
5. Quality of drainage at site : ~ Good D Adequate D Poor
6. Flooding potential of site: ~ Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable . If No, explain and recommend any changes to the
groundwater monitoring program:
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? D 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.
V. EVALUATION AND RECOMMENDATIONS
I. Provide any additional narrative regarding your review of the application.:
Samples of influent and effluent water delivered to lab, 03/16/2015. Field parameters of pH and conductivity
were similar. No unusual color or smell.
FORM: WI050027l_Ryen_Staff_Rep_06_17 _2015.doc 2
WATER QUALITY REGIONAL STAFF REPORT
The well is the water supply for the house and yard. A review of the 2010 influent sample (AB60309) showed
no standard violations, although Manganese was close at 47 ug/L (50 ug/L standard). The effluent sample
(AB60310) was virtually identical. This is not too surprising since there is only one well for both.
Attach Well Construction Data Sheet-if needed information is available
2. Do you foresee any problems with issuance/renewal of this permit? D Yes [8] 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
n/a
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
n/a
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
n/a
6. Recommendation: D Hold, pending receipt and review of additional information by regional office; D Hold,
pending review of draft permit by regional office; D Issue upon receipt of needed additional information; [8]
Issue; D Deny. If deny, please state reasons: __
FORM: WI0500271_Ryen_Staff_Rep_06_17_2015.doc 3
WATER QUALITY REGIONAL STAFF REPORT
7. Signature ofreport preparer(s): ► ~
Signature of APS regional supervis~r: --~~<----------''-------c·rL.~· ~~~-~i-10.~/;-~~!t-~__.~'-------
(
Date: ______ _
Attachments:
Copy:
Inspection report
Site sketch
RRO Files
FORM: WI050027 l _Ryen_ Staff_ Rep_ 06 _ 17_2015.doc 4
Com pliance Ins pection Re port
Permit: WI0500271
SOC:
Effective: 06/30/10
Effective:
Expiration: 05/31/15 Owner: Ronald Ryen
Expiration: Facility: Ronald and Shannon Ryen SFR
3718 Quail Meadow Dr County: Orange
Region: Raleigh
Contact Person: Bill Evangelist
Directions to Facility:
Hillsborough NC 27278
Title: Phone: [phone]
From downtown Hillsborough, go N. On Church St.INC 57. Take 57 to the right at the NC57-NC86 split. Go approximately 4 miles,
turn right on Mincey Road. Go approximately 3 miles, then left on Quail Meadow. House will be on the left.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 03/16/2015 Entry Time: 01 :OOPM Exit Time: 02:00PM
Primary Inspector: Joan Schneier Phone:
Secondary lnspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Heating/Cooling Water Return Well
Facility Status: ■ Compliant D Not Compliant
Question Areas:
■ Wells
(See attachment summary)
Page:· 1
Permit: WI0500271
Inspection Date: 03/16/2015
Owner -Facility: Ronald Ryen
Inspection Type : Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
The system was inspected due to permit renewal.
The pad was concreted on top, although the concrete was cracked.
The well was tagged.
The distance between the well and septic tank and field was paced at more than 120 ft.Surface drainage of the septic
system is away from the well.
The inluent and effluent bibbs were sampled for chlorides, nitrates, and metals.
No obvious contamination sources were observed.
Page: 2
Page 1 of 1
Orange County, NC GIS
1 inch = 200 feet
Created on 3f18/2015. Orange County, North Carolina.
http://server2.co.orange.ne.us/OrangeNCGIS/clefaultaspx
3/18/2015

Com pliance Ins pection Re port
Permit: WI0500271
SOC:
Effective: 06/30/10
Effective:
Expiration: 05/31/15 Owner: Ronald Ryen
Expiration: Facility: Ronald and Shannon Ryen SFR
3718 Quail Meadow Dr County: Orange
Region: Raleigh
Contact Person: Bill Evangelist
Directions to Facility:
Title:
Hillsborough NC 27278
Phone: [phone]
From downtown Hillsborough, go N. On Church St.INC 57. Take 57 to the right at the NC57-NC86 split. Go approximately 4 miles,
turn right on Mincey Road. Go approximately 3 miles, then left on Quail Meadow. House will be on the left.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 03/16/2015 Entry Time: 01 :OOPM Exit Time: 02:00PM
Primary Inspector: Joan Schneier Phone:
Secondary lnspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Heating/Cooling Water Return Well
Facility Status:
Question Areas:
■ Wells
■ Compliant
(See attachment summary)
D Not Compliant
Page: 1
Permit: WI050027 1
Inspection Date: 03/16/2015
Owner -Facility: Ronald Ryen
Inspection Type : Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
The system was inspected due to pennit renewal.
The pad was concreted on top, although the concrete was cracked .
The well was tagged .
The distance between the well and septic tank and field was paced at more than 120 ft.Surface drainage of the septic
system is away from the well .
The inluent and effluent bibbs were sampled for chlorides , nitrates, and metals .
No obvious contamination sources were observed.
Page: 2
Page 1 of 1
Orange County, NC GIS
1 inch = 200 feet
Created on 3/18/2015. Orange County, North Carolina.
http://server2.co_orange.nc.us/OrangeNCGIS/defaultaspx
3/18/2015

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW REQUEST FORM
Date: . March 2, 2015
To: RRO-WQROS: Rick Balkh / Danny Smith
From: Michael Rogers, WQROS — Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: Michael_Rogers@ncdenr_gov
A. Permit Number: W10500271
B. Applicant: Thomas and Shannon Ryen
C. Facility Name:
D. Application:
RECEIIEDIDENRWR
MARi07115
Water Quality i. r.o.utal
Operations .�.
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal
E. Comments/Other Information:
❑ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days,, please return a completed WQROS Staff
Report -
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact
person listed above.
RO-WOROS Reviewer: j a Sc�1 n1P I f - Date: 0 310 4 5'
NOTES_
'FORM: .WQROS-ARR. ver. 097614 Page 1 of 1

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW REQUEST FORM
Date: March 2, 2015
To: RRO-WQROS: Rick Bolich/ Danny Smith
From: Michael Rogers, WQROS -Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
A. Permit Number: WI0500271
B. Applicant: Thomas and Shannon Ryen
C. Facilitv Name:
D. 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.
RO-WOROSReviewer: __________________ Date: _____ _
COMMENTS:
NOTES:
FORM: WQROS-ARR ver. 0926l4 Page 1 of 1
·~A
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Ronald and Shannon Ryen
3718 Quail Meadow Drive
Hillsborough, NC 27278
March 2, 2015
RE: Acknowledgement of Application No. WI0500271
Geothermal Heating/Cooling Water Return Well
Orange County
Dear Mr. and Mrs. Ryen:
Donald R. van der Vaart
Secretary
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit application and supporting documentation received on February 23, 2015 . Your
application package bas been assigned the number listed above, and the primary reviewer is
Michael Rogers.
Central and Raleigh Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Water Quality Regional Operations Section
(WQROS) requests your assistance in providing a timely and complete response to any additional
information requests.
Please note that processing standard review permit applications may take as long as 60 to
90 days after receipt of a complete application. If you have any questions, please contact
Michael Rogers at [phone] or [e-mail].
cc: Raleigh Regional Office, WQROS
Permit File WI050027 l
~~~
Debra J. Watts, Supervisor
Animal Feeding Operations & Groundwater
Protection Branch
Division of Water Resources
1636 Mail Serv+ce Center, Raleigh, North Carol ina 27699 -1636
Phone: [phone] \ Internet: http ://www.ncwater.org
An Equal Opportunity \ Affirm ative Aalion Employer -Made in part by recycled paper
NORTII CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELL(S )
These well(s) iriject groundwater directly into the subsurface as part of a geothermal heating and cooling system
CHECK ONE OF THE FOLLOWING:
__ New Application 'X Renewal* __ Modification __ Permit Rescission Request*
*For Permit Renewals or Rescission Request, complete Pages 1 and 4 (sigo.ature page) only
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
)·'J'l
DATE: 2/ / fs' ,20 I) PERMIT NO. W £()Yoo (leave blank ifNew Application)
A. CURRENT WELL USE AND OWNERSHIP STATUS (leave blank if New Application)
B.
1. CurrentUseofWell /
a. Continue to use as ____lL_ Geothermal Well / Drinking Water Supply __ Other Water
Supply
b. Terminate Use: If the well is no longer being used as a geothermal injection well and you wish to
rescind the permit, check the box below. If abandoned, attach a copy of the Well Abandonment
Record (GW-30). RECEIVEO/DENR/OWR
D Yes, I wish to rescind the permit
2. CurrentOwnership Status
Has there been a change of ownership since permit last issued? 0 YES
If yes, indicate new owner's contact information:
FEB 2 3 2015
..-./ Water Quality Regional
Ll1' NO Operations Section
Name(s) --------------------------------
Mailing Address: ____________________________ _
City: __________ State: __ Zip Code: ______ County: _____ _
Day Tele No.: Email Address.:
STATUS OF APPLICANT (choose one)
Non-Government: Individual Residence ✓ Business/Organization __
Government: State Municipal __ County__ Federal
C. WELL OWNER(S)/PERMIT 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: g u IV ",,,J J b .,, "'>1 u,J fl v r.1,1
I
MailingAddress: 371 8 0. v";I fl,t .,Juw D,~ve
City: f+;ll.!>bu ,ov 9l, State:MZipCode:27278 County: 01 1,i NJe
DayTeleNo.: qi ()-~l-f 4-003 /, Cell No.: 91q -200-q qq 2
EMAIL Address: J..1v ~ 2-2. Z e. 1.0/, u Fax No.: /v
Geothermal Water Return Well Perm it Application (Revised Jan 20 I 5) Page I
D. WELL OPERATOR (if different from well owner) -For individual residences, list owner(s) on property
deed. For all others, list name of entity and name of person delegated authority to sign on behalf of the
business or agency:-------------------------------
Mailing Address:---------------------------------
City: _____________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: Email Address.:
E. LOCATION OF WELL SITE -Where the injection wells are physically located:
(1)
(2)
Parcel Identification Number (PIN) of well site: __________ County: _____ _
Physical Address (if different than mailing address): ________________ _
City: ________________ State: NC Zip Code: ________ _
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name: __________________________ _
NC Well Drilling Contractor Certification No.: _____________________ _
Company Name: _________________________________ _
Contact Person~: _______________ EMAIL Address: ___________ _
Address:------------------------------------
City: __________ Zip Code: _____ State: __ County: _________ _
Office Tele No.: Cell No.: Fax No.: ________ _
G. HV AC CONTRACTOR INFORMATION (if different than driller)
H.
HVAC Contractor's Name: ____________________________ _
NC HVAC 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 oper~tion?
Personal consumption?
YES ___ _ NO
YES __ _ NO ___ _
I. WELL CONSTRUCTION REQUIREMENTS -As specified in 15A NCAC 02C .0224 (d ):
(I) The water supply well shall be constructed in accordance with the water supply well requirements of
15A NCAC 02C .0107.
(2) If a separate well is used to inject the heat pump effluent; then the injection well shall be constructed
in accordance with the water supply well requirements of 15A NCAC 02C .0107, except that:
Geothermal Water Return Well Permit Application (Revised Jan 2015) Page2
(a) For screen and gravel-packed wells, the entire length of casing shall be grouted from the top
of the gravel pack to land surface;
(b) For open-end wells without screen, the casing shall be grouted from the bottom of the casing
to land surface.
(3) A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
---~· *EXISTING WELLS ____ PROPOSED WELLS
*For existing wells, please attach a copy of the Well Construction Record (Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
( c) Casing depth below land surface
( d) Casing height "stickup" above land surface
(e) Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited for sealing water-bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .0107(0(8 )
(f) Length o(well screen or open borehole and depth below land surface
(g) Length of sand or gravel packing around well screen and depth below land surface
K. OPERATING DATA
(1) Injection Rate: Average (daily) gallons per minute (gpm).
(2) Injection Volume: Average ( daily) gallons per day (gpd).
(3) Injection Pressure: Average (daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) __ ° F.
L. SITE MAP-As specified in 15A NCAC 02C .0224 (b )(4 ), attach a site-specific map that is scaled or otherwise
accurately indicates distances and orientations of the specified features from the injection well(s). The site map
shall include the following:
(I) All water supply wells, surface water bodies, and septic systems including drainfield, waste
application area, and repair area located within 250 feet of the injection well(s).
(2) Any other potential sources of contamination listed in 15A NCAC 02C .0107 (a )(2 ) located within 250
feet of the proposed injection well(s).
(3) Property boundaries located within250 feet of the parcel on which the propos~d injection well(s) are
to be located.
(4)-An arrow orienting the site to ope _of the cardinal directions (north, south, west, or east)
Geothem1al Water Return Well Pennit Application (Revised Jan 2015) Page3
NOTE: In most cases an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand Also, a `layer' can be selected showing topographic contours or
elevation data
M. CERTIFICATION (to be signed as required below or by that person's authorized agent)
I5A NCAC 02C .0211(e) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by all the persons) listed on the property deed.
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
°`1 hereby certify, under penalty of law, that 1 have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that 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 r Properly Owner/Applicant
11-O mi
Print or Type. Full Name
Signature of Property/Owne pplicant
Sl4MNr Jr 1 em
Print or Type Full N. ame
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
Division of Water Resources
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Return Well Permit Application (Revised ]an 2015) Page 4

~A
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Februaiy 6, 2015
CERTIFIED MAIL# 7014 1200 0001 3432 8367
RETURN RECEIPT REQUESTED
Ronald and Shannon Ryen
3 718 Quail Meadow Drive
Hillsborough, NC 27278
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No . WI0500271
Orange County
Dear Mr. and Mrs. Ryen:
Donald R. van der Vaart
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources {DWR) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, ~dis 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 located at the above referenced address
was issued to you on June 3 0, 2010, and expires on May 31, 2015. Per permit conditions and
requirements per 15A NCAC 2C .0224(c), the renewal application must be submitted at least 120
calendar days prior to expiration of your permit if you wish to continue operating the injection well.
According to our records, your permit renewal application is now past due. Please submit your
application (attached) as soon as possible if you wish to continue using the well for injection.
If Your Geothermal Water Return Well is Still Currently Being Used for In jection:
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211 , you must submit the enclosed renewal
application (Application for a Permit to Construct or Operate Injection Wells -Geothermal
Heating/Cooling Water Return Wells). The form is also available on-line at our website
http:/ /portal.ncdenr.org/web/wq/ aps/ gwpro/pennit-applications.
If Your Geothermal Water Return Well is NO LONGER Being Used for In jection:
If the well is no longer being used for injection, you do not have to renew your permit. Check the
box in Part A of the attached renewal application that you wish to rescind the permit and indicate
the current status of the well (i.e., used as water supply well, irrigation well, inactive, plugged and
abandoned, etc.). If it is no longer being used for any purpose, it must be permanently abandoned
according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C, Section
.0240. When the well is plugged.and abandoned, a well abandonment record (Form GW-30) must
be submitted to our· office to certify that the abandonment was properly conducted.
1636 Mail Serv ice Center , Raleigh, North Carolina 27699-1636
Phone: 919-807~6464\ Internet: www .ncdenr.gov
An Equal Opportunity\ Affirmative Action Emp loyer -Made in part by recycled paper
Ronald and Shannon Ryen Page2
If There has been a Change of Ownership of the Pro pe rty :
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change" Form must also be submitted in addition to the renewal application.
This form is not enclosed but can be found at the website listed above. Please submit the applicable
forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms in a timely manner may result in the assessment of civil
penalties in accordance with North Carolina General Statute 87-94. Thank you in advance for your
cooperation and timely response. If you have any questions, please contact me by phone at (919)
807-6406 or by email at Michael.Rogers@ncdenr.i:z ov.
Regards,
-~/27 ~
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: Raleigh Regional Office -WQROS w/o enclosures
Central Files -Permit No. WI0500271 w/o enclosures
U.S. Postal ServiceTM
CERTIFIED MAIL', RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
Fix delivery information visit our wet:mite at www.usps.cama
Postage
Certified Fee
Return Receipt Fee
(Errdoryrement Required)
Restricted Delivery Fee
{Endorsement Required)
Totes Postage & Fees
sent 70
Sore&r Ap
or PO 8o�
PS Form 3800, August 2006
Partrnark
Here
70 J
See Reverse for Instructions
SENDER: COMPLETE THIS SECTION
a Complete items 1, 2, and 3. Also complete
Item 4 If Restricted Delivery Is desired.
■ Print your narne and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailplece,
or on the front if space permits.
1. Article Addressed to:
OM Oa Cr.-d 4/0 ill991
3 �t Q
-!,'I/sbr41 C
7ir
COMPLETE TI-i1S SECTION ON DELIVERY
A. Signature
xr-
A.
-i
❑ Agent
Addressee
I
1r
D. Is delivery add • different from item 17 w -
If YkiS, enter delivery address below: No
( FEB 1 2 2015
livery
3.
ice Type
artifted Mai'3® 13 Priority Mal Express -
CI Registered 0 Return Receipt for Merchandise
0 Insured Mail © Collect on Delivery
Se
4. Restricted Delivery? (Extra Fee) in Yes
2. Articfe Number
(Transfer from service label]
PS Farm 3811, July 2O13
7014 120E1 0001 3432 8367
Domestic Return Receipt

AQUIFER PROTECTION REGIONAL STAFF REPORT
· Date: 06-29-2010
To: Aquifer Protection Central Office
Central Office Reviewer: Michael Ro gers
Regional Login No: __ _
County: Oran ge
Permittee: Ronald and Shannon R ven
Project Name: Injection SA7 Well
Application No.: WI0500271
I. GENERAL INFORMATION
1. This application is (check all that apply): ~ New O Renewal
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Recycle D High Rate Infiltration D Evaporation/Infiltration Lagoon
D Land Application of Residuals
D Distribution of Residuals
D Attachment B included
D Surface Disposal
D 503 regulated D 503 exempt
D Closed-loop Groundwater Remediation ~ Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ~ Yes or D No.
a. Date of site visit: 06-29-2010
b . Person contacted and contact information: Ronald Ryen , (919 ) 200-9992
c. Site visit conducted by: Lin McCartney
d. Inspection Report Attached: ~ Yes or D No.
2 . Is the following information entered into the BIMS record for this application correct?
~ Yes or D No. If no, please complete the following or indicate that it is correct on the current application .
For Treatment Facilities:
a . Location:
b . Driving Directions:
c. USGS Quadrangle Map name and number: __
d. Latitude: Longitude: __
e. Regulated Activities I Type of Wastes (e.g., subdivision, food processing, municipal wastewater): __
For Disposal and Injection Sites:
(If multiple sites either indicate which sites the information applies to . copy and paste a new section into the
document for each site . or attach additional pa ges for each site)
a. Location(s): 3718 Quail Meadow Dr .. Hillsborou gh , NC 27278
b. Driving Directions: Take US-70 BYP W . US-70 BYP becomes I-85 S , take Exit 170 toward NC-86 N,
Turn rh1:ht onto Pleasant Green Rd., Pleasant Green rd. becomes Schley Rd. Turn ri ght onto Quail Meadow
TRL.
c. USGS Quadrangle Map name and number: __
d. Latitude: 36-8-27 Longitude: 79-0-54
II. NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or minor
modifications, skip to next section)
Description Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification: __
FORM: Staff.Report-Ryen
REC,EIVED I OENR / DWQ
Aquifer Protection Section
JUL 0·12010
AQUIFER PROTECTION REGIONAL STAFF REPORT
'IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Descri ption OfWell(S) And Facilities-New, Renewal , And Modification
1. Type of injection system:
~ Heating/cooling water return flow (5A7)
D Closed-loop heat pump system (5QM/5QW)
D In situ remediation (SQ
D Closed-loop groundwater remediation effluent injection (SL/''Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? ~ Yes D No
3. Are there any potential pollution sources that may affect injection?~ Yes D No
What is/are the pollution source(s)? Se ptic Tank. What is the distance (?f the in jection well (s ) from the
pollution source (s)? 125 ft .
4. What is the minimum distance of proposed injection wells from the property boundary? 205 ft.
5. Quality of drainage at site: ~ Good D Adequate D Poor
6. Flooding potential of site: ~ Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: NI A
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? ~ Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
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 , explain:
2 . For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes D No. If yes . ex plain:
3. For renewal or modification of groundwater remediation p ermits (of anv typ e). will
continued/additional/modified in jections have an adverse impact on mi gration of the plume or mana gement of
the contamination incident? D Yes D No. If ves . exp lain:
FORM: Staff.Report-Ryen 4
AQUIFER PROTECTION REGIONAL STAFF REPORT
·4 _ Drilling contractor: Name : Hudson Well Compan y Inc .
Address: PO Box 05 . Rou gemont. NC 27522
Certification number: 2073
5 . Complete and attach Well Construction Data Sheet.
V . EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet -if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? D Yes IZ] No. If yes, please explain
briefly. __ .
4 . List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5 . List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6 . List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued . Make sure that you provide a reason for each special condition:
Condition Reason
FORM: Staff.Report-Ryen 5
AQUIFER PROTECTION REGIONAL STAFF REPORT
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): t- ' rl 'i 6.•6a.y fir► +�
Signature of APS regional supervisor ` r�
Date: P i/i
ADDITIONAL. REGIONAL STAFF REVIEW ITEMS
FORM: Staff.Report-Ryen 6

Permit: WI0500271
SOC:
County : Orange
Region: Raleigh
Effective:
Effective:
Contact Person: Bill Evangelist
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 06/29/2010
Primary Inspector: Lin McCartney
Secondary lnspector(s):
Reason for Inspection: Routine
Compliance Inspection Report
Expiration :
Expiration:
Title:
Owner: Ronald Ryen
Facility: Ronald Ryen & Shannon Ryen
3718 Quail Meadow Dr
Hillsborough NC 27278
Phone: [phone]
Certification: Phone:
Entry Time: 09:30 AM Exit Time: 12:00 PM
Phone : [phone]
Ext.4243
Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Heating/Cooling Water Return Well (5A7)
Facility Status: ■ Compliant D Not Compliant
Question Areas:
■Wells
(See attachment summary)
Page : 1
Permit Number WI0500271
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well (SA?)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Ronald and Shannon Ryen SFR
Location Address
3718 Quail Meadow Dr
Hillsborough
Owner
Owner Name
Ronald
Dates/Events
NC 27278
Ryen
Central Flies: APS_ SWP_
07/12/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Bill Evangelist
1117 Batchelor Rd
Apex
Major/Minor
Minor
Region
Raleigh
County
Orange
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Ronald Ryen
3718 Quail Meadow Dr
Hillsborough
NC 27523
NC 27278
Orig Issue
06/30/10
App Received Draft Initiated
Scheduled
Issuance Public Notice Issue
06/30/10
Effective
06/30/10
Expiration
05/31/15 06/21/10
_R_e..._a..;..u_la---'-te_d_A_c_;;_ti'-v..;..it'-ie'-s _______________ Re a uested/Received Events
Heat Pump Injection RO staff report requested
RO staff report received
Outfall NULL
Waterbody Name Stream Index Number Current Class
06/24/10
06/29/10
Subbasin
Permit Number WI0500271
Central Files: APS SWP
06/30/10
Permit Tracking Slip
Program Category
Ground Water
Status Project Type
In review New Project
Permit Type Version Permit Classification
Injection Heating/Cooling Water Return Well (5A7) Individual
Primary Reviewer Permit Contact Affiliation
rnichael.rogers Bill Evangelist
Coastal SW Rule
Permitted Flow
Fac iHt
Facility Name
Ronald and Shannon Ryen SFR
Location Address
3718 Quail Meadow Dr
Hillsborough
: .wrier
1117 Batchelor Rd
Apex
Major/Minor Region
Minor Raleigh
County
Orange
NC 27278 Facility Contact Affiliation
NC 27523
Owner Name
Ronald
ates/Events
Ryen
Owner Type
Individual
Owner Affiliation
Ronald Ryen
3718 Quail Meadow Dr
Hillsborough NC 27278
Orly Issue App Received Draft Initiated
06/21/10
Scheduled
Issuance
Public Notice Issue
Re,ulated Activities Re
Effective Expiration
t!o tod1Par.-erver4 cvn,++r
Heat Pump Injection
Outfall NULL
RO staff report requested 06/24/10
RO stall report received 06/29/10
Waterbody Name Stream Index Number Current Class Subbasin

•~A . s_.1;~1-
NCD~EM~R
North Ca rol ina Depart men t of Env ironm ent and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Ronald and Shannon Ryen
3 718 Quail Meadow Dr.
Hillsborough, NC 2 7278
Re: Issuance of Injection Well Permit
Permit No. WI0500271
Issued to Ronald and Shannon Ryen
Orange County
Dear Mr. and Mrs. Ryen:
Col een H. Sullins
Director
June 30, 2010
Dee Freeman
Secretary
In accordance with your application received June 21 , 2010 , I am forwarding Permit No. WI0500271 for the
operation of a SA 7 geothermal underground injection control (UIC) well heat pump system located at the above
referenced address. This permit shall be effective from the date of issuance until May 31, 2015, and shall be
subject to the conditions and limitations stated therein.
Please note; groundwater analytical results collected by the Raleigh Regional Office during the site inspection
will be forwarded to you at a later date after analysis by the laboratory.
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].
-~~
Michael Rogers , P .O . (NC & FL)
Environmental Specialist
cc: Jay Zimmerman -Raleigh Regional Office
Central Office File-WI0500271
Orange County Environmental Health Dept.
Bill Evangelist -Evangelist Service Company
Attachment( s)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleig h, North Carolina 27699-1636
Location: 2728 Capital Boulevard , Raleigh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 I Customer Service: 1-877-623-6748
Internet: www.ncwaterguality.org
An Equal Opportunitf \ Affirmative Action Employer
None, C 1. ortn aroma }Vaturally
NORTH.CAROLINA
ENVIRONMENT AL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143 , and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Ronald and Shannon Ryen
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 ofheat pump effluent. This
injection well is located at 3718 Quail Meadow Dr., Hillsborough, Orange County, NC 27278, and will be
constructed and operated in accordance with the application received June 21, 2010 , and in conformity with the
specifications and supporting data, all of which are filed with the Department of Environment and Natural
Resources and are considered a part of this permit.
This permit is for operation of an injection well shall be in compliance with Title 15A North Carolina
Administrative 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 May 31 , 2015 , and shall be
subject to the specified conditions and limitations Set forth in Parts I through VIII hereof.
Permit issued this the 30tll day of June 2010.
Coleen H . Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
WI0500271
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 (l SA NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This 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
3800 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.
WI0500271 2
3. The issuance of this permit shall not relieve the .Permittee of the responsibility of complying with any and
all statutes , rules, regulations , or ordinances, which may be imposed by other local, state, and federal
agencies, which have · jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
4. Continued operation of the injection system will be contingent upon the effluent not impacting
groundwater quality. The water quality of the effluent cannot be that of a lower quality than the influent,
which results in a degrading of water quality of the aquifer.
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.
WI0500271 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:
WI0500271
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
4
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The 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:
WI0500271
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
5
Ro gers, Michael
From:
Sent:
To:
Cc:
Subject:
Michael,
Zimmerman, Jay
Tuesday, June 29, 2010 4:18 PM
Rogers, Michael
Watts, Debra; Mccartney, Lin
Ryen permit# WI0500271
Staff report is in the mail. I'm ok if the permit is issued to allow the owners to obtain their CO from the County. Call Lin
or me if issues.
J
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to
third parties.
1
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: June 24, 2010
To: ❑ Landon Davidson, ARO-APS
❑ Art Barnhardt, FRO-APS
❑ Andrew Pitner, MRO-APS
® Jay Zimmerman, RRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: f 9191 715-6166
E-Noel: Michael.Roeersia'ncmail.net
❑ David May, WaRO-APS
❑ Charlie Stebman, WiRO-APS
❑ Sherri Knight, W-SRO-APS
Fax: [phone]
A. Permit Number: WI 0500271
B. Owner: Ronald and Shannon Rven
C. Facility/Operation:
❑ Proposed
D. Application:
1. Permit Type: ❑ Animal
❑ Recycle
® Existing
❑ Facility ❑ Operation
❑ SFR-Surface Irrigation❑ Reuse ❑ H-R Infiltration
❑ YE Lagoon ❑ GW Remediation (ND)
® UIC - 5A7 Geothermal well
For Residuals, ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. Project Type: ® New ❑ Major Mod. ❑ Minor Mod. ❑ Renewal ❑ Renewal w/ Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
NOTE:
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within, please take the following actions:
® Return a Completed APSARR Form and attach laboratory analytical results, if applicable.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-APS Reviewer:
FORM: APSARR 07/06
Page 1 of 1
Date:

·R A
NCDENR
North Carolina Department of Environmen t and Natu ral Resou rces
Div ision of Water Quality
Beverly Eaves Perdue
Governo r
Coleen H. Sullins
Di recto r
June 23, 2010
Ronald Ryen
Shannon Ryen
3718 Quail Meadow Drive
Hillsborough. NC 27278 ·
Subject: Acknowledgement of Application No. WI0500271
Ronald Ryen & Shannon Ryen
Injection Heating/Cooling Water Return Well (5A7)
Orange
Dear Mr. & Mrs. Ryen:
Dee Freeman
Se cr etary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on June 21, 2010. This application package has been assigned the number listed above and will be reviewed by
Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division reque,sts 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 al so note at this time, processing permit applications can take as 1011g as 60 -90 days after receipt of a complete
application. ·
lfyou have any questions , please contact Michael Rogers at 919-715-6166, or via e-mail at [e-mail] . If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to h Lm ://h2o.enr.state.nc.us/documents/dwq om chart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT .
Sincerely,
()~~
for Debra J. Watts
Supervisor
cc : Raleigh Regional Office, Aquifer Protection Section
Evangelist Service Co -Bill Evangelist, 1117 Batchelor Rd, Apex, NC 27523
Permit Application File WI0500271
AQUIFER PROiECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard. Raleigh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588; FA X 2: 919-715-6048 I Customer Service: 1-877-623-6748
Internet: www .ncwate rguality.org
An Equal Opponuniiy \ Affirmaiive .A.ciion Employer
NOnel C 1· ort 1 aro 1na
/Vaturall!I
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDI=NR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
_ TYPE 5-A7 WELLIS)
New Permit Application OR Renewal (check one)
DATE: 20 / 61
PERMIT NO.
(leave blank if NEW permit application)
A. PROPERTY OWNER(S)/APPLICANT(S)
List each Property Owner listed on property deed (if ownAd by a busi esss or government agency, state name of
representative
entity and a rtative w/authority for signature); o P. • rq.^IC7 ( Ry-
•
(I) Mailing Address: 3
Y~:•. w _ +�� _
City: rI r% P Aerie• +e State:/t/. (Zip Code: 2_ 7 Z i W County: eiA '•vti ►4?
Home/Office Tele No.: Cell No.: 51V9 Z e - /09 ' L
EMAIL Address:
(2) Physical Address of Site (if different than above): Sib
City: _ State: Zip Code: County: _
HomeJOffiee Tele No.: Cell No.:
EMAIL Address:
B. AUTHORIZED AGENT OF OWNER., IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAIL Address:
Address:
City: State: Zip Code: County: -
Office Tele No.: Cell No.:
Website Address of Company, Wanly
CGPU/LHC 5A7 Well Permit Application (Revised 4f111O7) Page 1
RECEIVED I DENR I ❑INQ
Aquifer Protection Section
JUN 21 2010

C. WELL DRILLER INFORMATION
Company Name:_ _ tr •
Well Drilling Contractor's Name:
NC Contractor Can ation No.:
� 1: '7 7
_,! Contact Person: i?`fJisj
Address: i
City: .� •i -. 4444; ! Zip Code: Z.- ) J ) i L-t e -r A -el.
Office Tele No.: 1 9 1) -3 / Dd Cell No,:
EMAIL Address;_
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: E V 64 IV Ge41Si' Slrg U, CC �'
Contact Person: Br4L &4NGEaS�VEMAIL Address: eueln le1we beJfSo1'A 'w+
Address: I in € tT c I'f ec o4 12O $h
City: __Q Zip Code: 2-723 county: CA14TiLA W7
Office Tele No.: Ili- 342 - 78/o Cell No.: 9/9 -- a) S '7)f (
E. STATUS OF APPLICANT
Private: Xr Federal:
State: Municipal:
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Ft" rt pamper, a us
G. W F,LL [JSE Will the injection well(s) also be used as the supply weli(s) for the following?
(I)
(2)
The injection operation?
Personal consumption?
YES _ /C NO __
YES - x— - NO
WELL CONSTRUCTION DATA (Skip to Section I if this is a Permit RENEWAL)
PROPOSED Well(s) to be constructed for use as an injection well- Provide the data in (I)
through (7) below as PROPOSED construction specifications. Submit Form GW-1 after
construction.
PEXISTING Well(s) being proposed for use as an injection well. Provide the data in (1) through
(7) below to the best of your knowledge. Attach a copy of Fortn GW-1 (Well Construction
Record) if available.
(1) Date to be constructed: - C� Number of borings:
Approximate depth of each boring (feet): .r_ 4 .,ir.
(2) Well casing. Is the well(s) cased? (check either (a) YES or (b.) NO below)
(a) YES t. If yes en provide the casing information below.
Type: Galvanized steel Black steel plastic Other (specify)
I �
Casing thickness;18 diameter (inches): (0 4.idepth: from 0 to 4dc7 ft. (reference to land surface)
Casing extends above ground r 7. inches
CPUIUTC 5A7 Well Permit Application (Revised 9t2007) Page 2

(3)
(4)
(5)
(6)
(b) NO
Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement _,, Bentonite__ Other (specify)_ ------
(b) Grouted surface and grout depth (reforence to land surface):
___ Around closed-loop piping; from ___ to--._ (feet).
__ Around well casing; from O to 7 t> t" (feet).
Well(s) Screen Infonnalion
Depth of Screen: From ____ to ____ feet below land surface
N.C. State Regulations (Title 15A NCAC 2C .0200) require the Permittce to make prov,s,ons for
monitoring wellhead water quality and processes. A faucet on both Influent (groundwater entering heat
pump) and Effluent (water being injected back into the well) lines is require. d. Will there ~cet on:
(a) Influent line? Yes __ No__ (b) Effluent line? Yes No_. __
Source Well Construction Information (if the water source well is a different well than the injection well)
Attach a copy of Form GW-L (Well Construction Record). IfFcirm GW-1 is ·not available, provide the
following data:
Groundwater Source. From what depth, formation, and 1ype of rock/sediment units will the groundwater
be withdrawn? (e.g. granite, limestone, sand, etc.) ·
Depth: · Formation: ______ Rock/sediment unit: ,.../
NOTE: . THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOlt EITHER EXISTING OR PROPOSED WELL<; IF
THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
L OPERATING DATA
{I) Injection rate:
(2) Injection Volume:
(3)
(4)
Injection Pressure:
Injection Temperature:
J. INJECTION-RELATED EQUIPMENT
Average (daily) b gallons per minute (gpm).
Average (daily) __ . gallons per day (gpd).
Average (daily) __ pounds/square inch (psi).
Average (January) __ ° F, Average (July) __ ° F.
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufa<.1urcr's brochure may provide supplementary
information. ·
K. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(I) 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 I 000 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 faciJity's location and the map name.
GPU/UJC SA 7 Well Permit Application (Revised 9i2007) Page 3
L. CERTIFICATION
Note: This Permit Application roust he signed by each person appearing on the
recorded legal property deed.
"I hereby certify, unrier penalty of law, that I have personally examined and :lm familiar with the information
submitted in this document and ail attachments thereto and that. based an my inquiry of those individuals
immcdiateiy responsible for obtaining said information, 1 helievc that the information is true, accurate and complete.
I am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable. abandon the injection well and
all related appurtenances in accordance with the approved specifications and conditions of the Permit:."
Signature of Property Owner/Applican� 2
Print or k FuUY,Narree
Signature of Pit v Owner/Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
UIC Program
1636 ]Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
2
ps_e,A itqo
GPURJlC 1A7 Wall Pcnnir Application (Revised 9/2007)
711
Page 4
RECEIVED I DENR 1 DVVa
Aquifer Protection Section
J1lN 21 2010

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county and its mapping companies assume no legal responsibility for the information on this reap.
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This map contains parcels prepared for the inventory of real property within Orange County, and is compiled from
recorded deed, plats, and other public records and data. Users of this map are hereby notified that the aforementioned
public primary information sources should be consulted for verification of the information contained an this map. The
county and its mapping companies assume no legal responsibility far the information an this map.
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