WI0300162_Regional Office Historical File Pre 2018

l
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Date: 12/18/2015
To: Mike Rodgers
Central Office Reviewer
Permit No.WI0300162
County: Cabarrus
Permittee/Applicant: NCDOT_
Facility Name: Former NCDOT Asphalt Testing Lab 17-4
L GENERAL INFORMATION
1. This application is (check all that apply): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
a. Date of Inspection: 12/15/2015
b. Person contacted and contact information: John Barile
c. Site visit conducted by: Edward Watson and Maria Schulte
d. Inspection Report Printed from RIMS attached: ® Yes ❑ No.
e. Physical Address of Site including zip code: 200 Countryside Road, Harmony, Iredell County
£ Driving Directions if rural site and/or no physical address: Latitude:35.989504 Longitude:
80.769271
Source of LatlLong & accuracy (i.e., Google Earth, GPS, etc.): Google Earth
IL DESCRIPTION OF INJECTION WELL(S) AND FACILITY
1. Type of injection system:
® Geothermal Heating/Cooling Water Return
❑ In situ Groundwater Remediation
❑ Non -Discharge Groundwater Remediation
❑ Other (Specify:
2. For Geothermal Water Return Well(s) only
a. For existing geothermal system:
Were samples collected from Influent/Effluent sampling ports? ® Yes ❑ No.
Provide well construction information from well tag:
b. Does existing or proposed system use same well for water source and injection? ® Yes ❑ No
If No please provide source/supply well construction info (i.e., depth, date drilled, well contractor,
etc.) and attached map and sketch Iocation of supply well in relation to injection well and any other
features in Section IV of this Staff Report.
3. Are there any potential pollution sources that may affect injection? ❑ Yes ® No
What is/are the pollution source(s)?
What is the distance of the injection well(s) from the pollution source(s)? south of the northern property
boundary.
4. Quality of drainage at site: ® Good ❑ Adequate ❑ Poor
5. Flooding potential of site: ® Low ❑ Moderate ❑ High
Rev. 6/1/2015 Page 1

A
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
6. For Groundwater Remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? n Yes ❑ No. If No,
attach map of existing monitoring well network if applicable and recommend any changes to the groundwater -
monitoring program. N/A
7. Does the map included in the Application reasonably represent the actual site (property lines, wells, surface
drainage)? ® Yes ❑ 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.
8. For Non -Discharge groundwater remediation systems only:
a. Are the treatment facilities adequate for the type of waste and disposal system? ❑ Yes ❑ No ® N/A.
If no, please explain:
b. Are the site conditions (soils, topography, depth to water table, etc.) consistent with what was reported by
the soil scientist and/or Professional Engineer? ® Yes ❑ No ❑ N/A. If no, please explain: _
III. EVALUATION AND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yes, explain.
2. List any items that you would Iike WQROS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item
Reason
3. 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
Periodic surface water monitoring based on the
estimated travel time through the soil sub-
straight.
Periodic monitoring for evidence of daylighting
of daughter/ degradation products resulting from
the injectant.
•
4. Recommendation
❑ Deny. If Deny, please state reasons:
❑ Hold pending receipt and review of additional information by regional office
❑ Issue upon receipt of needed additional information
® Issue
5. Signature of report preparer(s): Edward M. Watson
Signature of WQROS Regional Supervisor:
Rev. 6/1/2015 Page 2

4,0
t
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Date:
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS (I Needed)
Water samples were collected form Influent and effluent well ports and submitted to DWQ laboratory for analysis.
Water samples was tested for TDS, Nitrite as N, and Total Nitrate as (NO3 +NO2 - N), Chloride, Fluoride & Sulfate,
Hardness, Metals, Total and Fecal Coliform bacteria.
Lab results are attached.
Rev. 6/1/2015 Page 3

North Carolina Division of Water Resources
Water Sample Collection & Submittal Form
Central Laboratory (Water Sciences Section)
Visit ID:
(opti'ona1)
Ta,)
;ID I
Lab Use
Laboratory
Sample Number:
Only: ___
�""'"� " ""
Location Description:
John and Virginia Barite, 200 Countryside Road, Harmony, NC
Location Code:
WI03000162-INF
Date Received:.
County:
Iredell
�--Collector:
E Watson
Priority:
Water Matrix:
Location Type:
Time Received:
i7WR Region
(hosed on aunty)
MRO
DWR Office:
aro en name)
( agency
MRO
❑Ambient
El Routine
❑ Surface
-
River/Stream
EstuaryCanal
❑Lake
❑
❑Water Supply
❑Influent
Received By:
;.
'-;
River Basin
Yadkin -Pee Dee
Date:
12/15/2015
IM Stormwater
Delivery Method:
uState Courier
❑Hand Delivery
4 Compliance
❑ COL
❑ Emergency
Ground
❑ Waste
❑ Blank
❑ Solution
.1 Monitoring Well
❑Effluent
Field Blank
❑ Filter Blank
Notes: UIC System inspection
Time:
AM
111 Other:
❑ Chlorinated ❑ De -chlorinated in Field
Sampiing
Method.;-
❑ Grab ❑ Composite
Ill Other: Pump
Temperature ('C)
On Arrival:
li Trip Blank
Influent Port
Dissolved analysis: Enter"DIS„
❑ Filtered in Field
in check -boxes for parameters
Sample Depth:
• QA
Other:
Collectors Comments::. 1 Lat._35.989371 Long._80.769202 *Analyze Bacteria samples regardless of hold time.**
. Microbiology Parameters:
MBAS (surfactants) mg/L
Metals Parameters:
Tin (Sn) pg/L
Acidity, as CaCO3, to pH 4.5/8.3 mg/L
Oil and Grease, HEM, Total Recoverable mg/L
X
Aluminum (Al) pg/L
Titanium (Ti) izg/L
Alkalinity, as CaCO3, to pH 4.5/8.3 mg/L
Phenols, Total Recoverable pg/L
Antimony (Sb) pg/L
Vanadium (V) pg/L
BOD: Biochemical Oxygen Demand, 5-day mg/L
Residue: Total (Total Solids) mg/L
X
Arsenic (As) pg/L
X
Zinc (Zn) pg/L
cBOD: Carbonaceous BOD, 5-day mg/L
Residue: Volatile/Fixed, Total mg/L
X
Barium (Ba) pg/L
x
Coliform: Fecal MF /100ml
Residue: Suspended (Suspended Solids) mg/L
Beryllium (Be) pg/L
Boron (B), Total pg/L
x
Coliform: Total MF /100m1
Residue: Volatile/Fixed, Suspended mg/L
X
Cadmium (Cd) • pg/L
Mercury 1631, low-level ng/L
Coliform: Tube Fecal /100mi
X
TDS - Total Dissolved Solids mg/L
X
Calcium (Ca) mg/L
Coliform: Tube Total /100m1
Silica mg/L
X
Chromium (Cr), Total pg/L
Organics Parameters:
Specific Conductance, at 25 °C umhos/cm
Sulfide mg/L
Cobalt (Co) pg/L
Acid Herbicides
TOC- TotalOrganicCarbon mg/L
Tannin& Lignin mg/L
X
Copper(Cu) pg/L
Organochlorine Pesticides
Turbidity NTU
X
Iron (Fe) pg/L
Organonitrogen Pesticides
Other Parameters:
X
Lead (Pb) pg/L
Organophosphorus Pesticides
Wet Chemistry Parameters:
pH s.u.
Lithium (Li) pg/L
PCBs (polychlorinated biphenyls)
Bromide mg/L
X
Hardness, Total as CaCO3 - by titration mg/L
X
Magnesium (Mg) mg/L
x
Chloride mg/L
X
Manganese (Mn) pg/L
Semi -Volatile Organics (BNAs)
x
Fluoride mg/L
Mercury (Hg) pg/L
TPH Diesel Range
x
Sulfate mg/L
Nutrients Parameters:
Molybdenum (Mo) pg/L
Chlorophyll a pg/L
Ammonia as N (NH3-N) mg/L
X
Nickel (Ni) pg/L
Volatile Organics (VOA)
Color: ADMI c.u.
X
Nitrate -Nitrite as N (NO3+NO2-N) mg/L
X
Potassium (K) mg/L
Color: Platinum Cobalt c.u.
Total Kjeldahl Nitrogen as N (TKN) mg/L
X
Selenium (Se) pg/L
TPH Gasoline Range
COD: Chemical Oxygen Demand mg/L
Total Phosphorus as P (TP) mg/L
X
Silver (Ag) pg/L
Cyanide, Total mg/L
X
Nitrite as N (NO2-N) mg/L
X
Sodium (Na) mg/L
Biological:,,
Formaldehyde mg/L
X
Nitrate as N (NO3-N calculated) mg/L
Strontium (Sr) pg/L
Phytoplankton / Algae
Hexavalent Chromium (Cr5+) mg/L
Orthophosphate as P (PO4) mg/L
Thallium (TI) pg/L
LAB COMMENTS
Field Parameters(oprtanai)
Water Temp (°C):
pH (s.u•):... I
Dissolved Oxygen (ppm):
Conductivity (pmhos/cm
Salinity (opt):
Revision: 2/06/2015

North Carolina Division of Water Resources
Water Sample Collection & Submittal Form
Central Laboratory (Water Sciences Section)
Visit ID:
(optional),
Ta,
ID f
Lab Use
Laboratory
Sample Number:
Only:
Location Description:
John and Virginia Barite, 200 Countryside Road, Harmony, NC
Location Code:
WI03000162-EFF
DateReceived:
-
County:
Iredel(
Collector:
E Watson
Priority:
Water Matrix:
Location Type:
Time Recelged:;
DWR Region
(posed oncounty)
MRO
DWR Office:
(or agency name)
MRO
Ambient
❑
Surface
]River/Stream
❑Estuary
❑Stormwater
❑Monitoring Well
❑Effluent
❑Field Blank
❑ Blank
IDLake
❑Canal
❑Water Supply
❑Influent
Trip Blank
Effluent Port
Received By: ;...
.. ,....; .
River Basin
Yadkin -Pee Dee
; ,
Date:
12115/2015
Routine
Delivery Method:
-LA State Courier
❑Hand Delivery
0 Compliance
❑ COC
❑ Emergency
❑ QA
Ground
Notes: UIC System Inspection
Time:
AM
III Waste
❑ Blank
1111 Other:
Chlorinated ❑De -chlorinated in Field
Sampl!ng
Method:
❑Grab 11Composite
Temperature ( 'C)
erasure
on Arrival;
•
✓ Other: PumpFilter
Dissolved analysis: Enter "DIS"
ElFiltered in Field in check -boxes for parameters
Sample Depth:'
• Solution
El Other:
Collector'sComments: :ILat._35.989371 Long._80.769202 **Analyze Bacteria samples regardless of hold time.**
Microbiology Parameters:
MBAS (surfactants) mg/L
Metals Parameters:
Tin (Sn) pg/L
Acidity, as CaCO3, to pH 4.5/8.3 mg/L
oil and Grease, HEM, Total Recoverable mg/L
X
Aluminum (Al) pg/L
Titanium (Ti) pg/L
Alkalinity, as CaCO3, to pH 4.5/8.3 mg/L
Phenols, Total Recoverable pg/L
Antimony (Sb) pg/L
Vanadium (V) pg/L
BOD: Biochemical Oxygen Demand, 5-day mg/L
Residue: Total (Total Solids) mg/L
X
Arsenic (As) pg/L
X
Zinc (Zn) pg/L
cBOD: Carbonaceous BOD, 5-day mg/L
Residue: Volatile/Fixed, Total mg/L
X
Barium (Ba) pg/L
x
Coliform: Fecal MF /100m1
Residue: Suspended (Suspended Solids) mg/L
Beryllium (Be) pg/L
Boron (B), Total ug/L
x
Coliform: Total MF /10om1
Residue: Volatile/Fixed, Suspended mg/L
X
Cadmium (CO pg/L
Mercury 1631, low-level ng/L
Coliform: Tube Fecal /100m1
X
TDS - Total Dissolved Solids mg/L
X
Calcium (Ca) mg/L
Coliform: Tube Total /100m1
Silica mg/L
X
Chromium (Cr), Total pg/L
Organics Parameters:
Specific Conductance, at 25 °C umhos/cm
Sulfide mg/L
Cobalt (Co) pg/L
Acid Herbicides
TOC- Total Organic Carbon mg/L
Tannin & Lignin mg/L
X
Copper (Cu) pg/L
Organochlorine Pesticides
Turbidity NTU
X
Iron (Fe) (fg/L
Organonitrogen Pesticides
Other Parameters:
X
Lead (Pb) pg/L
Organophosphorus Pesticides
Wet Chemistry, Parameters: .
pH s.u.
Lithium (Li) pg/L
PCBs (polychlorinated biphenyls)
Bromide mg/L
X
Hardness, Total as CaCO3 - by titration mg/L
X
Magnesium (Mg) mg/L
x
Chloride mg/L
X
Manganese (Mn) JC/L
Semi -Volatile Organics (BNAs)
x
Fluoride mg/L
Mercury (Hg) pg/L
TPH Diesel Range
x
Sulfate mg/L
Nutrients Parameters:
Molybdenum (Mo) pg/L
Chlorophyll a pg/L
Ammonia as N (NH3-N) mg/L
X
Nickel (Ni) pg/L
Volatile Organics (VOA)
Color: ADMI c.u.
X
Nitrate -Nitrite as N (NO3+NO2-N) mg/L
X
Potassium (K) mg/L
Color: Platinum Cobalt c.u.
Total Kjeldahl Nitrogen as N (TKN) mg/L
X
Selenium (Se) pg/L
TPH Gasoline Range
COD: Chemical Oxygen Demand mg/L
Total Phosphorus as P (TP) mg/L
X
Silver (Ag) Jg/L
Cyanide, Total mg/L
X
Nitrite as N (NO2-N) mg/L
X
Sodium (Na) mg/L
Biological:
Formaldehyde mg/L
X
Nitrate as N (NO3-N calculated) mg/L
Strontium (Sr) pg/L
Phytoplankton /Algae
Hexavalent Chromium (Cr6+) mg/L
Orthophosphate as P (PO4) mg/L
Thallium (TI) pg/L
LAB COMMENTS :
Field Parametersfopuanat) :
Water Temp (°C): I
pH (s.u:): I
Dissolved oxygen (ppm):
Conductivity ((mhos/cm):
Salinity (ppt):
Revision: 2/06/2015

AC25207
7VC DWR. WaterSciencesSection-Chemistry Laboratory. &suits.
County: iredeil
River Bas1n Yadkin- Pee Dee
Report To DWM
Collector. g WATSON
Region: MRO
Sample Matrix: GROUNDWATER
Loc. Type: Influent Port
Emergency Yes/No
COC Yes/No
Division of Water Resources
Final Report
VisitID
Samples ID: AC25207
PO. Number# 15G0315
Date Received: 12/16/2015
Time Received: oa:s0
Labworks LoginlD MSWIFT
Final Report Date: 1/5/16
Report Print Date: 01105/2016
Loc. Descr.: JOHN AND VIRGINABARILE, 200 COUNTYSIDE'ROAD. HARMONY. NC
-
LocationID: WI03000162 INF
Collect Date: 12/15/2015
Collect Time: 11:30
Sample Depth NA
If this: report is labeled preliminary report, the results.have not been -validated. no not use for,Regulatorypurposes.
CAS # Analvte Name.
LAB.
Sample temperature at receipt by lab
PQL
Result/'
Qualifier
Units
1.7 'c
Method Anai sis 1/alidafed by
Reference Date
12/16/15 MSWIFT
MIC
Coliform, MF Fecal in liquid
1
1B2Q1 Cr01100m1 APHA9222D-201h 12/16/15 ESTAFFORDI
Coliform,MF Total in, liquid,
1 1.1B2Q1
CFI/1100ml APl-1A9222B-201h 12/16/15 ESTAFFORDI
WET
Ion Chromatography
71TLE mg/L EPA 300.0 rev2.1 12/16115. CGREEN
Fluoride
0.4 0.62 mg/L
EP&300.0 rev2.1 12/16/15 CGREEN
Chloride
1.0 1.0 mg)L EPA 300.0rev2.1 12/16/15 CGREEN
Bromide
0.4 0.4 -U mg/1. EPA 300.0.rev21 12/16/15 CGREEN
Sulfate
2.0 20 mg/L EPA300.0 rev2.1 12/16/15 CGREEN'
Total Dissolved Solids in liquid
12 111
mg/L
SM 2540 C-1997 12/1.6/15 CGREEN
NUT
NO2+NO3 as N. in liquid
0.02 0.02 U mg/L as N EPA 353.2 REV 2 12/21/15 CGREEN
Nitrate as N in liquid'
0.02 0.02 U n:g/L as N EPA 353.2 REV 2 12/28/15 CGREEN
Nitrite as.N In liquid
0.01 0.01.0 mg/L as N EPA 353.2 REV 2 12/17/15, CGREEN
MET
7440-22-4 Ag by ICPMS
1.0 1.0 U ug/L EPA200:8 12/18/1.5 ESTAFFORD1
7429-90-5 Al by ICP
50 50 U
ugli,
EPA.200.7 12/21/15 ESTAFFORD1
7440-38-2 As by ICPMS
2.0 2.0 U, uglL EPA200.8 12/16/15 ESTAFFORD1
7440-38-3 Ba by ICP
10 1011 ug/L EPA200.7 12/18/15. ESTAFFORDI
7440-70-2 Ca by ICP
0,10 8,2 mg/L EPA200.7 12/18/15. ESTAFFORDI
7440-43-9 Cd by ICPMS
0.50 0.50 U
ug/L
EPA200.8 12118/15 ESTAFFORDI
7440 47,3 Cr by ICPMS
5:0 5:0 U ugh. EPA200.8 12/18/15 ESTAFFORDI
7440-50-e Cu by ICPMS
2,0 4.2 ug/L EPA200.8 12/18/15 ESTAFFORD1
7439-89-6 Fe by ICP
50 50 U. ug/L - EPA200.7 12121/15 ESTAFFORDI
Hardness by Calculation
1.0 25 mg/L SM2340BEPA200.7 1/5/16 ESTAFFORD1
7440-09-7 I< by ICP
0.10 0.69 mg/L EPA200.7 12118/15 ESTAFFORDI
7439=95 4 Mg by ICP
0:10 1.1 mg/L EPA200.7 12/18/15 ESTAFFORD1
7439-96-5 Mn by ICP
10 10'U.
tlg/L
EPA200,7 12/21/15 ESTAFFORDI
7440-23-5 Na by ICP
0:10' 27 mg/L EPA2007 12/18/15 ESTAFFORDI
7440-02-0 Ni by ICPMS
2.0 2:0 U u911. EPA200.B 12/18/15 ESTAFFORDI
WSS Chemistry Laboratorya 1623Mali Sur iite Center, Raleighr.NC 27699-1623 pis) 733,3908
Fora detailed desolation or tho ovai8rcr nodes refer la<httn:// DOIt`dLacciepr.Or fweb%walonslmethodsand-pals>
Page 1 of 2

Location ID: W103000162_INF
XC fariinR. La6vratory Section 14sufts
Sample ID: AC25207 Collect Date: 1211512015. Collect Time:: 11:30
MET
CAS # Analyte Name
7439-92-1 Pb by 1CPMS
PQL,
2.0
Result/
Qualifier
2.0.0
Units
ug/L
Method
Reference
EPA 200:8
Analysis
Date
12/18/15 ESTAFFORD1
Validated by
7782-49-2 Se by ICPMS
1.0 1.0 U uglL EPA200.8 12/18115 ESTAFFORDI
7440-66-8 Zn by ICPMS
10 10 U ug/L EPA200.8 12/18115 ESTAFFORDI
WSS Chemistry Laboratory» 1523 Mall Service Center.Ralelgh,.NC 27699-1623 (919) 7334908
Fora dew tleacaltden of the aualfie.codes roar to •httt :IJDorfaI.ncdenr. ora/weblwa/ores/methods-and-nd ls>
Page 2 of 2

North Caro)ina Division of Water Resources
Central Laboratory (Water Sciences Section)
Loco Ton DesscrIptiue:
`• aDUtiIR'liegin''n �:
rR•'(bosed on county)
Water Sample Collection & Submittal Form
John and Virginia Bari(e, 200 Countryside Road, Harmony, NC
2.8 4.51-
Iredell
MRO
Collector:.
E Watson/ M. Schutte
r1NRte:` MRO
l[ 0 agencyoo r
River+basin Yadkin -Pee Dee
m� TMt
Notes:
UIC System Inspection
❑ Chlorinated ❑De -chlorinated in Field
12/1512015
(r .3o AM
Sa►npltn; n��e ❑Grab UComposite
rthod• ;
E Other: Pump
❑ Filtered In Field Dissolved analysis: Enter "1315"
in check -boxes for parameters
Ambient
❑ Routine
❑� Compliance
❑ coc
❑ Emergency
Visitit ID
optronalji,
W103000162-INF
Waten
❑ Surface
Ground
❑Waste
❑ Blank
❑ Solution
olleeioesCommeeflIS: Lat._35.989371 Long._80.769202 **Analyze Bacteria samples regardless of hold time."`
VFIVMicroiiio ggy)Para riVI :•, _.
x
Acidity, as CaCO3, to pH 4.5/8.3 mg/L
Alkalinity, as CaCO3, to pH 4.5/8.3 mg/L
BOP: Biochemical Oxygen Demand, 5-day mg/L
cBOD: Carbonaceous ROD, 5-day mg/L
Coliform: Fecal MF /100mi
Coliform: Total MF /100m1
Coliform: Tube Fecal /100ml
Coliform: Tube Total /10om1
Specific Conductance, at 25 °C umhos/cm
TOC - Total Organic Carbon mg/L
Turbidity .NTU
-,;4.74tNerChOirsfrAileg mete-.O.MMsIM.F4 "• et
x
x
x
Bromide
mg/L
Chloride mg/L
Fluoride
Sulfate
Chlorophyll a
mg/L
mg/L
pg,/L
Color: ADMI
Color: Platinum Cobalt
COD: Chemical Oxygen Demand -
Cyanide, Total
Formaldehyde
Hexavalent Chromium (Cr6+)
LAB COMMENTS :
c.u.
c.u.
mg/L
mg/L
mg/L
mg/L
FieldiParamtitersiaptt meg
,tr..s.�s:.aa,
r..
Y4lat��rteopp,(°A:(6.82,
MBAS (surfactants)
mg/L
Oil and Grease, HEM, Total Recoverable mg/L
pg/L
Phenols, Total Recoverable
Residu e: Total (Total Solids) mg/L
Residue: Volatile/Fixed, Total mg/L
Residue:Suspended (Suspended Solids) mg/L
Residue: Volatile/Fixed, Suspended
mg/L
TDS-Total Dissolved Solids mg/L
Silica
mg/L
Sulfide mg/L
Tannin & Lignin mg/L
"t1Ot}ier:Parameeis.... al
pH
s.u.
Hardness, Total as CaCO3 - by titration mg/L
FM.Nuti'ients�ParametE 74
x
Ammonia as N (NH3-N)
Nitrate -Nitrite as N (NO3+NO2-N)
Total K)eldahi Nitrogen as N (TKN)
Total Phosphorus as P (TP)
Nitrite as N (NO2-N)
Nitrate as N (NO3-N calculated)
Orthophosphate as P (PO4)
mg/L
mg/L
mg/L
mgJL
mg/L
mg/L
mg/L
DissoIAOxygent(ppm);
x
Location Type.
❑ Rive r/Stream
❑Estuary
❑ Stormwater
❑Monitoring Well
['Effluent
['Field Blank
['Filter Blank
Other:
NletatslRarameted:
Aluminum (Al)
x
.x
x
.x
Antimony (Sb)
Arsenic (As)
Barium Ma)
Beryllium (Be)
Cadmium (Cd)
Calcium (Ca)
Chromium (Cr), Total
Cobalt (Co)
Copper (Cu)
Iron (Fe)
Lead (Pb)
Lithium (Li)
Magnesium (Mg)
Manganese (Mn)
Mercury (Hg)
Molybdenum (Mo)
Nickel{Ni)
Potassium (K)
Selenium (Se)
Silver (Ag)
Sodium (Na)
Strontium (Sr)
Thallium (TI)
2.dz
❑Lake
❑Canal
❑ Water Supply
❑Influent
❑Trip Blank
Influent Port
Contains
1:3 •
Sultltilt Acid
SA-• 5og2a4a
EXP: G41a2116
ti'„ tlin t
Sep OS
pg/L
pg/L
pg/L
pg/L
pg/L
pg/L
mg/L
pg/L
pg/L
pg/L
pg/L
pg/L
µg/L
mg/L
pg/L
pg/L
pg/L
pg/L
mg/L
pg/L
pg/L
mg/L
pg/L
pg/L
Conductnrity(NmhosJcm). ` 4
__ 03 5 ,
geolgzo,kwie
c
toboratory
Sample Nil 6 ri
a te`Rececefvedtr
IS
:Ar��nee'Ijeceived• tr
l-2.
•
r'Dell eNNiettrodt
U Slab Courier
❑Hand Delivery
['Other:
Tin (Sn)
µg/L
Titanium (Ti) pg/L
Vanadium (V) pg/L
Zinc (Zn)
pg/L
Boron (B), Total ugll
Mercury 1631, low-level ng/L
Organia;Pararoet.5:
• Acid Herbicides
Organochlorine Pesticides
Organonitrogen Pesticides
Organophosphorus Pesticides
PCBs (polychlorinated biphenyls)
Semi -Volatile Organics (BNAs)
TPH Diesel Range
Volatile Organics (VOA)
TPH Gasoline Range
Phytoplankton /Algae
51inity'(pp'�t}-i
Revision: 2/06/2015

WATER QUALITY RE'GIONALL OPERATIONS SECTION
APPLICATION REVIEW REQUEST FORM
te: December 2, 2(915
To: Andrea Pitfner
:From: Michael Rogers, WQROSm- Anima l :Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: Michael. Rogers( thncdenr.,gov
Permit Nun"W1030011
Applicant: l3arilc
C. Facitity Name:
D. Applieatiun:
Permit Type: Geothermal Heating/Coolit:p wa�at:e
Prof it Type: Renewal
F. Corn:rnentsl'Qther Inforrnat:ion:
[� I ,ould like to a :c ata-tpannv aft on a site visit.
Return: Well
WUriOS
Attached, you will find all information submitted in support ot'ttte above -referenced application for your
review, comment, andlor actWithin 30
Report.
When you receive this reque
this sheet, and return
listed above,
RCS-WQROS Re%ies er:
OMMENTS:
Ida r days, please return a completed WQROS Staff
ease wriand dates in the spaces below make a c
private: Central Office Groundwater Protection Branch
QR0S-ARK ver.4,s? tslst
0

Water Resources
ENVIRONMENTAL QUAIITY
2015
RE: Aclenowledgenrent ofApplicati-In No, \ - "001 (2
(3eothcnnarl lleatinrr`'C'ooling Water°R.ei:ua'rr �1ell
lredelt County)
"vlr. and Mrs. Barite
PAT MCCRORY
DOA R. VAN DER VAART
se rarroow
S. JAY IMMF..RMAN
Orrecrot
The Water Quality Regional Opera tta ns Section (WQROS) acknowledges receipt
permit: application and supporting documentation received on November 23, ', 015,
application package has been assigned the number listed above, and the primary revi
Michael Rogers,
`our..
Central and Moor,. ill Regional Office staff wv^ill perform a detailed revof 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 re
90 days after receipt of a complete application
application
ave
Michael Rogers at (q 19) 807-6406 or uric laatelrrca c rs"£i ncdenr.gov.
\QR.
erely,
ue
ake as lot tt as 60 to
[)ebra J, Watts, Supervisor
eding Operations & Groundwater
Res
Satre of Nortk, Carolrr a Enthroatakr+u 0$ ualio Water r r`scthroe r
S'::ear thRNor Cowl P0egh, aar:at .aalsa it•s �-9tid€
9 i19 707 9000

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of I5A NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELLS
These wells injectgroundwater directly into the subsurface as part of a geothermal heating and cooling system
(check one) New Application /RenewaI * Modification
* For renewals complete Parts A-D and I, the signature page.
Print or Type Information and Mall to the Address on the Last Page.
DATE: t [ [ ? , 20 f 5
PERMIT NO. (A)1Q3OO I (aZ (leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Non -Government: Individual Residence
Government:
Illegible Applications Will Be Returned As Incomplete.
RECEIVED/DENRIDWR
NOV 2 3 2015
Water Quality Regional
Operations Section
Business/Organization
State Municipal County ' Federal
B. WELL OWNER/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 on b5half of the business or agency:
J1-1.ti -~.._ . Vl r I +'1 1
Mailing Address: ? OD C..,O(--) 1,-).1-(" S ( (D . e..1) ii
City: Pt ft (L yin c) A/ State: A/C -Zip Code: 2-Pa 3 `� County: _1 re j -(� I�
Day Tele No.: 70--1-- `6 6 ---7 `!' G d Cell No.: c i 1 - (-/ S Cs 4:1V 7 1
EMAIL Address: J cl G, r' ;1 ri- c' C i — &< i t. Co ".% Fax No.:
C. WELL OPERATOR (if different from well owner) - For individual residences, list owner(s) on property
deed. For all others, list name of entity and name of person delegated authority to sign on behalf of the
business or agency:
Mailing Address:
City: State: Zip Code: County:
Day Tele No.: Cell No.:
EMAIL Address: Fax No.:
D. LOCATION OF WELL SITE - Where the injection wells are physically located: ff
(1) Parcel Identification Number (PIN) of well site: CO li 7 ' oab County:, r, e
(2) Physical Address (if different than mailing address):
City: State: NiNC Zip Code:
GPU/UIC 5A7 Permit Application (Revised 5/23/2014) Page I

E. WELL DRILLER INFORMATION
Well. Drilling Contractor's Name:
NC Well Drilling Contractor Certification. No.:
Company Name:
Contact Person
Address:
EMAIL Address:
City: Zip Code: State: County:
Office Tele No.: Cell No.: Fax No.:
F. HVAC CONTRACTOR INFO ON ' than driller)
HVAC Contractor's Name:
NC HVAC Contractor License No.:
Conipany Nainc:
Contact Person:
Address:
City: Zip Code:
Office Tele No,: Cell No.:
EMAIL Address:
County:
Fax No.:,
G. WELL USE Will the injection well(s) also be used as the supply : 's) for the following?
(1) The injection operation?
(2) Personal consumption?
11 WELL CONSTRUCTION REQUIREMENTS — As specified in .15A NCAC 02C .0224(d):
(3)
YES
YES
NO
NO
The water supply well shall be constructed in accordance with the water supply well requirements of
I 5A Nc_A(7 0;?(.7Q,
'la separate well is used to inject the heat pump effluent, then the injection wellshall, be constructed
in accordance withthe water supply ‘vell requirements of 15A NCAC 02( .01.07„ except that:
(a) For screen and gravel -packed wells, the entire length of casing shall be grouted fromthe top
of the gravel pack to land surface;
(b) For open-end wells without screen, the casing, shall be grouted from the hottoin 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.
(Revised 5/23/2(11,1)
l'age 2

I. 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 •ofthe . 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
ntg/L chloride or greater per 15A NCAC 02C . 0107(f) ($)
(f) Length of well screen or open borehole and depth below land surface
(g) Length of sand or gravel packing around well screen and depth below land surface
J. OPERATING DATA
(1) Injection Rate: Average (daily) 6 gallons per minute (gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average (daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) ° F.
K. SITE MAP — As specified in 15A NCAC 02C .0224(b)(4), 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 wells) are
to be located.
(4) An arrow orienting the site to one of the cardinal directions (north, south, west, or east)
NOTE: In most cases an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand Also, a `layer' can be selected showing topographic contours or
elevation dada.
Page 3
GPU/UJC 5A7 Permit Application (Revised 5/2.3/2014)

•
CERTIFICATION (to be si
,d as required below or by that person's authorized agent)
NCAC O2CO2 f,1(e) requires that all permit applications shall be signed as follows:
I . for a corporation: by a responsible corporate officer;
2, fir a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
for a municipality or a state, federal, or other public agene: by either a principal executive
officer or ranking publicly elected official.
4. for all others: by the well owner (person(s) listed on the property deed)_
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf,
hereby e ertit" °, under penalty ()flaw, that I have personally exatnined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
itttn°tediately responsible for obtaining said information, I believe that the information is true, accurate and
complete, 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."
Submit two copies of the comp
Property Owner/Applicant
c
Name
fAutliori ed Agent,
Name
'td application package to:
der rounel Injection Control 1'rttgram
isl+att of Water Resources
1636 Mail Service Center
l:aleigh, NC 27699-1636
hone (919) 8t17-6496

4
North Carolina Division of Water Resources
Central.Laboratory (Water Sciences Section)
Water Sample Collection & Submittal Form
4y - r A_.
iocationppio7pjni
onr John and Virginia Barile, 200 Countryside Road, Harmony, NC
_ti ri. Coririty:it �.`. Iredell
.'. s
DWR_Reglons.: r
4:1-7/0diais.;gcrifOrtryl.'
MRO
,Lueatidrr.Code . `
•
VisitJD: :.
(optiona(
W 103000162-EF F
Tqc�
1D•� _
1 .Collecto :.•: E Watson/ M. Schutte
DR Offrce ':{ MRO
194egency n ameJ
•tflx•River Basin:•—
Yadkin -Pee Dee
12/15/2015
Notes:
U(C System Inspection
.1 (', 44-S AM
❑ Chlorinated ❑De -chlorinated in Field
Sampan g
.Method: .
Grab 11Composite
Other: Pump
Dissolved analysis: Enter'01S"
❑ Filtered in Field in check -boxes for parameters
p•
le Depth:!
�,�Prlar.Ity: _•
;
❑ Ambient
❑ Routine
E Compliance
❑ co
❑ Emergency
❑CIA
kW •Matrb
❑ Surface
2 Ground
❑ Waste
❑ Blank
❑Solution
Cn!lecrar'scomments:,. fat. 35.989371 Long._80.769202 "Analyze Bacteria samples regardless of hold time."
~;;:Microbldfagjr,PaFaineteis:.=q�;,� .•• _, : �i
x
x
x
X
x
Acidity, as CaCO3, to pH 4.5/8.3 mg/L
Alkalinity, as CaCO3, to pH 4.5/8.3 mg/L
BOD: Biochemical Oxygen Demand, 5-day mg/L
cBOD: Carbonaceous BOD, 5-day mg/L
Collform: Fecal MF /100ml
Collform: Total MF /100m1
Collform: Tube Fecal /100m1
Coliform: Tube Total /100m1
Specific Conductance, at 25 °C umhos/cm
TOC- Total Organic Carbon mg/L
Turbidity NTU
Wet chamiss--ry'iParai.eters;t=z- " 'h01...=` V41;
Bromide mg/L
Chloride mg/L
mg/L
Fluoride
Sulfate mg/L
Chlorophyll a pg/L
Color: ADM!
C.U.
Color: Platinum Cobalt
C.U.
COD: Chemical Oxygen Demand
Cyanide, Total
Formaldehyde
Hexavalent Chromium (Cr6+)
LAB COMMENTS :
Fla,1iiAarame�teregooara rs
;wale Teempi(!er.h,
mg/L
mg/L
mg/L
mg/L
x
x
x
x
MBAS (surfactants) mg/L
Oil and Grease, HEM, Total Recoverable mg/L
Phenols, Total Recoverable pg/L
Residue: Total (Total Solids) mg/L
Residue: Volatile/Fixed, Total mg/L
Residue: Suspended (Suspended Solids) mg/L
Residue: Volatile/Fixed, Suspended mg/L
TDS- Total Dissolved Solids mg/L
Silica mg/L
Sulfide mg/L
Tannin & Lignin mg/L
pH
S.U.
Hardness, Total as CaCO3 - by titration mg/L
Niiti;igiitS P.aramete?s:. • :; Aar,', ) • '";"`:_ - ,'
Ammonia as N (NH3-N) T mg/L
Nitrate -Nitrite as N (NO3+NO2-N)
Total Kleldahl Nitrogen as N (TKN)
Total Phosphorus as P (TP)
Nitrite as N (NO2-N)
Nitrate as N (NO3-N calculated)
Orthophosphate as P (PO4)
9. 1,
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
tir
y 'L'oat on Type; :a � % • `Y
❑River/Stream El Lake
Estuary ❑Canal
❑Stormwater
❑Monitoring Well ❑Water Supply
❑Effluent ❑Influent
❑Field Bfank ['Trip Blank
❑Filter Blank •
0Other: Efluent Port
, -• Metals:Paranieters: is
x
x
x
x
x
x
x
x
x
x
x
x
x
x
�Dissoived,Oxygen POrn) j+2.ia
Aluminum (Al)
Antimony (Sb)
Arsenic (As)
Barium (Ba)
Beryllium (Be)
Cadmium (Cdl
Calcium (Ca)
Chromium (Cr), Total
Cobalt (Co)
Copper (Cu)
Iron (Fe)
Lead (Pb)
Lithium (Li)
Magnesium (Mg)
Manganese (Mn)
pelt
pg/L
pg/L
pg/L
pg/L
pg/L
mg/L
pg/L
ug/L
pg/L
pg/L
pg/L
pg/L
mg/L
Mercury (Hg)
Molybdenum (Mo) pg/L
pg/L
Nickel (Ni)
Potassium (K)
Selenium (Se)
Silver (Ag)
Sodium (Na)
Strontium (Sr)
Thallium (TI)
•
pg/L
pg/L
mg/L
pg/L
pg/L
mg/L
ilg/L
pg/L
Conductrvvity,(pmhos/cm)•v L9
i:,fe•i,..a •...li!&d•--., .. rvr =. • (v7
x
C#3
SamplelNpmber: ��,���
Dote Received:
•lime Received:;
gRece iBy•sr
".30
"ram""''r' Ustate auder
DelNely— rethad:: ❑Hand Delivery
c,,:.: ,• ❑Other:
Tempe-rature (`C1'
' an Arrival:
Tin (5n) pg/L
Titanium (Ti) ug/L
Vanadium (V)
pg/L
Zinc (Zn) pg/L,
Boron (B), Total
Mercury 1631, low-level ng/L
Acid Herbicides
0rganochlorine Pesticides
Organonitrogen Pesticides
Organophosphorus Pesticides
PCBs (polychlorinated blphenyfs)
Semi -Volatile Organics (BNAs)
TPH Diesel Range
pg/L
PH r ]: +nge Contains
s Add _
SA—$0g2Q4i? tiitfit Acid •-
h�+f =u4/p r ae HA=5049100
2/' EXP:02118111i
SeeMSOS . Warning!
See MSDS
; ti^• ▪ 5alinit pt
Volati! ss (V�
Conlalr_
T
ulfuri
Biota-
Warning!
Revision: 2/06/2015

AC25206
NCTOWX Water Sciences Section-CFiemistryLaboratory lesults
County: Iredell
Rivar Basin Yadkin- Pee Dee
Report To DWM
Collector: a WATSON
Region: MRO
Sample Matrix: GROUNDWATER
Loc. Type: Eftuent Port
Emergency Yes/No
COC Yes/No
Division of Water Resources
Final Report
VisilID
Sample ID: AC25206
PONumber # 15G0314
Date Received; 1211612015
Time Received: 08:30
Labworks LoginiD MSWIFT
Final Report Date: 115116
Report Print Date: 01/05/2016
Loc. Descr.: JOHN AND VIRGINA BARILE, 200 COUNTYSIDE ROAD. HARMONY. NC
Location ID:
W103000162 EFF
Collect Dale: 12115/2015
Collect Time: 11:45
Sample Depth NA
If this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
CAS # Analyte Name.
LAB
Sample temperature at receipt by lab
PQL
Result!
Qualifier
1.7 °c
Units
Method Analysis Validated by
Reference Date
12/16/15 MSWIFT
MIC
Coliform, MF Fecal In liquid
1
1 B2Q1 CFUI10Dm1 APHA92220-20th 12/16/15 ESTAFFORD1
Coliform, MF Total in liquid
1
1 B2Q1 CFU1100m1 APHA922213-20th 12/16f15 ESTAFFORD1
WET
Ion Chromatography
TITLE
mg/L
EPA 300.0 rav2.1 12/16/15 CGREEN
Fluoride
0.4 0.66
mg/L
EPA300.0 rev2.1 12/16/15 CGREEN
Chloride
1.0 1.1 mg/l. EPA 300.0 rev2,1 12/16/15 CGREEN
Bromide
0.4 0.4.0 mg/L. EPA 300.0 rev2.1 12/16/15 CGREEN
Sulfate
2.0 19 mg/L EPA300.0 rev2.1 12/16/15 CGREEN
Total Dissolved Solids in liquid
12 114 mg/L SM 2540 C-1997- 12116115 CGREEN
NUT
NO2+NO3 as N in liquid
0.02 0.02 U mg/L as N EPA 353.2 REV 2 12/21/15 CGREEN
Nitrate as N in liquid
0.02 0.02 U mg/L as N EPA 353.2 REV 2 12128/15 CGREEN
Nitrite as N in liquid
0.01 0.01.0 mg/L as N EPA353.2 REV 2 12/17/15 CGREEN
MET
7440-22-4 Ag by ICPMS
1.0 1.0 U.
ug/L
EPA200.8 12/18/15 ESTAFFORD1
7429-90-5 AI by ICP
50 50 U ug/L EPA200.7 12/21/15 ESTAFFORD1
744e-3B-2 As by ICPMS
2.0 2.0,U ug/L EPA200.B 12/18/15 ESTAFFORDI
7440-38-3 Ba by ICP
10 10U
ug14
EPA 200.7 12118/15 ESTAFFORDI
7440.70-2 Ca by 1CP
0.10 8:3 mg/L EPA 200.7 12/18/15 ESTAFFORD1
7440-43-9 Cd by ICPMS
0.50 0.50 U ug/L EPA200.8 12/18/15 ESTAFFORDI
7440-47-3 Cr by ICPMS
5.0 5:0 U ug/L
EPA 200.8 12/18/15 ESTAFFORD1
7440-50-8 Cu by ICPMS
2.0 4:3 ug/L EPA200.8 12116115 ESTAFFORD1
7439-89-6 Fe by 1CP
50 50.0 ug1L - EPA200.7 12/21/15 ESTAFFORD1
Hardness by Calculation
1.0 25 mg/L SM23408EPA200.7 1/5/16 ESTAFFORDI
7440-09-7 K by ICP•
0.10 0.68 mg/L EPA200.7 12/18/15 ESTAFFORDI
7439-95-4 Mg by ICP
0.10 1.1 mg/L EPA 200.7 12/18115 ESTAFFORD1
7439-96-5 Mn by ICP
10 10 U. Mg1L EPA200,7 12/21115 ESTAFFORDI
7440-23-5 Na by ICP
0.10 28
mg/L
EPA 200.7 12/18/15 ESTAFFORD1
7440-02-0: NibyICPMS
2.0 2.0 U ug/L EPA200.8 12118/15 ESTAFFORDI
Vie
WSS Chemistry Laboratory->.1623 Mall Service Coiner,. Raleigh, NC 27699-1623 (919).733-3908
For adala➢eddescrfOtiorlofnieauat miles refer to <htto:// norial .tedepr.orefw ebfwa /otos kriethoci.s'and-Da1S>
Page 1 of 2

V DW& Ca6oratorySection &suits
Location ID: W103000162_EFF Sambre ID: AC25206 Collect Date: 1211512015 Collect Time:: 11:45
MET
CAS #
7439-92-1
Analyte Name
Pb by ICPMS
PQL
2.0
Result!
Qualifier
2.0.0
Units
ug1L
Method Analysis Validated by
Reference Date
EPA 200.8 12/18115 ESTAFFORD1
7782.49-2 Se by ICPMS
1.0 1.0 U ug1L EPA200.8 12/18/15 ESTAFFORD1 •
7440-66-6 Zn by ICPMS
10 10 U ug1L EPA200,8 12118115 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mall Service Center Raleigh, NC,276%9-1623 (919).733-3908
Fora cletagod aesglwion of the aua:iiier aides mkt to<h_ttt):/1Dortal. licdenr.ort=lweb/walops/methods-and-nals>
M Page 2 of 2 __ - _ .

Water Resources
ENVIRONMENTAL QUAL„tr*
Janus
John D. and Virginia M. Barile
200 Countryside Road
Harmony, NC 28634
: 15. 2016
Re: Issuance of Injection Well Permit
Permit No. W10300162
Geothermal Heating/Cooling Water Return Well
iredell County
Dear Mr. and Mrs,. 'Barile:
PAT MCCRORY
Uovemor
DONALD DER VAART
S. JAY ZIMMERMAN
lArrector
gt.t,',CERIt iNc D:ENA.(yeiR
6666; 2 6 !666
WQROS
MOOR!: SA/ ,,t„ R f6l4 „ OFF CE
In accordance with. your permit renewal .application received November 23, 201.5,1 ant forwarding
Permit No. W10300162 for the, continued operation of geothermal 'heating/cooling water return
well(s) located at the above referenced address, This permit shall be effeetiVe .from date of issuance,
until 'December 31, 2020, and shall be subject to the conditions and limitations stated therein.
Please Note:
Samples from the influent and effluent sampling ports of your geothermal well system
were collected by. the Mooresville Regional Office on December 15, 2015. Laboratory,
analytical results were sent to you on January 5, 2016.
1.11 order to continue uninterrupted legal use of this Wel l 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. ‘vithout prior notice to, and approval by., the Director of the
Division of Water Resources., If put have any questions regarding your permit or the Underground
tnieetion Control .Program please call rne at [phone],
Best .Regards,
Nltichael Roger. „G. (N.(' &I"1„,)
I„',inderground Injection Control WIC), Manager - droJcnEog
Division of Water Resources„ NCDEQ
Water Quality Regional Operations Section
StaR* Nonh Carnirtm Fiworonmental Owitrtv i Water Re.,0(if ces
16 matl senlce ; R.0 k!,0, Nc2=t1h.C'WOinA .2;[,,,rq- to 1,1
91,a 401),9

Andre r itn r star
Central Office 1 i1 m 1v030016
Iredell County n n enta1 H a t1
Reg
epartn er

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
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
John D. and Virginia M. Barite
FOR THE CONTINUED 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 200 Countryside Road, Harmony, Iredell
County, NC 28634 will be operated in accordance with the application submitted November 23, 2015, and
conformity with the specifications and supporting data, all of which are filed with the Department of
Environmental Quality and are considered a part of this permit.
This permit is for continued operation of an injection well shall be in compliance with Title I5A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until December 31, 2020, and shall be
subject to the specified conditions and limitations set forth in this permit.
Permit issued this the 15th day of January 2016.
r1-4{
S. Jay Zimmerman, P.G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission.
Permit #W103001.62
U1C/5A7
ver. 11/15/2015
Page 1 of 5

PART I — PERMIT GENERAL CONDITIONS
11.
1. The Permittee shall comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is grounds
for enforcement action as provided for in N.C.G.S. 87-94
2. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [15A NCAC 02C .0211(a)].
3. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data [15A NCAC 02C .0211(1)].
4. This permit is not transferable without prior notice and approval. In the event there is a desire for the facility
to change ownership, or there is a name change of the Permittee, a formal permit amendment request must
be submitted, including any supporting materials as may be appropriate, at least 30 days prior to the date of
the change [15A NCAC 02C .0211(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 in accordance
with the requirements of rule 15A NCAC 02C .0107 except as required in Item #2 below.
2. Any injection well shall be constructed in accordance with the requirements of rule 15A NCAC 02C .0107
except that the entire length of the casing shall be grouted 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.
For screened wells, grout shall be emplaced from the top of the gravel pack to the land.surface. For open-
end wells, the casing shall be grouted from the bottom of the casing to the land surface [15A NCAC 02C
.0224(d)(2),(3)].
3. Bentonite grout shall not be used to seal any water -bearing zone with a chloride concentration equal to or
greater than I,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. 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)].
5. 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).
. 6. Each well shall have permanently affixed an identification plate [15A NCAC 02C .0107(j)(2)].
Permit #W10300 i 62
UIC/5A7
per. 11/15/2015
Page 2 of 5

7. _A completed Well Construction Record (Form GW-1) shall be submitted as described in Part V.5 of this
permit.
PART III — OPERATION AND USE CONDITIONS
1. The Permittee shall comply with the conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and the rules of 15A NCAC 02C .0200,
even if compliance requires a reduction or elimination of the permitted activity [15A NCAC 02C .0211(j)].
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. 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 [15A NCAC 02C .0206].
PART IV — INSPECTIONS [15A NCAC 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
obtain samples of groundwater, surface water, or injection fluids.
2. DWR representatives shall have reasonable access for purposes of inspection, observation, and sampling
associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting -any necessary samples of the injection facility's activities.
PART V = MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction, repair, or abandonment shall be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on -site and available for inspection [15A NCAC
02C .0224(f)(2), (4)].
2. Monitoring of any well may be required to ensure protection of the groundwater resources of the State and
compliance with the groundwater quality standards specified in 15A NCAC 02L [15A NCAC 02C
.0224(f)(1)].,
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 standards, or
that a malfunction of the injection system may cause the injected fluids to migrate outside the approved
injection zone or area. As specified in rule 15A NCAC 02C .0211(r), noncompliance notification shall be
as follows_
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence, to the Mooresville Regional Office, telephone number 704-663-1699.
(B) Written notification shall be made within five days of the occurrence and submitted to the addresses
in Item 45 below.
Permit #W10300162
U IC/5A7
ver. 11/15/2015
Page 3 of 5

(C) The written notification shall contain a description of the noncompliance and its cause; the period o`
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. The Permittee shall record the number and location of the wells with the register of deeds in the county in
which the facility is located. [15A NCAC 02C .0224(f)(3)].
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 Mooresville Regional Office
610 East Center Ave.
Mooresville, NC 28115
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.
Permit 1I WI0;00162
UIC15A7
ver. 11 /15/20 15
Page of5

-PART VII — CHANGE OF WELL STATUS [15A NCAC 02C .0240]
1. Procedures for temporarily or permanently abandoning a well are the same as those specified in rule I5A
NCAC 02C .0113. While some of those criteria are given below, the Permittee bears the responsibility of
complying with all applicable regulatory requirements.
2. If a well will no longer be used for any purpose, then it should be permanently abandoned according to rule
15A NCAC 02C .0113(b) in order to prevent the well from deteriorating and acting as a source or conduit
of contamination, which is prohibited by General Statute 87-88(c).
3. If a well is taken completely out of service temporarily, the Permittee shall install a water -tight cap or well
seal that cannot be removed without the use of hand or power tools.
4. When injection operations have ceased at the facility and a well will no Ionger be used for any purpose, the
Permittee shall permanently abandon that injection well in accordance with the procedures specified in 15A
NCAC 02C .0113(b), which include, but are not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
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 in accordance with rule 15A
NCAC 02C .0111(b)(1)(A),(B), and (C).
(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 those cases when a subsurface cavity has been created as a result of the injection
operations, each well shall be abandoned in such a manner that will prevent the movement
of fluids into or between underground sources of drinking water.
(F) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0224(f)(4) within 30 days of completion of abandonment.
5. The written documentation required in Part VII (4)(F) shall be submitted to the addresses specified in Part
V.5 above.
Permit # W103 001 62
UIC/5A7
ver. 11/15/2015
Page 5 of 5

Pat McCrory
Governor
NCDENR
North Carolina Department of Environmental Quality
November 3, 2015
CERTIFIED MAIL # 7014 1200 0001 3432 8510
RETURN RECEIPT REQUESTED
John and Virginia Barile
200 Countryside Road
Harmony, NC 28634
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No. WI0300162
Iredell County
Dear Mr. and Mrs. Bartle:
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, 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 December 9, 2010, and expires on November 30, 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 the permit if you wish to continue operating the injection well
on your property. According to our records, the permit renewal application is now past due.
Please submit your renewal 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 BeingUsed 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.ncd enr. org/web/wqlaps/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
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: 9l9-8G7-64641 Internet hitp:/Iwww.ncwater.org
An Equal opportunity l Affiunaiive Action Employer— Made in pail by recycled paper

Barile SFR Page 2
according to the regulatory requirements listed under 'NCAC Titlel5A, 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.
If There has been a Change of Ownership of the Property:
If there has been a change of ownership of the property, an -Injection Well Pennit
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
VIC 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 z,tt .Michael.R.ogers*iedenr.gov.
Regards.
Michael Rogers, P.C. (NC & FL.)
Ilydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: :Mooresville- Regional Office -- WQROS w/o enclosures
Central Tiles - 'Permit No. W10300162 w/0 enclosures

Courrly; IREDELL
Rlwer Basin
Report To MROAP
Golfectar: t AliridE
Region MR© a
Sari ple Matrix: GRQUN'D k?ATER.
t_ec. Type: WATER U E1X
Emrargency Yes/No„
CtJ,` YesfNo
WI030012EF
CAS # At1alyte Name
LA B
mole temperature at receipt by lab
Visit
Result/.
Qualifier
2.1
Sample ID: AB65746
PO Number d igTat73#3
Dale Received: 111712010
Time Received: 0810
Labworks Lo9eiiD HPARI(ER
Report Generated. 12/20110
Date Reported' 12120/2010
cs Time: 11:32
Units
ct Analysis voli s
Reference Date Y
11117110 SMATHIS
MIC
WET
orn1, ME Fecal in liquid
lon Chronlato iraph`y
Chloride
Fluoride
1 B2Q1
CFII(100m1 APHA92220-20th
`TITLE.
1.0
4
mg/L
EPA 300,0
EPA 300,0
CGREEN
11/18110 CGRE.EN
11l18$10 CGREEN
EPA '300.0
0 CGREEN
Suifate
2
mgrL
EPA 300,0
CGREEN
Total Ilsolved ,Solids
lieuid 12
NUT
N©2+NO3 as. N in 'liquid
0,02 0.02 U
mg/L as N
APHA2540C•18TH
/10 CGREEN
Lac10-107-04-1-c 11119/10 CGREEN
Nitrate as N in liquid
Nitrite as N in liquid
0 02 0.02 U
11 . 0.01 U
mg/L as N
N
107-04-1-,-c 11/23110
7-04
MET
7429-90-5 Al by ICP
7440.38.2 As by ICP
7440-38-3 Ba by ICP
7440-70-2 Ca by ICP
/44s a s 9 by ICPMS
440-41 3 Cr by ICP
7440-50-8 Cu by tCPM.S
7409-89-6 Fe by 1CP
4
ug/L
50
50 U
2 2.0 U
0 10 U
10 U ugd'I
3.4
50 U
ug/L
EPA '200.7
11/23(10 ESTAFFORDI
PA 1?I23/1b ESTAFFORD1
EPA 200,7 11/2 /10 ESTAFFORD1
EPA 200,8
EPA 200.7
1.1/23I10 ESIAFFQRDI
11i23/10 ESTAFFORD1
EPA 200,7 11R3/10 ESTAFFQRD1
by ICP
0'1
5
7439-96-5 Mn by ICP
10
U
u
EPA 200,7
EPA 200,7
/1123/10 ESTAFFORD1
ESTAFFORD1
7440-23-5 Na by ICP
7440 '3260 Ni by ICPMS
74'39 92°1 Pb by ICPMS
7782-49.
744
Se by ICPMS
Zn by 1CPMS
32 mg/L EPA 200,7
0 ESTAFFORD1
10 U
iU
ug/L
EPA 200.8 11/23/10 ESTAFFORD1
EPA 200,8
23(10 ESTAFFORD1
5
0
5,0 U
u
EPA 200,8
ESTAFI-0RD1
10 U
EPA 200,8
11/23/10 ESTAFFORD1

Date: 11/16/2010
Temp.io G„ (, • °C ,Odor 1
Appearance i.7 0.,E'- j
Field Analysis By: Maria Schulte
LABORATORY ANALYSES
BOD 310
mg/L
COD High 340
mglL
CCD Low 335
mglL
X
Caliform: MF Fecal 31616
I10om1
X "
Colifonn: MFTotal 31504
1t00m1
T0C 680
mg/L
Turbidity 76
NTU
Residue, Total Suspended 530
mg/L
•
pH 403
units
Alkalinity to pH 4.5 410
mg/L
Alkalinity to pH 8.3 415
mglL
Carbonate 445
mg/L
Bicarbonate 440
mg/L
Carbon dioxide 405
mg/L
X
Chloride 940
mglL
Chromium: Hex 1032
uglL
Color: True 80
CU
Cyanide 720
mg/L
GROUNDWATER FIELD/LAB FORM
Location code .W10300162-EFF
Countylredell
Quad No Serial No.
Lat. Long.
Report To: ARO, FRO, MRO, RRO, WaRO, WiRO,
SAMPLE TYPE
❑ Water
❑ Soil
O Other
❑ Chain of Custody
SAMPLE PRIORITY
0 Routine
❑ . Emergency
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by:Bus, Courier, Hand Del.; Other:
Collector(s): Maria Schulte
FIELD ANALYSES
pH 400 Z,12, Spec. Cond.94 /516 ' rS
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
Purpose: UIC System Inspection
lam° �n� l �5��
Lab Number II %
Date Received i l ' 11' ' l o Time:
Rec'd By: From:Bus;
Other.
30
Hand Del.,
Data Entry By: 1 Ck:
Date Reported:
Time /C` ? L Baseline, C int, Compliance, LUST, Pesticide Study, Federal Trust, Other:
w rcre one)
Owner. Oataw� �-s� (�rJ l� r, �e
at 25°C Location or Site: 200 Countryside Road, Harmony
r (& ( Description of sampling point: Effluent
Sampling Method: Pump
Remarks {Numu. bauer, etas
(Pumping lima, air temp., etc.)
X
Diss. Solids 70300
mg/L
XFluoride
951
mg/L
X
Hardness: Total 990
. mg/L
Hardness (non-carb) 992
mg/L
Phenols 32730
ug/I
Specific Cond. 95
pMhoslcm
X
Sulfate 945
mglL
Sulfide 745
mglL
Oil and Grease
mg/L
NH3 as N 610
mg/L
TKN es N 825 .
mg/L
X
NO2- + NO3 as N 630
mglL
P: Total as P 665
mglL
X
Nitrate (NO3as N) 620
mg/L
X
Nitrite (NO2 as N) 615
mg/L
Ag-Silver 46566
uglL
X
Ai -Aluminum 46557
uglL
X
As-ArsenIc 46551
ug/L
X
Ba-Barium 46558
uglL
X
Ca -Calcium 46552
mg/L
X
Cd-Cadmium 46559
ug/L
X
Cr-Chromium 46559
ug/L
X
Cu-Copper 46562
uglL
X
Fe -Iron 46563
ug/L
Hg-Mercury 71900
ug/L
X
K-Potassium 46555
mg/J.
X
Mg-Magneslum 46554
mglL
X
Mn-Manganese 46565
ug/L
X
NaSodlum 46556
mgn.
X
NI -Nickel
ug/L
X
Pb-Lead 46564
ug/L
X
Se-Selenlum
ug/L
X
Zn-Zinc 46567
uglL
Sample Interval
Organochlorine Pesticides
Organophosphorus Pesticides
.
Nitrogen Pesticides
Add Herbicides
PCBs
r
Semivolatile Organics
TPH-Diesel Range '
Volatile Organics (VOA bottle)
TPH-Gasoline Range
TPH-BTEX Gasoline Range
LAB USE ONLY
4 ,
Temperature on arrival (°C): 2,
Lab Comments
GW-54 REV. 7103
For Dissolved Analysis -submit filtered sample and write "DIS' In block.
- ( f 4-) `I =' ,J Ay,

DWR Laboratory Supplies Request Form
Email general supply orders to NCDENR.ChemLabOrders
Email EPA 1631 Hg Sampling Kit orders to denr.dwq.mercurykit C1,1ists.ncmail.net.
Requestor
Edward Watson
Telephone
704-235-2188
Section/Location
MRO
Date
12/07/2015
Item
# Requested
Unit
Analyses
Chemicals
1+1 Nitric Acid
1
Case of 24 ampoules
Metals
1:1 Sulfuric Acid
1
ml as requested — contact lab
Total Phenolics, Pest/PCB and Acid
Herb
Conc. Phosphoric Acid
1
Case of 24 ampoules
TOC, DOC
25% Sulfuric Acid
1
Case of 24 ampoules
Nutrients, COD
10% Sodium Thiosulfate
30 ml dropper bottle (ea.)
NH3, TKN, CN, Phenol, VOA — water
quality, SVOA, Pest/PCBs, Acid Herb.
deCl2
6N Sodium Hydroxide
10
30 ml dropper bottle (ea.)
CN, Sulfide, Pest/PCB, Acid Herb.
Ascorbic Acid
1
Pack of 10 vials (0.6 g ea.)
CN, VOA — ground water deCl2
Sodium Bisulfate
1
Pack of 10 vials (0.25 g ea.)
VOA —ground water
Ferrous Ammonium Sulfate
Pack of 10 ampoules
Total Phenolics
6N Sulfuric Acid
10
ml as requested — contact lab
HEM Oil and Grease
1+1 Hydrochloric Acid
ml as requested — contact lab
VOA — water quality
Deionized Water (for DOc filter
blanks) Note: Order immediately
prior to sampling event— not to be
stored.
1 liter bottle
DOC
Supplies
Security Seals
1
Box of 100
Chlorine Test Strips
Bottle of 50
Wide -range pH test strips
Pack of 100
1.4-2.8 pH test strips
Roll
Bottles
# Requested
Unit
500m1 disposable
Case of 100
1 liter plastic (BOD/Cyanide)
Ea .
Plastic coliform
10
Ea
Pesticide (gallon glass)
Case of 4
Chlorophyll (brown plastic wide -mouth)
Ea
Grease and Oil (1 liter wide -mouth)
Ea
1 Liter glass (Phenols)
Ea
Sediment - 4oz. (sediment volatile)
Case of 24
Sediment - 8oz. (all other sediments)
Case of 12
VOA - NaHSO4 preserved (GW)*
1
Case of 72
VOA - HCI preserved (WQ)
Case of 72
VOA - Zn Acetate preserved (Sulfide)
1
Pack of 12
VOA - unpreserved
Case of 72
EPA 1631 Hg
Sampling Kits.
Two -station kit:
Each sampling kit
consists of:
1 cooler,
2 empty 500 ml
bottles, and
2 500 ml bottles
filled with
blank water
# Requested
One -station kit:
Each sampling kit
consists of
1 cooler,
1 empty 500 ml
bottle, and
1 500 ml bottle
filled with
blank water
*UST personnel must contact their Regional Office Supervisor for VOA bottle orders.
Comments (please note project or special study when applicable):
Sf23/2013

Date:
AQUIFER PROTECTON SECTION
APPLICATION REVIEW REQUEST FO
)avidson. ARO-A.PS
Barnhardt. FRO-.APS
drew P_itner, MRO-APS
litntnerma.n, RRO-APS
Mic,ha,e1^Rogerti (,ro .t?dwater Pr tt t>.on
Telephone: 9'197l 6.
E-Mail: Mich
El David I
ri Churl Stelttnatt,'il A.PS
r_ Sheri i ltini ht. W-SRO-APS
A. ;Permit Number:
B. Owner: John., and
C. F acility/Operation:
0 Proposed
D. Application:
1. Permit T1>pc: Ant
Reeve
E LAC
For Residuals:
0 so
2. Project Type:
E. Comments/Other tnfornmation:
PP,
0 Operation
SUP -Surface 1rrigatio.nReuse .FI-R Infiltration
.-'E .Lagoon LI iVGx Remediation (ND)
L
503 1
en pt
ai rr Mod. Minor Mod.
Surface L)isposa.l
0 .Animal
Renewal fl Renewal ,'` Mod,
uld like to accompany you on a sae visa.
NOTE
Attached, you will
review
information. s
.rent, and'o.r action. Within, please take
Return a.
?attach VeII Cr` ttstruction l.)at.a Sheet.
(i Attach. Attachment t f tr "crtif eaticrtb by the LAPCt.
0 Issue an Attachment F3 Cer zficatitrt: from the R(.:1.*
pun of the above -
RR Form and attach la.bora
1 apphcati ?
sults,
pplic
Remember that you will he responr hale f r et rardinatinr site visits and retiew° , as s ell as ad 1 tit n:i1
information requests with other RO-tA:[ S representatives in order to prepare a complete Attachment I for
certification, Refer to the RPP SOP for additional detail,
When rtau receive this request form, please write your name and dates ita the spaces below, snake a copy
of this sheet, and return it; to the appropriate Central Office -Aquifer Protection Section contact person
listed above,
RO-APS R
Date:
FOR\1: APSARR tt7 16

CD
North aroilria gar ment of nrnl nco ' atura
of a
I) ire:11166A
arile
untryside Road
NC 28634
Acknowledgement of Application No, ' 62
Min and Virginia I3arile
In,(eetion Heating/Cooling Water Return Well ( A'
Dear .Mr. & Mrs. .Bartle.
Resources
The Aquifer Prntectton Section of the Divz'lsron of Wt ater Quality (Dtv'iston) acknowledges receipt of your permit applicanon and
supporting materials on October 29. 2010. This application package has been assigned the number listed above and will be reviewed
by=Michael Rogers.
The reviewer will pertorrn a detailed review° and contact ynu with a request for additional information if necessary. To ensure the
maxis um efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division`s Regional Office. copied below. must provid.e recommendations pritrr to final action by the
Division. Please also note at this time, processing. permit applications can take as long as 60 - 90 days after receipt of a complete
application.
If you have any questions, please contact Michael Rogers at p1q '315-f 16,6, or via e-mail at ntichael,rogersta.nedenr.gov, If the
reviewer is unavailable, you may leave a message, and they will respond promptly.
PLEASE REFER TO THE ABOVE APPLICATICIN NUMBER WHEN MA IN • INQUIRIES IIN THIS PROD CT.
Sincerely.
.) Debra J. Watts
Supervisor
cc: Mooresville Regional Office, Aquifer Protection Section
Parks Quality Air - 249 Beach BrookLane. Statesville, NC::°
Permilication File WI:0300162
acasEE. 26,128 -aAtzi[,iUuicvst, Rav,Angy�
t.<m•; '. www.newat c*13.."...
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NORTH CAROL INA
E)FPAR'FMENT OF LNVIRONME:N`i AND NA`1 UR.AL RESOURCES.
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USF. A WELL FOR INJECTION
WITH .A GEOTHERMAL HEAT PUMP SYSTEM
TYPE 5A7 "OPEN LOOP" INJECTION W E LL(S1
check one) uNccvw° Perrnit. Application iZenevv=al i i tdif cation
DATE: October 29, 2010
PERMIT NO.: WI
_m(leavre blank ifNE:VV permit applicatio
A. PROPERTY OWNER/PERMI I° APPLICANT
Name of ea owner listed on prcperty deed. E°att°
name of perm delegated authority to sign application on behalf of the business,/agency:
John D. & Vir inia M. Barile
1D Mailing Address: 200 Count side Rd
City: Harmony State: _NC„ Zip Code:
Home/Office Tele No.: 704 546-7900
Fax No.
Physical Address ofWell
City_
Home/Office No.:
Fax No.
f diffe
u.siness or govern
vent agency,. state naive of entity nd
4 County: Irede
No,:
ail Address:. jdbarileasimail.com
an ahove,):,
Zip Code:
Cell No.:
Address:
PROP ERT°Y OWN ,RSH1P DOCI.tMFNTATION
Provide legal documentation of property° t vvnersl ip, such as a contract, deed, article
a PLAT map shoving the property, this irtf rnttttion may be obtained fforn county
websi1c.
AUTHORIZED ANENT', I:I ' ANY
County:
incorporation, etc, and
sister of Deeds or GIS
tt tkre property owner/permit applicant wants to authori,e srtt Leone else to sign tyre permit on tltorr be.hald
attach a sigped letter from the property owner/permit applicant specifying and authorizing their agent
driller, heat pump contractor, or other type of contractor/agent) to sign this application on their behalf
Company Name:
Contact. Person:
Address:
City: State:Zip Code:
Office `Tele No.: _... Fax No.
Website Address of Company, if any:,..
it Address:
County:
Cell No,:
Type 5A7 'Injection Well PermPermh Applieaion f Rev. August 2009)

D. WELL DRILLER INFORMATION
Company Name: Taylorsville Well Drilling inc
Well Drilling Contractor's Name: Mr. Russell
NC Contractor Certification No.: 2232 Contact Person: Mr. Russell
Company Website: WWW. Email Address:
Address: 2992 Vashti Rd
City: Taylorsville State: NC Zip Code: 28681 County: Alexander
Office Tele No.:_(828) 632-8377 Fax No.: Cell No.:
E. HEAT PUMP CONTRACTOR INFORMATION (if different than Driller)
Company Name:Parks Quality Air Contact Person:
Company Website: www.parksqualitvair.com Email Address:
Address: 249 Beach Brook Ln
City: Statesville State:NC_ Zip Code: 28625 County: Iredell
Office Tele No.:_(704) 873-0080 Fax No._(704) 872-0562_ CeII No.
F. The well will be used to supply an openloop groundsource heat pump and serve as the
primary HVAC system for the home
G. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES X
(2) Personal consumption? YES X
NO
NO
H. WELL CONSTRUCTION DATA
PROPOSED Wells) 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.
X EXISTING WeII(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 the Well Construction Record (Form
GW-1) if available.
(1) Well Construction Date: June 17, 2010 Number of borings: 1
Depth of each boring (feet): 645
(2) Well casing. Is the well(s) cased?
(a) YES If yes, then provide the casing information below.
Type: Galvanized steel Black steel Plastic Other (specify) SBR21
Casing thickness: _.25 diameter (inches): 6depth: from _0 to_110_ feet (relative to land surface)
Casing extends above ground 12 inches
(b) NO
(3) Grout material surrounding well casing:
(a) Grout type: Cement_X_ Bentonite* Other (specify)
*By selecting bentonite grout, a variance is hereby requested to I5A NCAC 2C .0213(d)(I)(A), which requires a cement type grout.
(b) Depth of grout around well casing (relative to land surface): from _0 to 30 feet
Type 5A7 Injection Well Permit Application (Rev. August 2009) Page 2 of 4

(4) Well Screen or Open Borehole depth (relative to land surface): from to feet
(5) N.C. State Regulations (Title 15A NCAC 2C .0200) require the Permittee to make provisions for
monitoring wellhead processes. A faucet on both Influent (groundwater entering heat pump) and Effluent
(water being injected back into the well) lines is required. Will there be a faucet on:
(a) Influent line? Yes X No (b) Effluent line? Yes X No
(6) Source Well Construction Information. If the water source well is a different well than the injection
well, attach a copy of the well construction record (Form GW-1). If Form GW-1 is not available, provide
the following data:
From what depth, formation, and type of rock/sediment units will the groundwater be withdrawn? (e.g.
granite, limestone, sand, etc.)
Depth: Formation: Rock/sediment unit:
NOTE: THE WELL DRILLING OR HEAT PUMP CONTRACTOR CAN HELP SUPPLY THE DATA IF THIS
INFORMATION IS OTHERWISE UNAVAILABLE.
I. OPERATING DATA
(1) Injection Rate: Average (daily) 6_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.
J. INJECTION -RELATED EQUIPMENT
Attach a schematic diagram or cross-section of the well construction that shows the total depth, Length of casing,
extent of grout, stickup, location of influent/effluent sampling ports, etc. If this is a modification, show the
engineering layout or proposed modification of the injection equipment and exterior piping/tubing associated with
the injection operation. The manufacturer's brochure may provide supplementary information if needed.
K. LOCATION OF WELL(S)
(I)
Attach a site map (can be drawn) showing: houses and other structures, property lines, surface water bodies,
potential sources of groundwater contamination, and the orientation of and distances between the proposed
injection well(s) and any other existing well(s) or waste disposal facilities such as septic tanks or drain fields
located within 1000 feet of the geothermal heat pump well system. Label all features clearly and include a
north arrow.
(2) Attach a scaled topographic map of the area extending 1/4 mile from the property boundary that indicates
the facility's location, a north arrow, and the map name.
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.
Type 5A7 Injection Well Permit Application (Rev. August 2009) ' Page 3 of 4

�. CERTIFICATION o be signed as required below t-rr by that person's authorized agent)
NCAC 15A 2C .021 I(h) requires that all perimt applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
for a partnership or sole proprietorship. by a general partner or the proprietor, respectively;
for a municipality or a state, federal„ or other public agency. by either a principal executive
officer or ranking publicly elected official;
for all others: by the well owner:
If an authorized agent is signing on behalf of the applicant;, titan ttbm t a fetter signed by the
applicant that names and authorizes their agent as specified in Part C of Ihi permit application.
"I hereby certify, under penalty of law, that 1 have personally examined and am fitmiiiar 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, l 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 infection well and all related appurtenances in accordance with the approved
specifications and conditions of the Permit."
wner/Applicant
ahn D. Barile
'Tint or Type Full Name
ataare cif Property fvafner/Applic
Virginia M. Barile
int rrr Type Full Name
Signature o'Authori ed Agent,
Type hull Name
Submit IWO signed copies of'the completed application packagee and all attachments to:
UIC Program
Aquifer Protection Section
North Carolina DENR-I)WQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone].
'Type 5A7 Injection \A II Pemm Application 1R

Appraisal Card
BARILE JOHN D & VIRGINIA M
200 COUNTRYSIDE RD
000077436706
**IREDELL COUNTY 2007 REVAL** C FRO4 SW(1)
SR 1839
?PRAISED BY 37 ON 01/01/2007 06000 EAGLE MILLS SOUTH
FOUND *
SUBFLR*
EX WL1*
RF STR*
RF CVR*
INT W1*
FLOOR1*
FLOOR2*
FUEL *
HEAT *
AC *
BEDRMS*
BATHS *
QUAL DESIGN*QUAL*SIZE *
AVERAGE 1.00 1.00 .98*
TOTAL QUALITY INDEX *
TYP GS AREA PCT
BAS 1,618 100
FSP 220 040
FOP 96 035
3 CONT FOOTING *
4 PLYWOOD
05 ASBTS-FIBER S*
03 GABLE
03 COMP SHINGLE *
5 DRYWALL/SHEET*
05 ASPHALT TILE *
12 HARDWOOD
02 OIL/WOOD/COAL*
04 AIR -DUCTED * 4
01 NONE
BAS-2FUS-OLL- 0 *
BAS-1FUS-OLL- 0 * 7
89
.98
87
RPL CS
98,536
5,359
2,071
FIREPL 3 1 STY SINGL $2250
1,934 108,216
02GARAGE 20 14 28000
2
TW-06 C-
1919 AP
5
80101 1,740 87 60.90 108,21659594800000032
27SINGLE FAMILY RESIDENTIAL - SFR CONSTRUCTION
7SCALE 1/202 STORIES 01 1.0 STORIES
3
20
8
IBAS
I
I
I
I
2
8
I
I
I
I
28
+
IFSP
1
0
I
+
22 +
I
1
0
I
22 +---16---+
1
1
I
1
8
I
I
+ 23 +
I
1.
0
I
+---17----+--12--+---19---+
IFOP I
8 8
I I
+--12---+
600100L748403 031
521
521
HID AREA
WED, AUG 4, 2010, 1:16 PM
4871 69 7641.000
MAP BL PIN COND CC L H
ID NO: 0617F00000A036
CARD NO. 1 OF 1
.00AC 2.000AC
EX- AT- LAST ACTION 20100521
2000
1618
MARKET
21,640
520
23,320
45,480
45,480
45,480
PRIOR PERMIT INFO
22,200
24, 630
46,830
160820011204CV* QI 44,000
113103470399OT XV
SPLIT'05 HSE FROM 4871-6
9-9499
HAS=W16FSP=N10W22S10E22$W50528E17F0P=S8E12N8W
12$E26N10E23N18$.
RF AC LC TO OT T
RURAL AC 0120RA 191 20604103+08+00+00+00-05RP 5,50000
2000AC212 11,66000 23,320
2000
I I - 1-1 1 - —
23320
LAND NOTES
http://www.co.iredell.nc.us/apprcard/apprcard.asp?Parcel=4871697641.000&Card=001 (1 of 3) [10/29/2010 11:54:38 AM]

Appraisal Card
CONSTRUCTION DETAIL MARKET VALUE
U M EFF AR IN EFF Ii REPL CST E A NRM E F % CD CREDENCE TO
DEPR BLDG VALUE
❑EPR Of3XF VALUE
LAND VAL - MKT
MKT VAL - CARD
REGR VAL - CARD
INC VAL - CARD
APPR VAL - CARD
APPR VAL - PARCEL
http://www.co.iredell.nc.us/apprcard/apprcard.asp?Parcel=4871697641.000&Card=001(2 of 3) [10/29/2010 11:54:38 AM]

Appraisal Card
CD DESC LN WI) UNITS IJNIT rs L A E AN p, OBXF
PRICE 0 B Y Y DP C DEPR VAL
SALES DATA
DEED DT TYP Q SALE
©K PO M Y V PRICE
BUILDING DIMENSIONS
NOTES
TOTAL OB/XF VALUE
LAND USE UCD LOCAL ERNT DEP SZ L CF OTHER ADJUST LNri UNIT TOT LAND U TL ADJUST LAND
ZONE f3 PRICE UNITS T AD PRICE VALUE
TOTAL LAND DATA
http://www.co.iredell.nc.us/apprcard/apprcard.asp?Parcel=4871697641.000&Card=001 (3 of 3) [10/29/2010 11:54:38 AM]

S
•
m 4»
{
PR
Mk
e o�
a
S:
v
-* Co •
MOO
©'2010`vat11e,
Date; Feb 25, 2005 35'59'19.87' N 80'46'09,26' W. elev 927 ft
Eye .a It

1
MRS. J.G. SMITH
VICTOR L. PISAURO
SITE PLAN EX15T1NG HOUSE PLACEMENT
TRACT 2
S.b'13 ACRES • .
i(d.T
r�8
it
111,
,;I
11111
3i11l
8
a

and \/ir
Basile
200 Countryside Rd,
Harmony. NC 28634
Re: Issuance of Itx eetion
Permit No, 4t"II) Cftll62
Issued to John and Virg.
l redeil County
Dear l eis. and Mrs. Barifc:
In accordance aitl
the operation of
above referenced
and shall be sub
w application received October 29. 2010. 1 any fo
hernial underground injection control (1..1IC )
dress, This permit shall be effective from the date of
the conditions and limitations stated therein.
Water sarnpies were c allected from tltc influent and effluent sa. plin.g ports durin
Mooresville Regional Office on November 16, 2010. The laboratory analytical result
you after they are received from the lab, unless you have had the well previously sam
lredell County Environmental Health Department, we recommend not using Ovate r favarr
purposes until the Regional Office receive the results from the lab.
In order to continue uninterrupted legal use of this
application to renew the permit 120 days prio
not transferable to any person without prior nonce
Quality.. If you have any questions t.egard
please call me. at (9919 Fr l 5-6166.
Best Retards,
ael Rogers.
aa'ot°tmental 5pe eialist
located at
her 3(L 01 R,
;pecnorr b�,,. the
ill he forwarded to
ed and tested by the
this 'for,drinking,
well for the sttated purpose. you should submit: an
xpiration dates s indierrted in the permit.. this permit i
and approval by. the Dire" ctor of the Division of Water
Underground infection Control Program.
Andrew Pitner — Mooresville lieg anal ltffi
Central Office Files WW1103(
lredell County Environmental Health Dept,

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
John and Virginia Baffle
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL, defined in Title 15A North Carolina
Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat pump effluent. This
injection well is located at 200 Countryside Rd., Harmony, Iredell County, NC 28634, and will be constructed
and operated in accordance with the application October 29, 2009, and in conformity with the specifications and
supporting data submitted, all of which are filed with the Department of Environment and Natural Resources
and are considered a part of this permit.
This 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 November 30, 2015, and shall
be subject to the specified conditions and limitations set forth in Parts I through VIII hereof.
rel
Permit issued this the day of O c pi6 P , 2010.
ih Sea4-4-e—
oleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit #WI0300162
UIC/5A7
ver. 03/2010
Page 1 of 5

PART I. - WELL CONSTRUCTION GENERAL CONDITIONS
The Permittee must comply with all conditions of this permit and with the standards and criteria specified.
rn Criteria and Standards Applicable to injection Wells (15A NCAC 2C ..0200), Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds tier enforcement action as provided. for in N.C.G.S, 87-94..
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,
Each injection shall not hydraulically connect separate aquifers.
4. Each injection. well shall he constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen,
5. Each injection well shafl be secured to reasonably insure against unauthorized access and use, Each well
Shall he permanently labeled with a wa.ming 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 proteetlon against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.0213(g),
PART II — OPERATION AND USE GENERAL CONDITIONS.
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.
This permit is not transferable'wigrolit 'Prioit 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 mateilars as may he appr6pti/te, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules. regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
4. Continued operation of the injection system will he contingent upon the effluent not impacting
groundwater quality. The water quality of the effluent cannot he that of a lower quality than the influent.
which results in a degrading of water quality of the aquifer.
Permit AM/10300162
U iC/5A7
ver, 03/2010
Page 2 of 5

PART III - PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater 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.
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.
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.
Permit UW10300162
U C/5A7
ver. 03/2010
Page 3 of 5

The Permittee shall report by —telephone, ithin 48 hours of the occurrence or first knowledge of the
occurrence, to the Mooresville Regional affiee. telephone number [phone]. any of the following:
(A) Any occurrence at the injection facility that results in any unu.sua] operating circumstances
(B) Any failure due to k own or unkno n reasons that renders the facilit incapable of proper
injection operations, such as mechanical or electrical f tilut'es;
Where the Pen r ittee lieconies aware of an omission of an rel iant facts in a pertnit applican
itrconiec,.t information submitted in said application or in an) report to the Director, the
correct facts or information shall be promptly submitted to the Director by the Permittee.
In the event that the permit ed facility fails t.o perform satisfactorily, the Permittee shall take such
immediate action as rna\a he required by° the Director,
PART ` 1 .. PER ' RENEW
In order to coinu : uninterrupted legal use of the itaj
submit an application to renew the penrait ,12(1 days prior to
PART %Ill CHANGE OF 4`E 1., STATUS
the stated purpose. the Permittee shall
n date.
The Permittee shall provide written notification ~ithin 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 Pennittee 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)(1 ). \y'ell
Construction Standards.
Whcn. operations have ceased at the facility' and a well will no longer he used for and purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 1.5A. NCAC 2C.'.
.C1314, ncludin< but not limited to the following:
Permit #
n
A) A.11. casing and atery be removed prior to initiatiotra of abandonment procedures if
the Director finds such removal wih not be responsible for, or contribute to. the.
contarninatiotr of an undo round source of d.rinkirt„t water.
(B) The entire: depth of each well shall be sounded bef€are
obstructions that may interfere with sealing operations.
Each well shall be thcarottghly° disinfected. prior to
failure to do so ctlu]d lead to the contamination
'water.
d to insure freedom from
aling, if the Director determines that
pan under€;roun.d source of drinkin,:
(D) Each ts,ell shall he completely° filled°ith c°craaerrttrout,which shall he introdu
well through a pipe which extends to the bottom of the: well and is raised as
filled.
UYC/s
user. 03,/2010
Page 4 of 5

(E) In the case of gavel -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.
The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(1) within 30 days of completion of abandonment.
(G)
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Permit #W10300162
UIC/5A7
ver. 03/2010
Page 5 of 5

ttc tGE 1 eatt rc Report
"0. "``NC''` ecorded deeds, plats, and
other public records. Users of these maps are hereby notified that the information provided herein should be
verified, Iredell County assumes no legal responsibilities for any of the information contained on this site, Users
e advised that the use of any of this information is at their own risk, All maps on this site were prepared using a
1OOO€TM Grid based upon the North Carolina State Plane Coordinate System from the 1983 North American
Datum. The delinquent real property tax overlay is updated monthly. The information presented is not intended to
be used or relied upon as official notice of tax liens For additional information regarding delinquent taxes, contact
the Iredell County Tax Collectors Office_
'Crt, The maps prepared for this
� � �:;ti _ website are generated from
Iredell Zoning RPO
Page 1 of
http://ircdell.coannectgis.com/DownloadFile.ashr i a s rnap3b73f067841 40d0 cd749h17h449ax,ht,,.. H /10/20110

nnectGlS Feature Report Page 2 of 2
OID
3159
PIN
4871697641.000
Name
BARILE JOHN D4VIRGINIA M
Deed Book
1608
Deed Page
2001
Doc Type
WD _
Deed Date
20041217
Tax Acres
2
Lot#
Plat
Description
HAYES SR 1839
Township
06
NBH
06000
http://iredell.connectgis.com/DownloadFile.ashx?i= ags_map3b73 67841b40d08ed749b1730b449ax.ht... 11/10/2010

GROUNDWATER FIELD/LAB FORM
Location code W10300162-EFF
County,Iredell
Quad No Serial No.
Lat. Long.
Report To: ARO, FRO, MRO, RRO, WaRO, WiRO,
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by: Bus, Courier, Hand Del., Other:
Collector(s): Edward Watson
FIELD ANALYSES
pH 400
Temp.lo
Appearance
SAMPLE TYPE
❑ Water
❑ Soil
❑ Other
❑ Chain of Custody
SAMPLE PRIORITY
❑ Routine
❑ Emergency
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
Lab Number
Date Received Time:
Rec'd By: From:Bus, Courier, Hand Del.,
Other:
Data Entry By: Ck:
Date Reported:
Purpose: UIC System Inspection
Date: 12/ /2015 Time Baseline, Complaint, Compliance, LUST, Pesticide Study, Federal Trust, Other:
Owner: John and Virginia Basile (circle °n°)
Spec. Cond.st at 25°C Location or Site: 200 Countryside Road, Harmony
°C Odor Description of sampling point: Effluent
Sampling Method: Pump
Field Analysis By: Maria Schulte Remarks li'umo. Garter. etc
(Pumping time, air temp., etc.)
LABORATORY ANALYSES
BOD 310
mglL
COD High 340
mglL
COD Low 335
mg/L
X
Coliform: MF Fecal 31616
1100m1
X
Coliform: MF Total 31504
1100m1
T0C 680
mglL
Turbidity 76
NTU
Residue, Total Suspended 530
mglL
pH 403
units
Alkalinity to pH 4.5 410
mglL
Alkalinity to pH 8.3 415
mg/L
Carbonate 445
mg/L
Bicarbonate 440
mg/L
Carbon dioxide 405
mglL
X
Chloride 940
mg/L
Chromium: Hex 1032
uglL
Color: True 80
CU
Cyanide 720
mglL
Lab Comments
X
Diss. Solids 70300
mglL
Fluoride 951
mg/L
X
Hardness: Total 900
mglL
Hardness (non-carb) 902
mglL
Phenols 32730
ugll
Specific Cond. 95
pMhos/cm
X
Sulfate 945
mg/L
Sulfide 745
mglL
Oil and Grease
mg/L
NH3 as N 610
mglL
TKN as N 625
mglL
X
NO2+ NO3 as N 630
mg/L
P: Total as P 665
mglL
X
Nitrate (NO3 as N) 620
mglL
X
Nitrite (NO2 as N) 615
mg/L
Ag-Silver 46566
ug/L
X
AI Aluminum 46557
ug/L
X
As -Arsenic 46551
ug/L
X
Ba-Barium 46558
uglL
X
Ca -Calcium 46552
mglL
X
Cd-Cadmium 46559
ug/L
X
Cr-Chromium 46559
ug/L
X
Cu-Copper46562
uglL
X
Fe-tron 46563
ug/L
Hg-Mercury 71900
uglL
X
K-Potasslum 46555
mglL
X
Mg -Magnesium 46554
mg/L
X
Mn-Manganese 46565
ug/L
X
Na-Sodium 46556
mglL
X
Ni-Nickel
uglL
X
Pb-Lead 46564
ug/L
X
Se -Selenium
ug/L
X
Zn-Zinc46567
uglL
Sample Interval
Organochlorine Pesticides
Organophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
PCBs
Semivolatile Organics
TPH-Diesel Range
Volatile Organics (VOA bottle)
TPH-Gasoline Range
TPH-BTEX Gasoline Range
LAB USE ONLY
Temperature on arrival (°C):
GW-54 REV. 7/03
For Dissolved Analysis -submit filtered sample and write'DIS' in block.

GROUNDWATER FIELD/LAB FORM
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
Location code W10300162-IN
County lredelt
Quad No Serial No.
Lat. Long.
Report To: ARO, FRO, MRO, RRO, WaRO, WiRO,
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by: Bus, Courier, Hand Del., Other:
Collector(s): Edward Watson
FIELD ANALYSES
pH 400 Spec. Cond.e4 _ at 25°C
Temp.10 °C Odor
Appearance
Field Analysis By: Maria Schutte
LABORATORY ANALYSES
BOD 310
mg/L
COD High 340
mg/L
COD Low 335
mg/L
X
Coliform: MF Fecal 31616
/100m1
X
Coliform: MF Total 31504
I100m1
TOC 680
mg/L
Turbidity 76
NTU
Residue, Total Suspended 530
mg/L
pH 403
units
Alkalinity to pH 4.5 410
mg/L
Alkalinity to pH 8.3 415
mgiL
Carbonate 445
mg/L
Bicarbonate 440
mglL
Carbon dioxide 405
mg/L
X
Chloride 940
mg/L
Chromium: Hex 1032
ug/L
Color: True 80
CU
Cyanide 720
mg1L
SAMPLE TYPE
❑ Water
❑ Soil
❑ Other
❑ Chain of Custody
SAMPLE PRIORITY
❑ Routine
❑ Emergency
0 Lab Number
Date Received Time:
Rec'd By: From:Bus, Courier, Hand Del.,
Other:
Data Entry By: Ck:
Date Reported:
Purpose: UIC System Inspection
Date: 12/ /2015 Time Baseline, Complaint, Compliance, LUST, Pesticide Study, Federal Trust, Other:
Owner: John and Virginia Barile (circle one)
Location or Site: 200 Countryside Road, Harmony
Description of sampling point: Influent
Sampling Method: Pump
Remarks [Num nailer. etc.)
(Pumping time, alr temp., etc.)
X
Diss. Solids 70300
mg/L
Fluoride 951
mg/L
X
Hardness: Total 900
mg/L
Hardness (non•carb) 902
mg/L
Phenols 32730
ug/I
Specific Cond. 95
pMhos/cm
X
Sulfate 945
mglL
Sulfide 745
mg/L
Oil and Grease
mg/L
NH3 as N 610
mg/L
TKN as N 625
mg/L
X
NO2 + NO3 as N 630
mg/L
P: Total as P 665
mglL
X
Nitrate (NOaas N) 620
mg/L
X
Nitrite (NO2 as N) 615
mglL
Ag-Silver 46566
ug/L
X
Al -Aluminum 46557
ug/L
X
As -Arsenic 46551
ug/L
X
Ba-Barium 46558
ug/L
X
Ca -Calcium 46552
mg/L
X
Cd-Cadmium 46559
ug/L
X
Cr-Chromlum 46559
ug/L
X
Cu-Copper46552
ug/L
X
Fe -Iron 46563
ug/L
Hg-Mercury 71900
ug/L
X
K-Potassium 46555
mg/L
X
Mg -Magnesium 46554
mg/L
X
Mn-Manganese 46565
ug/L
X
Na-Sodium 46556
mglL
X
NI -Nickel
ug/L
X
Pb-Lead 46564
u•/L
X
Se -Selenium
uq/L
X
Zn-zinc 46567
uglL
Sample Interval
Organochlorine Pesticides
0rganophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
PCBs
Semivolatite Organics
TPH-Diesel Range
Volatile Organics (VOA bottle)
TPH-Gasoline Range
TPH-BTEX Gasoline Range
LAB USE ONLY
Temperature on arrival (°C):
Lab Comments
GW-54 REV. 7/03 For Dissolved Analysis -submit filtered sample and write °DIS' in block.

GROUNDWATER FIELD/LAB FORM
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
Location code W10300162-IN
County Iredell
Quad No _ Serial No.
Lat. Long.
Report To: ARO, FRO, MRO, RRO, WaRO, WiRO,
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by: Bus, Courier, Hand Del., Other:
Collector(s): Edward Watson
FIELD ANALYSES
pH 400 Spec. Cond.94 at 25°C
Temp.io °C Odor
Appearance
Field Analysis By: Maria Schutte
LABORATORY ANALYSES
BOD 310
mg/L
COD High 340
mg/L
COD Low 335
mg/L
X
Coliform: MF Fecal 31616
/100m1
X
Coliform: MF Total 31504
1100m1
TOC 680
mg/L
Turbidity 76
NTU
Residue, Total Suspended 530
mg/L
pH 403
units
Alkalinity to pH 4.5 410
mg/L
Alkalinity to pH 8.3 415
mg/L
Carbonate 445
mg/L
Bicarbonate 440
mg/L
Carbon dioxide 405
mg/L
X
Chloride 940
mg/L
Chromium: Hex 1032
uglL .
Color: True 80
CU
t
Cyanide 720
mg/1
Lab Comments
SAMPLE TYPE
E Water
❑ Soil
❑ Other
❑ Chain of Custody
SAMPLE PRIORITY
❑ Routine
Emergency
0 Lab Number
Date Received Time:
Rec'd By: From:Bus, Courier, Hand Del.,
Other:
Data Entry By: Ck:
Date Reported:
Purpose: UIC System Inspection
Date: 12/ /2015 Time 'Baseline, Complaint, Compliance,LUST, Pesticide Study, Federal Trust, Other:
e o
Owner: John and Virginia Barile •(circlno)
Location or Site: 200 Countryside Road, Harmony
Description of sampling point: Influent
Sampling Method: Pump Sample Interval
Remarks Wump. Daher, etc,3
(Pumping time, air temp., eta)
X
Diss. Solids 70300
rng/L
Fluoride 951
mg/L
X
Hardness: Total 900
mg/L
Hardness (non -cart) 902
mg/L
Phenols 32730
ug/I
Specific Cond. 95
liMhos/cm
X
Sulfate 945
mg/L
Sulfide 745
mg/L
Oil and Grease
mg/L
NH3 as N 610
mg/L
TKN as N 625
mg/L
X
NO2 + NO3 as N 630
mg/L
P: Total as P 665
mg/L
X
Nitrate (NO3 as N) 620
mg/L
X
Nitrite (NO2 as N) 615
mg/L.
Ag-Silver 46566
ug/L
X
Al-Aluminum46557
ug/L
X
As -Arsenic 46551
ug/L
X
Ba-Barium 46558
ug/L
X
Ca -Calcium 46552
mg/L
X
Cd-Cadmium 46559
ug/L
X
Cr-Chromium 46559
ug/L
x
Cu-Copper 46562
ug/L
X
Fe -Iron 46563
ug/L
Hg-Mercury 71900
ug/L
X
K-Potassium 46555
mg/L
X
Mg -Magnesium 46554
mg/L
X
Mn-Manganese 46565
ug/L
X
Na-Sodium 46556
mgfL
X
NI -Nickel
uglL
X
Pb-Lead 46564
ug/L
X
Se -Selenium
ug/L
X
Zn-Zinc 46567
ug1L
Organochlorine Pesticides
0rganophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
PCBs
Semivolatile Organics
TPH-Diesel Range
Volatile Organics (VOA bottle)
TPH-Gasoline Range
TPH-BTEX Gasoline Range
LAB USE ONLY
Temperature on arrival (°C):
GW-54 REV, 7/03 For Dissolved Analysis -submit filtered sample and write'D1S' in block.

GROUNDWATER FIELD/LAB FORM
Location code WI0300162-EFF
County Iredell
Quad No Serial No. _
Lat. Long.
Report To: ARO, FRO, MRO, RRO, WaRO, WiRO,
WSRO, Kinston FO, Fed. Trust, Central Off., Other:
Shipped by: Bus, Courier, Hand Del., Other:
Collector(s): Edward Watson
FIELD ANALYSES
pH 400 Spec. Cond.94 at 25°C
Temp.la
Appearance
Field Analysis By: Maria Schutte
SAMPLE TYPE
❑ Water
❑ Soil
❑ Other
❑ Chain of Custody
SAMPLE PRIORITY
❑ Routine
❑ Emergency
Date: 12/ /2015 Time
°C Odor
LABORATORY ANALYSES
BOD 310
mglL
COD High 340
mglL
COD Low 335
mg/L
X
Coliform: MF Fecal 31616
/10om1
X
Coliform: MF Total 31504
1100m1
TOC 680
mg/L
Turbidity 76
NTU
Residue, Total Suspended 530
mg/L
pH 403
units
Alkalinity to pH 4.5 410
mglL
Alkalinity to pH 8.3 415
mg1L
Carbonate 445
mg/L
Bicarbonate 440
mg/L
Carbon dioxide 405
mg/L
X
Chloride 940
mg/L
Chromium: Hex 1032
ug/L
Color: True 80
CU
Cyanide 720
mg/L
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
Lab Number
Date Received Time:
Rec'd By: From:Bus, Courier, Hand Del.,
Other:
Data Entry By: Ck:
Date Reported:
Purpose: U1C System Inspection
Baseline, Complaint, Compliance, LUST, Pesticide Study, Federal Trust, Other:
Owner: John and Virginia Barile (circle one)
Location or Site: 200 Countryside Road, Harmony
Description of sampling point: Effluent
Sampling Method: Pump Sample Interval
Remarks Wumo, bailer, etC.l
(Pumping time, air temp., etc.)
X
Diss. Solids 70300
mg/L
Fluoride 951
mg/L
X
Hardness: Total 900
mglL
Hardness (non-carb) 902
mg/L
Phenols 32730
ug/I
Specific Cond. 95
'Mhos/cm
X
Sulfate 945
mg/L
Sulfide 745
mg/L
Oil and Grease
mg/L
NH3 as N 610
mg/L
TKN as N 625
mg/L
X
NO2 + NO3 as N 630
mg/L
P: Total as P 665
mg/L
X
Nitrate (NO3 as N) 620
mg/L
X
Nitrite (NO2 as N) 615
mglL
Ag-Silver 46566
ug/L
X
Al -Aluminum 46557
ug/L
X
As -Arsenic 46551
ug/L
X
Ba-Barium 46558
ug/L
X
Ca -Calcium 46552
mg/L
X
Cd-Cadmium 46559
ug/L
X
Cr-Chromium 46559
ug/L
X
Cu-Copper46562
ug/L
X
Fe -Iron 46563
ug/L
Hg-Mercury 71900
ug/L
X
K-Potassium 46555
mg/L
x
Mg -Magnesium 46554
mg/L
X
Mn-Manganese 46565
ug/L
X
Na-Sodium 46556
mg/L
X
Ni-Nickel
ug/L
X
Pb-Lead 46564
ug/L
X
Se -Selenium
ug/L
X
Zn-Zinc 46567
uglL
Organochlorine Pesticides
Organophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
PCBs
Semivolatile Organics
TPH-Diesel Range
Volatile Organics (VOA bottle)
TPH-Gasoline Range
TPH-BTEX Gasoline Range
LAB USE ONLY
Temperature on arrival (°C):
Lab Comments
GW-54 REV. 7/03 For Dissolved Analysis -submit filtered sample and write'DIS' in block.

MCDEFIR
North .Carolina'Departmentof Environment' and Natural Resources
Division of Water Quality
Beverly Eaves Perdue_ Coleen F{. Sullins ..,,.�.:
Governor Director !i.__..•
December 9, 2010
John and Virginia Barile
• 200 Countryside.Rd.
Harmony, NC 28634
Re: Issuance of Injection Well Permit
Permit No. WI0300162
Issued to John and Virginia Barile
Iredell County
DEC -•9. 2010
MVO -Astilvar2leolkin
Freeman
Secretary
Dear Mr. and Mrs. Barile:
In accordance with your' application received October 29, 2Q10, I am forwarding PermitNo. WI0300162 for
the operation of a 5A7 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 November 30, 2015, •
and shall be subject to the conditions and limitations stated therein.
Water samples were collected from the influent and effluent sampling ports during the inspection by the
Mooresville Regional Office on November 16, 2010. The laboratory analytical results will be forwarded to
you after they are received from the lab. Unless you have had the well previously sampled and tested by the
Iredell County Environmental Health Department, we recommend not using water from this well for drinking
purposes until the Regional Office receive the results from the lab.
In order to ,continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit 120 days prior to its expiration date. As indicated in the permit, this permit is
not transferable to any person without prior notice to, and approval•by, the Director of the Division of Water
Quality. If you have any questions regarding your permit or the Underground Injection Control Program
please call me at [phone]. •
Best Regards,
Michael Rogers, P.G. (IBC & FL)
Environmental Specialist
cc: Andrew. Pitner —' Mooresville Regional Office
Central Office File — W10300162
Iredell County Environmental Health Dept.
•
AQUIFER PROTECTION SECTION
1636 Mail Service Cerrer, Raleigh, Nora' 'Carolina 27E99 1636
Location: 2728 Capital boulevard. Raleigh. North Carolina 27604
Pnonn: 919-733-3221 t, FAX 1: 919-715-0588; FAX 2: 919-715.80481 Customer Service:1-877.623-6746
heater www.ncwaterouality,orq
An Euu Opportunity`At/rmaliye 1lcF Empigr .
N orthCarolina
.Vurai,

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
• DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
. RALEIGH, NORTH CAROLINA :
PERMIT FOR THE CONSTRUCTION AND OPERATION OF-A•WELL FOR INJECTION
In accordance with the provisions of Article 7; Chapter 87; Article 21, Chapter 143, and other applicable ••
Laws, Rules, and Regulations •
PERMISSION IS HEREBY GRANTED TO
John and Virginia Barile
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL, defined in Title 15A North Carolina.
Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat pump effluent. This •
injection well is located at 200 Countryside Rd., Harmony, Iredell County, NC 28634, and will be constructed
and operated in accordance with the application October 29, 2009, and in conformity with the specifications and
supporting data submitted, all of which are filed with the Department of Environment and Natural Resources
and are considered a part of this permit.
•
•
This 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 November 30, 2015, and shall
be subject to the specified conditions and limitations set forth in Parts I throughWIT hereof.
nd
Permit issued this the day of Oa:cei1e , 2010.
oleen H. Sullins, Director.
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit #WI0300162
UIC/5A7
• ver.03/2010
Page 1 of 5

• PART I - WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards•Applicable to• Injection Wells (15A NCAC 2C .0200). Any noncompliance with
Conditions of this permit constitutes a violation of the North Carolina Well Construction Act.and is
grounds. for enforcement action as provided for in.N.C.G.S. 87-94. -
2. .This permit shall become voidable unless.theTacility 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 eonstrueted 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. Eachinjection 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).
• 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.
•
• , w. hit
2. This permit is not transferable' if' lit- rio 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 Permitteg. farMal perrnitzpiendinent request must be submitted to the. Director,
• including any supporting material as may be•ap irDtteiat least 30 days prior to the date of the change. .
Tina
• 3. -The issuance of this permit shall not relieve the Perrnittee 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 theinfluent,
which results in a degrading of water quality of the aquifer.
Permit #W10300162. . UIC/5A7
ver. 03/2010
Page 2 of 5

PART III PERFORMANCE STANDARDS
1. -The injection facility shall be effectively, maintained and operated at all' times so that there is no.
containination 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, ar 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 Permitteeof 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 mustbe maintained under the terms and conditions of this permit, and may obtain
samplesof 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.
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.
Permit #WI0300162
• UIC/5A7
ver. 03/2010
Page 3 of 5

2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of -the
occurrence, to the Mooresville 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;
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 perforin ' satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VII — PERMIT RENEWAL
ba order to continue uninterrupted legal use of the injection facility for the stated purpose, the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
PART VIII — CHANGE OF WELL STATUS
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
completelyout 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)(1), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to' initiation of abandonment procedures if
the Director finds such removal 'will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a.pipe which extends to the bottom of the well and is raised as the well is
filled.
Permit #W10300162
.UIC/5A7
ver. 03/2010
• Page4of5 .

(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,
The Permittee shall submit a Well Abandonment Record, (Form GW-30) as specified in
15A NCAC 2C .0213(h)(1) within 30 days of coinpletion of abandonment.
(G)
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
• 1636 Mail Service Center
Raleigh, NC 27699-1636
Permit #W10300152
UIC/5A7
ver. 03/2010 •
Page 5of5

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
6. For Groundwater Remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? El Yes ❑ No. If No,
attach map of existing monitoring well network if applicable and recommend any changes to the groundwater -
monitoring program. N/A
7. Does the map included in the Application reasonably represent the actual site (property lines, wells, surface
drainage)? ® Yes ❑ 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.
8. For Non -Discharge groundwater remediation systems only:
a. Are the treatment facilities adequate for the type of waste and disposal system? ❑ Yes ❑ No ® N/A.
If no, please explain:
b. Are the site conditions (soils, topography, depth to water table, etc.) consistent with what was reported by
the soil scientist and/or Professional Engineer? ® Yes ❑ No ❑ N/A. If no, please explain:
IIL EVALUATION AND RECOMMENDATIONS
I. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yes, explain.
2. List any items that you would like WQROS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item
Reason
3. 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
Periodic surface water monitoring based on the
estimated travel time through the soil sub-
straight.
Periodic monitoring for evidence of daylighting
of daughter/ degradation products resulting from
the injectant.
4. Recommendation
❑ Deny. If Deny, please state reasons:
❑ Hold pending receipt and review of additional information by regional office
❑ Issue upon receipt of needed additional information
® Issue
5. Signature of report preparer(s): Edward M. Watson
Signature of WQROS Regional Supervisor:
Rev. 6/1/2015 Page 2

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Date:
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS (If Needed)
Water samples were collected form Influent and effluent well ports and submitted to DWQ laboratory for analysis.
Water samples was tested for TDS, Nitrite as N, and Total Nitrate as (NO3 + NO2 - N), Chloride, Fluoride & Sulfate,
Hardness, Metals, Total and Fecal Coliform bacteria.
Lab results are attached.
Rev. 6/1/2015 Page 3

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Date: 12/18/2015
To: Mike Rodgers
Central Office Reviewer
Permit No.WI0300162
County: Iredell
Permittee/Applicant: Barite Residence
Facility Name: John and Virginia Barile
L GENERAL INFORMATION
1. This application is (check all that apply): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
a. Date of Inspection: 12/15/2015
b. Person contacted and contact information: John Barile
c. Site visit conducted by: Edward Watson and Maria Schutte
d. Inspection Report Printed from B1MS attached: ® Yes ❑ No.
e. Physical Address of Site including zip code: 200 Countryside Road, Harmony, Iredell County
£ Driving Directions if rural site and/or no physical address: Latitude:35.989504 Longitude:
80.769271
Source of Lat/Long & accuracy (Le., Google Earth, GPS, etc.): Google Earth
II. DESCRIPTION OF INJECTION WELL(S) AND FACILITY
1. Type of injection system:
® Geothermal Heating/Cooling Water Return
❑ In situ Groundwater Remediation
❑ Non -Discharge Groundwater Remediation
❑ Other (Specify:
2. For Geothermal Water Return Well(s) only
a. For existing geothermal system:
Were samples collected from Influent/Effluent sampling ports? ® Yes ❑ No.
Provide well construction information from well tag:
b. Does existing or proposed system use same well for water source and injection? ® Yes ❑ No
If No please provide source/supply well construction info (i.e., depth, date drilled, well contractor,
etc.) and attached map and sketch location of supply well in relation to injection well and any other
features in Section IV of this Staff Report.
3. Are there any potential pollution sources that may affect injection? ❑ Yes ® No
What is/are the pollution source(s)?
What is the distance of the injection well(s) from the pollution source(s)? south of the northern property
boundary.
4. Quality of drainage at site: ® Good ❑ Adequate ❑ Poor
5. Flooding potential of site: ® Low ❑ Moderate ❑ High
Rev. 6/1/2015 Page I

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Date: 12/18/2015
To: Mike Rodgers
Central Office Reviewer
Permit No.WI0300162
County: Iredell
PermitteelApplicant: Barile Residence
Facility Name: John and Virginia Barile
L GENERAL INFORMATION
I. This application is (check all that apply): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
a. Date of Inspection: 12/15/2015
b. Person contacted and contact information: John Barile
c. Site visit conducted by: Edward Watson and Maria Schutte
d. Inspection Report Printed from BIMS attached: ® Yes ❑ No.
e. Physical Address of Site including zip code: 200 Countryside Road, Harmony, Iredell County
f. Driving Directions if rural site and/or no physical address: Latitude:35.989504 Longitude:
80.769271
Source of Lat/Long & accuracy (i.e., Google Earth, GPS, etc.): Google Earth
IL DESCRIPTION OF INJECTION WELL(S) AND FACILITY
I. Type of injection system:
® Geothermal Heating/Cooling Water Return
❑ In situ Groundwater Remediation
❑ Non -Discharge Groundwater Remediation
❑ Other (Specify:
2. For Geothermal Water Return Well(s) only
a. For existing geothermal system:
Were samples collected from Influent/Effluent sampling ports? ® Yes ❑ No.
Provide well construction information from well tag:
b. Does existing or proposed system use same well for water source and injection? ® Yes ❑ No
If No, please provide source/supply well construction info (i.e., depth, date drilled, well contractor,
etc.) and attached map and sketch location of supply well in relation to injection well and any other
features in Section IV of this Staff Report.
3. Are there any potential pollution sources that may affect injection? ❑ Yes ® No
What is/are the pollution source(s)?
What is the distance of the injection well(s) from the pollution source(s)? south of the northern property
boundary.
4. Quality of drainage at site: ® Good ❑ Adequate ❑ Poor
5. Flooding potential of site: ® Low ❑ Moderate ❑ High
Rev, 6/1/2015 Page I

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
6. For Groundwater Remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ❑ Yes ❑ No. If No,
attach map of existing monitoring well network if applicable and recommend any changes to the groundwater -
monitoring program. N/A
7. Does the map included in the Application reasonably represent the actual site (property lines, wells, surface
drainage)? ® Yes ❑ 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.
8. For Non -Discharge groundwater remediation systems only:
a. Are the treatment facilities adequate for the type of waste and disposal system? ❑ Yes ❑ No ® N/A.
If no, please explain:
b. Are the site conditions (soils, topography, depth to water table, etc.) consistent with what was reported by
the soil scientist and/or Professional Engineer? ® Yes ❑ No ❑ N/A. If no, please explain:
IIL EVALUATION AND RECOMMENDATIONS •
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yes, explain.
2. List any items that you would like WQROS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item
Reason
3. 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
Periodic surface water monitoring based on the
estimated travel time through the soil sub-
straight.
Periodic monitoring for evidence of daylighting
of daughter/ degradation products resulting from
the injectant.
4. Recommendation
❑ Deny. If Deny, please state reasons:
❑ Hold pending receipt and review of additional information by regional office
❑ Issue upon receipt of needed additional information
® Issue
5. Signature of report preparer(s): Edward M. Watson
Signature of WQROS Regional Supervisor:
Rev. 6/1/2015 Page 2

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Date:
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS (If Needed)
Water samples were collected form Influent and Effluent well ports and submitted to DWQ laboratory for analysis.
Water samples was tested for TDS, Nitrite as N, and Total Nitrate as (NO3 + NO2 - N), Chloride, Fluoride & Sulfate,
Hardness, Metals, Total and Fecal Coliform bacteria.
Laboratory analysis reports groundwater chemistry are within acceptable limits for both influent and effluents ports.
Lab results are attached.
Recommend permit renewal.
Rev. 6/1/2015 Page 3

1
North Carolina Division of Water Resources
Central Laboratory (Water Sciences Section)
Loco ion DescriiLffotlon:
` � pDINR:Regfo`"i = C•
based
tin counryi
Water Sample Collection & Subm'ttal Form
John and Virginia Barile, 200 Countryside Road, Harmony, NC
Iredell
MRO
• D40:0f17EZt
un_cyaome)
E Watson! M. Schutte
MRO
Rfver 8asfa:'•"' . Yadkin -Pee Dee
Notes:
UIC System Inspection
❑ Chlorinated ❑De -chlorinated in Field
'•
Dissolved analysis: Enter "DIS
❑ Filtered in Field
in check -boxes for parameters
:SartMiNWeptiri
12/15/2015
[r 3o
AM
❑Grab UComposite
CI Other. Pump
Gollecioif Cio rrrenrs: Lat._35.989371 Long._80.769202 Analyze Bacteria samples
ii t-uo6lolagyiP etOw. _ _.
Acidity, as CaCO3, to pH 4.5/8.3
mg/L
x
x
Alkalinity, as CaCO3, to pH 4.5/B.3
BOD: Biochemical Oxygen Demand, 5-day
cBOD: Carbonaceous 80D, 5-day
Coliform: Fecal MF
Coliform: Total MF
mg/L
mg/L
mg/1
/1Gom1
/10om1
Coliform: Tube Fecal /100m1
Coliform: Tube Total
Specific Conductance, at 25 °C
TOC -Total Organic Carbon
/100m1
umhos/cm
mg/L
Turbidity .NTU
y�;,`,;,Wet;,Chemis"tryjP,ai�amete_rs�5��}; °
x
x
x
Bromide mg/L
Chloride mg/L
Fluoride mg/L
Sulfate
Chlorophyll a
mg/L
pg/L
MBAS (surfactants)
Oil and Grease, HEM, Total Recoverable
Phenols, Total Recoverable
Residue: Total (Toth, Solids )
Residue: Volatile/Fixed, Total
Residue: Suspended (Suspended Solids )
Residue: Volatile/Fixed, Suspended
TOS - Total Dissolved Solids
Silica
Sulfide
Tannin & Lignin
otfie►Pararri:Krs „ _
pH
Hardness, Total as CaCO3 - by titration
VisttlD
(opnonal):
Locatfoa'Eade:• WI03000162-INF
❑Ambient
❑ Routine
2Compliance
El coc
❑ Emergency
❑oA
regardless of
mg/L
mg/L
ug/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
5.u.
mg/L
tNater�•
❑ Surface
❑r Ground
❑ Waste
❑ Blank
❑ Solution
hold time.**
Locat!on.Type
❑ River/Stream
❑Estuary
❑ sto rmwater
Monitoring Well
El Effluent
❑Field Blank
Filter Blank
❑� Other:
r.
1 C- 03 15
a,R nC
-►(.15
❑ Lake
❑Canal
❑Water Supply
influent
❑Trip Blank
Influent Port
TNet.g Parameters:'
Aluminum (Al)
x
x
.x
Antimony (Sb)
Arsenic (As)
Barium (Be)
Beryllium (Be)
Cadmium (Cd)
Calcium (Ca)
Chromium (Cr), Total
Cobalt (Co)
Copper (Cu)
Iron (Fe)
Lead (Pb)
Lithium (Li)
Magnesium (Mg)
Manganese (Mn)
Mercury (Hgl
Color: ADMI
Color: Platinum Cobalt
COD: Chemical Oxygen Demand •
Cyanide, Total
Formaldehyde
Hexavalent Chromium (Cr6+)
LAB COMMENTS :
Fierdiperametersfopgono!
c.u.
mg/L
mg/L
mg/L
mg/L
VIaterT�emp (qC T t , oz..
, Niitrlents Parameters:M" ZSTE&T
Ammonia as N (NH3-N)
mg/L
Nitrate -Nitrite as N (NO3+NO2-N)
mg/L
Total Kje(dahl Nitrogen as N (TKN)
Total Phosphorus as P (TP)
Nitrite as N (NO2-N)
Nitrate as N (NO3-N calculated)
Orthophosphate as P (PO4)
r�yi '4r---.,,,
,t3
mg/L
mg/L
mg/L
mg/L
mg/L
I
x
x
x
.x
X
ve
Dissolved,Oxygen-(ppm):
•
Molybdenum (Mo)
Nickel (NI)
Potassium (K)
Selenium (Se)
Silver (Ag)
Sodium (Na)
Strontium (Sr)
Thallium (TI)
Contains
1:3
Suitttrit Acid
SA- $asn t4
Exp;Qai4?Ji6 •
ttt(,;atogl
tee WAS
Conductivity (Nmhos/,cm) u
pg/L
Ng/L
pg/L
pg/L
pg/L
pg/L
mg/L
pg/L
pg/L
pg/L
ylg/L
pg/L
pg/L
mg/L
pg/L
pg/L
pg/L
pg/L
mg/L
pg/L
pg/L
mg/L
pg/L
pg/L
x
Time Received:
Ss
Received Brr
a
rTemperature ('G).
Tin (Sn)
UStatCourier
['Hand Delivery
❑Other:
ug/L
pg/L
Titanium (Ti)
Vanadium (V) ug/L
Zinc (2n)
pg/L
Boron (3), Total P8/1-
Mercury 1631, low-level ng/L
Organics Pararrreters " ;
• Acid Herbicides
Organochtorine Pesticides
Organonitrogen Pesticides
Organophosphorus Pesticides
PCBs (polychlorinated biphenyls)
Semi -Volatile Organics (BNAs)
TPH Diesel Range
Volatile Organics (VOA)
TPH Gasoline Range
Phytoplankton / Algae
'�5a lintty'(p. pit}
Revision: 2/06/2015

AC25207
9V.COWX WaterSciencesSection-Citernistry Laboratory Wgsurts
County lredeli
River Basin Yadkin- Pee Dee
ReportTo DWM'
Collector: E WATSON
Region: MRD
Sample Matrix: GROUNDWATER
Loc. Type: Influorit Part
Emergency Yes/No
COC Yes/No
Division of Water Resources
Final Report
VisItID
Sample ID: AC25207
PO Number# 15G0315
Date Received: 12/1812015
Time Received: 08:30
Labworks Lagin1D MSWIFT
Final Report Date: 1/5/16
Report Print Date: 01/05/2016
Loc. oescr.: JOHN AND VIRGINA BARILE, 200 COUNTYSIDE ROAD. HARMONY. NC
Location ID: WI03000162_INF
Collect Date: 12/15/2015
Collect Time: 11:30
Sample Depth NA
If this report is labeled preliminary report, the results have not been validated Do not use for Regulatory purposes.
CAS # Analvte Name
LAD
Sample temperature at receipt by lab
PQL
Result/
Qualifier
1.7
.0
Units
Method_ Ana___1l_v s Validated by
Reference Date
12/16/15 MSWIFT
MIC
Coliform, MF Fecal in liquid
1 B2Q1
CFU/100m1 APHA9222D-20th 12/16/15 ESTAFFORD1
Coliform, MF Total in liquid
1 B2Q1
CFU/100m1 APHA92228-20th 12J16/15 ESTAFFORD1
WET
Ion Chromatography
_TITLE
mg/L
EPA 300.0 rev2.1 12/16/15 CGREEN
Fluoride
0:4 0.62
mglL
EPA 300.0 rev2.1 12/16115 CGREEN
Chloride
1.0 1.0
mg/L
EPA 300.0 rev2.1 12/16/15 CGREEN
Bromide
0.4 0.4 U•
mg/L
EPA 300.0 rev2.1 12116/15 CGREEN
Sulfate
• 2.0 20
mg/L
EPA 300.0 rev2.1 12/16115 CGREEN
Total Dissolved Solids in liquid
-12 111
mg/L
SM 2540 C-1997 12/16/15 CGREEN
NUT
NO2+NO3 as N in liquid
0.02 0.02 U
mg/L es N EPA3532 REV 2 12121/15 CGREEN
Nitrate as N in liquid
0.02 0.02 U
mg/L as N EPA3532 REV'2 12/28/15 CGREEN
Nitrite as N in liquid
0.01 0.01 U
mg1L as N EPA 353.2 REV 2 12/17/15 CGREEN
MET
7440-22-4 Ag by ICPMS
1.0 1.0 U
ug/L
EPA200.8 12/18/15 ESTAFFORD1
7429-90-5 AI by ICP
50 50 U
ug/L
EPA 200.7 12/21/15 ESTAFFORDI
7440-38-2 As by ICPMS
2.0 2.0 U
ug1L
EPA 200.8 12/18/15 ESTAFFORDI
7440-38-3 Ba by ICP
10 10 U
ug/L
EPA 200.7 12/18/15 ESTAFFORDI
7440-70-2 Ca by ICP
0.10 8.2
mg/L
EPA 200.7 12118115 ESTAFFORD1
7440-43.9 Cd by ICPMS
0.50 0.50 U
ug/L
EPA 200.8 12/18/15 ESTAFFOR01
7440 47-3 Cr by ICPMS
5:0 5:0 U
ug/L
EPA 200.8 12/18/15 ESTAFFORD1
7440-50-8 Cu by ICPMS
2.0 4.2
ug/L
EPA200.8 12/18/15 ESTAFFORDI
7439-89-6 Fe by ICP
50 50U
ug/L
EPA 200.7 12/21/15 ESTAFFORDI
Hardness by Calculation
1.0 25
mg/L SM2340BEPA 200.7 1/5/16 ESTAFFORDI
7440-09-7 K by 1CP
0.10 0.69
mg/L
EPA 200_7 12/18/15 ESTAFFORDI
7439.95.4 Mg by ICP
mg/L
EPA 200.7 12/18/15 ESTAFFORDI
7439-96-5 Mn by. ICP
10 10 U
ug/L
EPA 200.7 12/21115 ESTAFFORDI
7440-23-5 Na by ICP
0.10 27
mg/L
EPA 200,7 12/18/15 ESTAFFORDI
7440.02-0 Ni by ICPMS
2.0 2.0 U
ug1L
EPA200.8 12/18/15 ESTAFFORDI
WSS Chemistry Laboratory» 1823 Malt Service Center. Raleigh.. NC 27699-1623 [phone]
Fora detaileddwa+ n Cha QuarlerWdesref m<htto://borta1.nedenr.orE/webJwalons/methods-and-Dez s>
Page 1 of 2

Location ID: WI03000162_INF
.NC WO& La6oratorySection su&ts
Sample ID: AC25207 CogectPate: 1211512015 Collect Time:: 11:30
MET
CAS # Analyte Name
7439.92-1 Pb by ICPMS
PQL
2.0
Result!
Qualifier
2.0.0 ug/L
Units
Method
Reference
EPA200.8
Analysis
Date
12118/15 ESTAFFORD1
Validated by
7782-49-2 Se by ICPMS
1,0 1.0 U ug/L EPA200.8 12J18115 ESTAFFORDI
7440-66-6 Zn by ICPMS
10 10 U u9/L EPA200.8 12/18115 ESTAFFORDI
WSS Chemistry. Laboratorp> 1623 Malt Service Center, Raleigh, NC 27699-1623 (919).733.3908
For a�� description of the merle. axles refer mhttii://aortal.ncdenr.or&wOiwalons/methods-and-n6ts>
Page 2 of 2