WI0500414_GEO THERMAL_20160927

Permit Number WI0500414
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
James Bartram and Jane Bailey SFR
Location Address
410 Whitehead Cir
Chapel Hill NC
Owner
Owner Name
James
Dates/Events
Orig Issue
9/6/2011
App Received
6/24/2016
Reg ulated Activities
Heat Pump Injection
Outfall
Waterbody Name
27514
Bartram
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
9/27/2016
Permit Tracking Slip
Status
Active
Version
2.00
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
James Bartram
Owner
410 Whitehead Cir
Chapel Hill
Region
Raleigh
County
Orange
NC
Issue
9/27/2016
Effective
9/27/2016
27514
Expiration
8/31/2021
Re quested /Received Events
RO staff report requested
RO staff report received
Streamlndex Number Current Class
6/28/16
9/20/16
Subbasin
PAT MCCRORY
Governor
DON ALO R. VAN DER V AAR T
Water Resources
ENVIRONMENTAL QUALITY
James Bartram & Jane Bailey
410 Whitehead Circle
Chapel Hill
NC 27514
Re: Issuance of Injection Well Permit
PermitNo.WI0500414
September 26, 2016
Geothermal Heating/Cooling Water Return Well
Orange County
Dear James & Jane:
Secretary
S. JAY ZIMMERMAN
Director
In accordance with your permit renewal application received June 24, 2016, I am forwarding Permit
No. WI0500414 for the continued operation of geothermal heating/cooling water return well(s) located
at the above referenced address. This permit shall be effective from date of issuance, until August 31,
2021, 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 on August 12, 2016. Laboratory analytical results have been forwarded to
you by Raleigh Regional office on September 15, 2016.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit 120 days prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water Resources.· If you have any questions regarding your permit or the Underground
Injection Control Program, please call me at [phone] .
Best Regards,
Shristi Shrestha
Underground Injection Control (UIC)-Hydrogeologist
Division of Water Resources, NCDEQ
Water Quality Regional Operations Section
State of North Carolina I Environmental Quality I Water Resources
1611 Mail service Center I Raleigh, North Carolina 27699-1611
919 707 9000
cc: Danny Smith-Rick Bolich, Raleigh Regional Office
Central Office File, WI0500414
Orange County Environmental Health Department
Page2 of2
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR TIIE 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
James Bartram & Jane Bailey
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 410 Whitehead Circle, Chapel Hill, Orange
County, NC 27514 will be operated in accordance with the application submitted June 24, 2016, and in 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 ISA North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until August 31, 2021, and shall be
subject to the specified conditions and limitations set forth in this permit.
Permit issued this the day of 27th September 2016.
S. Jay Zimmerman, P.G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission.
Permit#WI0500414 UIC/5A7
ver. 11/15/2015
Page 1 ofS
PART I -PERMIT GENERAL CONDITIONS
1. The Permittee shall comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NC'\C 2C .0200). Noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is grounds
for enforcement action as provided for in N.C.G.S. 87-94
2. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [15A NCAC 02C .021 l(a)].
3. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data [15A NCAC 02C .0211(1)].
4. This permit is not transferable without prior notice and approval. In the event there is a desire for the facility
to change ownership, or there is a name change of the Permittee, a formal permit amendment request must
be submitted, including any supporting materials as may be appropriate, at least 30 days prior to the date of
the change [15A NCAC 02C .021 l(q)].
5. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply · that all
regulatory requirements have been met [15A NCAC 02C .0203].
PART II -WELL CONSTRUCTION GENERAL CONDITIONS
1. The well supplying water for the geothermal heating and cooling system shall be constructed 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 1,500 milligrams per liter. In areas where elevated chloride levels are known to exist or are
probable, such as coastal areas, chloride levels shall be verified in the field to determine existing conditions.
[15A NCAC .0225(g)(8)].
4. 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 perm~ently affixed an identification plate [15A NCAC 02C .0107(j)(2)].
Pennit#WI0500414 UIC/5A7
ver. 11/15/2015
Page 2 of5
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
I. 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 .021 l(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 [ISA NCAC 02C .021 l(k)]
1. Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable time for the purpose of 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
I. 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(t)(2), (4)].
2. Monitoring of any well may be required to ensure protection of the groundwater resources of tµe State and
compliance with the groundwater quality standards specified in ISA NCAC 02L [ISA NCAC 02C
.0224(t)(l )].
3. The Permittee shall report any monitoring or other information that indicates noncompliance with a specific
permit condition, that a contaminant may cause a violation of applicable groundwater quality 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 I SA NCAC 02C .0211 (r), noncompliance notification shall be
as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence, to the Raleigh Regional Office, telephone number 991-791-4200.
(B) Written notification shall be made within five days of the occurrence and submitted to the addresses
in Item #5 below.
Permit#WI0500420 UIC/5A7
ver. 11/15/2015
Page 3 of5
(C) The written notification shall contain a description of the noncompliance and its cause; the period of
noncompliance, including dates and times; if the noncompliance has not been corrected, the
anticipated time it is expected to continue; and any steps taken or planned to reduce, eliminate, and
prevent reoccurrence of the noncompliance.
4. 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 Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
PART VI -PERMIT RENEW AL [ 15A NCAC 02C .0224( c )]
As required by rule an application for permit renewal shall be made at least 120 days prior to the expiration
date of the permit. This permit condition does not apply if the Permittee chooses to discontinue operation
of the well for injection of effluent from the geothermal heating and cooling system associated with this
permit.
PART VII-CHANGE OF WELL STATUS [15A NCAC 02C .0240]
1. Procedures for temporarily or permanently abandoning a well are the same as those specified in rule 15A
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 longer 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 .01 l l(b)(l)(A),(B), and (C).
Pennit#WI0500420 UIC/5A7
ver. 11/15/2015
Page 4 of5
(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#WI0500420 UIC/5A7
ver. 11/15/2015
Page 5 of5
WQROS REGIONAL STAFF REPORT FORM
UIC Program Support
Permit No. WI0500414
Date: 09/15/2016
To: Shristi Shrestha
Central Office Reviewer
County: Orange
Permittee/Applicant: James Bartram & Jane Bailey
Facility Name: Bartram/Bailey Geothermal Well
L GENERAL INFORMATION
1. This application is (check all that apply): D New IZI Renewal
D Minor Modification D Major Modification
a. Date of Inspection: 07/26/2016
b. Person contacted and contact information: Jane Bailey 919-240-7738
c. Site visit conducted by: Laura Robertson
d. Inspection Report Printed from BIMS attached: D Yes IZI No
e. Physical Address of Site including zip code: 410 Whitehead Circle. Chapel Hill. NC 27514
f. Driving Directions if rural site and/or no physical address:
g. Latitude: 35.897055 Longitude: -79.050686
Source of Lat/Long & accuracy (i.e., Google Earth, GPS, etc.): Goo gle Earth
II. DESCRIPTION OF INJECTION WELL{S) AND FACILITY
1. Type of injection system:
IZI Geothermal Heating/Cooling Water Return
D In situ Groundwater Remediation
D Non~Discharge Groundwater Remediation
D Other (Specify: )
2. For Geothermal Water Return Well(s) only
a. For existing geothermal system:
RECEIVED/NCDEQ/DWR
SEP 2 0 2016
Water Quality
Regional Operations Section
Were samples collected from Influent/Effluent sampling ports? IZI Yes D No.
Provide well construction information from well tag: Total d epth 550 ft , Casing depth 73 ft , Drilledl0-
27-2011, Pump at 80 ft . Return pi pe 500 ft.
b. Does existing or proposed system use same well for water source and injection? D Yes IZI 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? D Yes IZI No
What is/are the pollution source(s)? _________________________ _
What is the distance of the injection well(s) from the pollution source(s)? ___________ _
4. What is the minimum distance of proposed injection wells from the property boundary? -------
5. Quality of drainage at site: IZI Good D Adequate D Poor
6. Flooding potential of site: IZI Low D Moderate D High
Rev. 6/1/2015 Page 1
WQROS REGIONAL STAFF REPORT FORM
UIC Program Support
7. 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.
8, 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.
9, For Non -Discharge groundwater remediation systems only:
a. Are the treatment facilities adequate for the type of waste and disposal system? ❑ Yes ❑ No ❑ NIA.
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. E VAL UATION 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 Treason for each special condition:
Condition Reason
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):
Signature of WQROS Regional Supervisor:
r
Date: 9-15-201 b
Rev, 5/1/2015 Page 2

WQROS REGIONAL STAFF REPORT FORM
UIC Program Support
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS a/Needed)
The well is used for geothermal heating/cooling as well as irrigation.
Rev. 6/1/2015 Page 3
Water Resources
ENVIRONMENTAL QUALITY
September 15, 2016
James Bartrann & Jane Bailey
410 Whitehead Circle
Chapel Hill, NC 27514
Subject: Geothermal Well Sampling Results
410 Whitehead Circle
Chapel Hill, NC — Orange County
Dear Dr. Bartram & Ms. Bailey:
PAT MCCRORY
r ej1"'7�(V-
DONALD R. VAN DER VAART
Ssa wny
S. JAY ZIMMERMAN
Derevils?
Groundwater sampling was conducted at the geothermal well on your roperty on July 26,
2016. We are forwarding herewith the laboratory reports dated August l2, 3016, issued for the
following analyses in the influent and effluent samples: fecal and total coliform bacteria, chloride,
fluoride, sulfate, total dissolved solids, nitrate-nitnte as N, and metals.
The laboratory results indicate that several metals were detected in the groundwater
samples collected on July 26 2016'Total coiiform bacteria were just above detection during the
July 26 sampling event, and for all analytes tested,'the results of the influent and effluent samples
are very smlar in concentrations. Copper and zinc were slightly elevated in the samples on July
26, although both analytes in both samples were below the 15A NCAC 02L .0202 groundwater
standards on this date. Your permit application renewal is a=ently processing and will be mailed
to you separately.
Please find the attached laboratory results. Feel free to contact me with any questions.
Sincerely,
b W& ��Vvu
Laura Robertson, L.G.
HydrogeoIogist
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
Enclosure
cc: RRO Files
Orange County Health Department
state ofNodb caml = 1 Favironrnwe Q wjty i water Resources
1629 Mail Sawa Center I Raleigh, North Caralma 27694-1628
919 7914200

AC31201
Loe. Descr.;
County :
Region :·
Ri~B~lf1
Emergency
coc Yes/No
North Carolina Division of Water Resources Water Sciences Section Laborato ry Results
410 WHITEHEAD CI RCLE
ORANGE
BBQ ,
CPF01
Collector:
Report'To
Collect Date;
Colle.ct Time :
Sample Depth
LROBERTSON
RRO
_07/26/2016
11.i.s
VisitlD
Loc11tlon ID:
Prionty
Sampie .Matri x:
Lao,Type :
Final Re port
5P068W10500414 INF
ROUTINE .
GROUNDWATER
Water Supply
Sample ID :
PON(imber#
Date. Received :
'llrn!I Received :
labWPrks Log info
Dellvetji Method
AC31201
0V26/201&
13:45
TASCENZ01
Hand datlvered
F!hai R!!pClrt bate: ~
RepClrt Print Date :· ilB/1212016
ff this report Is labeiet!ptellminaryte;,orl, the ~ults hav, 11ot bee" v.alldated; Do not use for Regu/atory piJrpos,s .
CAS#
7429°90•5
7440•70-2
7440-47-3
7440-50-8
7439-89'6
7440-09.7
7439-;954
7439-96,,q
7440-23•5
7440-02--0
7439-92•1
7440°66~6
..
Resul:tl Y!!j!g Method . Analtsis,
Anal yt e Name ;PQL qualifiei-Referem:e
i.AB
Sample temperature at receipt by lab' 3.9 ·c
MIC
Coliform ; MF Fecal ih liquid 1 1 EJ2 ¢i=i.Jt1ooml SM 9222'tl-'1997
C.oliform , MF Total ih liquid 3 CFi,J/1QPml SM 922Z S-1997
NYT
N02+N03 as N in liquid 0 ,02 3.3 rngllasN EPA 353.Z REV 2
WET
Bromide 0.4 0.4 U. 'mg/L EPA3.oo·.o rev2.1.
Chloride 1.0 13 rng/L EPA300 .0 reV.2.1.
Fli,ioride 0.4 0:4 l)' mg/L EPA3Q0'.0 rev2 .1
sulrate· 2.0 15 rng/L EPA$oo;0 rev2.1.
Total D1$$1l1Yacj Soli(:1$ in liquid, 12 16f mg/L SM2540C-1M7
~Eff
Alby ICP' 50 sou ug/L EPA 200 ·.1 Rev4.4·
Caby ICP 0.10 16 n,gll EPA-200 .7 Rev4.4
CrbylCPMS 5.0 s.ou: ugll EPA 200 ;8 Rev5;4
Cu.bylCPMS 2.0 320 ug/L EPA:2Q0 .8 Rev5;4
FebYICP 50 sou \Jg/L EPA200.7. Rav4:4
H1;11'dne$S by Calculation 1.0 70 mgll SM2340BEPA WO . 7
K bylCP 0.10 0.51 mg/L EPA200 ,7 R_ev4.4
Mg byi(:;p 0 ,10 7.2 rng/L EPA2'00.7 Rev4'4
MnbylCP 10 17 ug/L EPA 200:1 Rev4.4
NabylCP 0.10 14 mg/L EPA200 .7 Rev4.4
NioylCPMS 2.0 2.0 0. ugll EPA200 :e· Rev5.4
Pbby ICPMS 2.0 2.0 U ug/l EPA200 :8 Rev5.4
Znby ICP 10 560 ug!L· EPA 200:7 Rev4.4
WSS Chemistry Laboratory» 1623 Mall .Service Center, Raleigh, NC 27699-1623 (919) 733•3908
"Not Detected" or "U" does not indicate the sarnple is analyte free but that the analyte is not detected at or above the PQL ,
Page 1 of 1
Date
7126116
7126116
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8/9/16
7/26/16
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7/26 /16
7/26/1.6
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7/28/16
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8/2/16
7/28/16
8/1/16
7/27/16
7/27/1.6
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7127/16
8/2116
8/2116
7128/16
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Calcium (Ca)
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rahah [Co)
pe/L
Acid Herbicides
TOC- Total Orgxric Catbon
mg/L
Tarmm & Ugnm
mg/L
Coµ er (Cu)
j]g/L
noi:Marine Pesticides
Turb+drty
NTU
Iron (Fe)
pg1L
arganonitm PeshcAes
Lead (Pb[
lrg/L
Organaph horus PeSheides
Wet Chengmy Parameters ' Iw c
PH
s u
Ulha= [Lt}
PCRs { ychlwrnatr?d W Lsl
Bromide
mg/L
Hardness, Total as CaCO3 - by titration
mg/L
d
Magnesium f M
mg1L
Chloride
MOIL
V
Manganese (NM
µgk
Semi -Volatile Orgaruta (BMM)
Fluunde
mg/L
Mercu (H
pgA
TPH diesel Range
5ufate
rng1L
Nutrients Paameters-
Molybdenum (Mo)
PXA
Chlarophy4a
pg11
Ammonia as N (NH3-N
"VA
N.,w
pgjL
Volatile 0rpnics (VOA)
Color ADMi
C u
Nitrate-Ndrrte as N (NO3+Na2-N)
mg/L
Potassium
MgIL
Color Plannum Cobalt
c u
Total K ahl Nrtra en as N CNN).
m&&
Selenium (Se[
P&A
TPH Gasobne Ran e
om chemical Grygen Mires d
MG&
Total Phoa hams as P (TP)
ftwA
Silver (AF,)
poll.
C dnide, Total
mg/L
Nitrate as NI NO2-N)
mgji
Sodium (Nal
MOIL6ta�agir�l:
•+>a' '� "1 r, �.
e
Formaldehyde
mg/L
Nitrate as Nl {NO3-N cakulated)
r loL
Strontium (5►)
pg/L
Phyoo nkton /Al
Fieiavalent Chromrurn (Cr6*)
mKIL
0,0,phosptiate as P (PO4j
mg/L
rhall,um (ill
µg/L
tA8 COMMENTS
Parart�etersloFmmip tl Water Temp f cj. y (ppmv.�' ; I ' • C°qdirc>Arity {jiinh°s/up)°
Revision

AC31202
Loe. Dnc~;:
County:
Region :
Rive{Baslr,
Emergency
coc Yes/No
North Carolina Division of Water Resources Water Sciences Section Laboratory Results
41 D WHIJEHEAD CIRCLE
ORANGE _
RRO ,
CPFD1
Colleetor.
Repc,rtTo
Collect Date ;
Collect Time:
SampleDeptll
LROBERTSON
RRO
07/28/2016
13:~D
VisltlD
Location ID ;
Prlol1\Y
Sampie Matrix:
Loe. Type,
Final Re port
5P06BW10500414 EFF
ROUTINE.
GROU NDWATER
Water Supply
San'jple iD :
PO Number#
Date. Received:
Tirtle Recel_ved:
Labworks LoginfD
Delliletj Method
i=lnal R11port Date:
Rf:po~ ~rJnf Date:
AC31202
07/26/2016
13:45:
TASCENZ01
Hand drillvere4
8{12i1ii
il811212ii1ii •
ii this report_ J~ lalJeiec! ptellir;lnary teP,ort,. thf) /flsultiJ ha.ve not been WJl/dated. Do ,npt us~ for Regci#1fo_ry Pil,Pos11s.
Result/ Units Method .Analisis
CAS# Analyt e Name '·paL Qualifier' Reference Date Validated b~
~AB
Sample temperature at receipt by lab 3.9 ·c 7126/16 MSWIFT
MIC
Coliform, MF Feca.l in liqui<!. 1 ~2 ¢FU/10Pml SM 9222 D-1997 7/26/16 ESTAFFOR01
Coliform, MF Total in liquid 2 CFU/100ml SM 9222 ~-1997 7/i6/16 ESTAFFORQ1
NUT
N02+N03 as N in liquid 0 .02. 3.4. i'ng/Laa .N EPA 353:2 REV 2 8/9/16 CGREEN
WET
Br-prnide 0.4 0.4U m9'L EPA300';(i: t$v2 .1 7/26/18 CGREEN
Chloride 1.0 13 mg/I., EPA300.o:rev2, 1 1/26/11!, CGREEN
Ffjjoride 0.4 0.4 U mg/[. EPA 30M rev2.1 1/'1.6/16 CGREEN
Suifat(3_; 2:.1) 15 mg/L Ef'A3QQ;Qniv2.1; 112§[1.ii QGREEN
Total Dls!:!olved Solid~ h1 liquid : 12 168 mg/L SM254.0G-1M7 7/29/11S CGREEJ:'-1°
NIET
7429 °.90-5 Al bylCP 50 50U ug/L EPA200? Rev4 ;4-7/28116 ESTAFFOR01
744°"7.0:-2 .Caby ICP 0.10 15 mgiL EPA•200.7 Rev4.4 7/27116 ESTAFFOR01
7440-47-3 Cr:by l CPMS 5.0 5.0U !,ig/L E:PA 200:e Rt;vM 8/4/.1 6 ESTAFFORD1
7440-50-8 Cu bylCPMS 2.0· 330 ug/L l:PA2Q,O .!l Rev5.4· 6/2/16 ESTAFFORD1
7439-89:.S Fe.--bylCP 50 sou: ug/l EPA200.7. Re\/4 .4 7/28116 E$TAi=FORD1
Hiardne~ by Calculation 1.0 66 mg/L SM2340Sl:PA 200 ,7 8/1/16 ESTAFFORD1
74.40-09-7 K.bylCP: 0,10 0.50 mg/L EPA 200 ;7 Rev4A 7/27116 ESTAFFORD1
7439°85-4 Mg .bylCP 0.10 7.(1. mg/L EPA.2Qo.7'Rev4,4 712711.6 ESTAFFOR01
7439~845 Mn bylCP 10 16 ug/L EPA200\7 Rev4 .4 7/28/16 ESTAFFORD.1
7440-23-5 NabylCP 0 .10 ··14. mg_/L EPA-200; 7-Rev4 .4 7/27/16 ESTAFFORD.1
7440-02--0 NibylCPMS'-2:0 2~0 v: ug/l EPA 200 .8 Rev5.4: . 8/2/18 ESTAFFOR0·1
743g;;9z,.1 Pbby ICPMS 2 .0 2.0U ug/L EPA200 :8 Rev5.4 8/2/16 ESTAFFORD .1
7440,66-6 Znby ICP 10 540 i.Jg_/L EPA 200 : 7 Rev4;4-7/28/16 ESTAFFOR0'1
WSSChemlstry Laboratory» 162~ Mall Servlca Center, Raleigh, NC 27699-1623 [phone]
"Not Detected" or "U" does not Indicate the sample is analyte free but that the analyte-is not detected at or above the POL.
Page 1 of 1
North Carolina Dtvtsurn of Water Resources '+� 11ic1�iEk T
Central l<abon tory (water Saerices Secton) Water Sample CaBecdon & Snbmitbd Farm , ; r AC3'! 202
°e da-0-
`
%/
"ICj—ijl
❑►tm��eM
�Rou[ute
❑ComPltanGe
❑ i7GC
❑�mergenCY
❑iA
❑
�Gmund
❑ Waste
❑ IdR}[
❑Sodutton
LCCat1LlR Typw,'
❑�
❑Stptmuvater
❑htortihurutgWeB
❑Effluent
❑Fw $3alrk
❑Filter BianSr
❑Q[fi er
:. :. � i
penal
QWatersupply
❑Influent
[]Trip Blank
♦.
r .DWR Regfoe:
- aay •=-� � ►h.J
.
r��a ` K 1r1R]
� '
� ;s � n_
.:� y f'
?� to Couw
Cebwy IPRand i3eltvery
r• a r �
:�y I dlF►er
itrOrea
Z Ilw-�
- '
❑ Ghkumated ❑DO-ddwmaled in Field
Owisolvad analy riLa EnW "Df +
❑ Fdtemd m Field
Sri Gl1r'.tiFl]Q%e5 for p"dran!@jer8
"45Cf(1p&np' a f�J �"
'#
fluter
Sarr�rlg _ ir_ d
� ,�
r�eY°t"1e I •q' � � 9
'pP 141J'Illlri; � 3
}
h ••l` W, � '
. COIIeCtD�S CQilf1118pRS•'
Mrcrabiolpgy ParameUers
MBAS (surfactants)
mg/L
iAletalsireraraelees:
F'" ' - •
TinSnj Pg/L
Roddy, as CaCO3, to PH 4 518 3
Oil and Grease, HEM, Total Recoverable
mg/L
Aluminum JAI}
C L
Thorium fril wYL
Aykafimty, as CaCO3, to pH 4 $A 3
my,/>.
Phenols, Total Recoverable
pg/L
Antimony (Sb)
ltg/L
Vanadium M PAIL
000 ism rntrs! ory Aesnand 5 day
MAIL
Residue Total (Total Sours]
mg/L
Assemr (Asl
WL
Tsmc (Zn) NAIL
cBOD Carbonaceous ROD, 5-day
mg/L
Residue Vulable/FvoedJotal
mgiL
Barium (8a)
MA
rm Fecal MF
JIMMl
Restdoe Suspended j% pendedSohds
m
Berl Mum Be
AIL
Boron 8l, Total NIL
Coldbr m ToMl OAF
1200ml
Residue Votahk Nwed, Swe!nded
MCA
Cadmium JulVS/L
I Mminy 1631, low-level nA/L
Cokdorm Tube Fetal
I1a0rrd
Y
TDS - Total Dissahred Solids
mgA
V
cabum (Cal
mgfL
Wiform TubeTmal
/Inorw
Saga
mg/L
Chfomrum (rr} Total
PKA
.,,QrganicsParamdm,
Spacific Conductance, at 25 C
wnhu,;lan
Sulfide
mg/L
iz tDbwt JCo)
Ng/L
Acid HerGtndes
TOC. Total Otgamc Carbon
rr L
Tannin & LVLn
mg/L
Cap r Ieu
µg/L
Orgar"hlurme Pesbudes
Turbidity
MU
I
VII
Iron lFel
NgR
OrganontVaeen Pediades
athwPatameteML '+s' •°
Lead(Pbl
pg/L
0 rgartaphosphorusPesoades
Wet ChemLmyr 4mmtttem ..
s •
.PH
s u
lithium (Lrj
Ng/L
PCBs 1pdychlonnated bwbanvls)
Bromide
rrtg/L
V
Hardness, Total as CaCO3 - ttbabM
mg/L
Magnesium (Mw
mglL
Chlande
MOA
Mangarw.se IMn)
N&IL
Semi-VolatileOrgan-%(SNAsj
FIUQMIe _
MercuryjHo
LWL
TPH Dtesef Range
Sulfate
A&)Iybijenun+ (MaL
WA
Chlora hylI a
}+A/L
Ammoma as N (NH3-N)
rrWL
Vj
Ntckrl Inky
vg/L
Volatile Organtrs (VGA)
Color ADMI
c u
Nitrite-Ma=e as N (NO3+NOZ-N)
mgjL
Potassium (KI
Mg&
Coiar PFabnum Cobalt
c u
Total N)eldald Nitmgm as N
L
Selenium JSe)
pglL
TPH Gasohne Range
COD chemical Q.ym Demand
mg/L
Total Phaghinrus as P (M)
MAIL
Solver
AIL
tde, Total
MAIL
Nitrite as N (NO2-N)
Sodium (Na)MOL
Farmaldehyde
ma/L
Nitrate as N (Np3-N rafculated]
mg/L
Strontium (Sr)
yg/L
Phytaplankton I Algae
Hettavalent Chromium CrG•rl
mall
Ortho h hate as P (PO41
L
ThaWm }
NAIL
LAB COAtlMENTS :
Fkald Far.6MiersjQ"d' Q+,1NaUL ', ',hp r4; .- RH +1,+ i ' D+SSFil+ied Qicy ge {ppmj:y� i Core UdMCy (NmhQi.T . - . I ,,sa1tl,ttyr {pPty • j j

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW RE QUEST FORM
Date: June 28, 2016
To: Danny Smith -Rick Bolich
From: Shristi Shrestha, WQROS -Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
Permit Number: WI0500414
A. Applicant: James Bartram & Jane Bailey
B. Facility Name:
C. Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal
E. Comments/Other Information:
__ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a completed WOROS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy of
this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact person
listed above. ·
RO-WOROS Reviewer: __________________ Date: _____ _
COMMENTS:
NOTES:
FORM: WQROS-ARR ver. 092614 Page 1 ofl
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELL (S )
These well(s) inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
CHECK ONE OF THE FOLLOWING:
__ New Application ~Renewal* __ Modification __ Permit Rescission Request*
*For Permit Renewals or Rescission Request, complete Pages 1 and 4 (signature page) only
Print or Type Jriformation and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: _______ ~20 __ PERMIT NO. /IVJ:0500 s-'l ~leave blank ifNew Application)
A. CURRENT \\'ELL USE AND OWNERSHIP STATUS (leave Blank if New Application)
B.
C.
1. Current Use of Well t
a. Continue to use as Geothermal Well __ Drinking Water Supply __ Other Water
Supply
b. Terminate Use: If the well is no longer being used as a geothermal injection well and you wish to
rescind the permit, check the box below. If abandoned, attach a copy of the Well Abandonment
Record (GW-30). RECEIVEDfNCDEQ/DWR
D Yes, I wish to rescind the permit JUN 2 4 2016
2. Current Ownership Status Water Quality Regional
Has there been a change of ownership since permit last issued? D YES D NOOperations .Section
If yes, indicate new owner's contact information:
Name(s) ______________________________ _
Mailing Address : ____________________________ _
City: __________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: Email Address.:
STATUS OF APPLICANT (choose one) \/
Non-Government: Individual Residence fr-. Business/Organization __
Government: State__ Mumcipal __ County__ Federal
WELL OWNER(S)/PERMIT APPLICANT-For individual residences, list owner(s) on property deed. For
all others, list name of entity and name of person delef$ated authority to sign: __________ _
...J-AM-€s k ~~{(,f:'\ er '1AN£ B-All.:e ")
Mailing Address:ft VJ h ,~ho,A) Cu:ili
City: Cb.Qfaj BuJ State: N L Zip Code: ~ 7 S I l/--County: 0 fl AN 0 t
Day Tele No.: 9 \ q !l 4P t7 3 '6 Cell No.: q \ q q 2...~ 2 4Aa b
EMAIL Address: b~t ~wtfll,w\@cr aJ .(OW) Fax No.:
Geothermal Water Return Well Permit Application (Revised Jan 2015) Page I
D. WELL OPERATOR (if different from well owner) -For individual residences, li st 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.: ---------------~E=m=a=i~l A~d=dr~e=s=s -~: ___________ _
E. LOCATIOI\' OF WELL SITE-Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of we ll site: __________ County: _____ _
(2) Physical Address (if different than mailing address): _________________ _
City: ________________ State: NC Zip Code: _________ _
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name:
NC Well Drilling Contractor Certification No.: _____________________ _
Company Name: ________________________________ _
Contact Person~: _______________ EMAIL Addres s: ___________ _
Address: _________________________________ _
City: Zip Code: _____ State: __ County:
Office Tele No .: Cell No .: Fax No .: ---------·---------
G. HV AC CONTRACTOR INFORMATION (if different than driller)
HVAC Contractor's Nam e: ____________________________ _
NC HVAC Contractor License No.: _________________________ _
Company Name: ________________________________ _
Contact Person~: _______________ EMAIL Address : ___________ _
Address:------------------------------------
City: Zip Code: ----c----State: __ County: _________ _
Office Tele No.: Cell No.: Fax No.: ---------------------------
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES ___ _ NO ___ _
YES ___ _ NO ___ _
I. WELL CONSTRUCTION REQUIREMENTS-As specified in ISA NCAC 02C .0224 {d):
(1) The water suppl y well shall be constructed in accordance with the water supply well requirements of
ISA NCAC 02C .0107.
(2) If a separate well is used to inject the heat pump effluent, then the injection well shall be constructed
in accordance with the water supply well requirements of 1 SA NCAC 02C .0107, except that:
Geoth ermal Water Return Well Permit Application (Revised Jan 20 15 ) P age 2
(a) For screen and gravel-packed wells, the entire length of casing shall be grouted from the top
of the gravel pack to land surface;
(b) For open-end wells without screen, the casing shall be grouted from the bottom of the casing
to land surface.
(3) A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
*EXISTING WELLS ---------' _____ PROPOSED WELLS
* For existing wells, please attach a copy of the Well Construction Record (Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
( c) Casing depth below land surface
( d) Casing height "stickup" above land surface
(e) Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited/or sealing water-bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .0107(0(8 )
(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
K. OPERATINGDATA
(1) fojt;ction Rate: Average (daily) gallons per minute {gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average ( daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) __ ° F.
L. SITE MAP-As specified in 15A NCAC 02C .0224{b )(4 ), attach a site-specific map that is scaled or otherwise
accurately indicates distances and orientations of the specified features from the injection well(s). The site map
shall include the following:
(1) All water supply wells, surface water bodies , and septic systems including drainfield, waste
application area, and repair area located within 250 feet of the injection well(s).
(2) Any other potential sources of contamination listed in 15A NCAC 02C .0107 (a )(2 ) located within 250
feet of the proposed injection well(s).
(3) Property boundaries located within 250 feet of the parcel on which the proposed injection well(s) are
to be located. ·
(4) An arrow orienting the site to one of the cardinal directions (north, south, west, or east)
Geothermal Water Return Well Permit Application (Revised Jan 2015) Page3
NOTE: In most cases an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county G1S 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 selecred showing topographic contours or elevation
data
M. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC D2C .Q211te1 requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship. by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer -
or ranking publicly elected official;
4. for all others_ by all the 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 n2mes and .authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the passibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of the
Permit."
Signature of Property erlAxliplican
Print or 1'yp • Name
Signature of Property 0wnerlA5plicant
QtcA'M
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
Division of Water Resources
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Return Well Permit Application (Revised Jaa 2015) Page 4

PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
Water Resources
ENVIRONMENTAL QUALITY S. JAY ZIMMERMAN
June 28, 2016
James Bartram & Jane Bailey
410 Whitehead Circle
Chapel Hill NC 27514
RE: Acknowledgement of Application No. WI0500414
Geothermal Heating/Cooling Water Return Well
Orange County
Dear James & Jane:
· The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
pennif application and supporting documentation received on June 24, 2016. Your application
package has been assigned the number listed above, and the primary reviewer is Shristi Shrestha
Central and Raleigh Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Water Quality Regional Operations Section
(WQROS) requests your assistance in providing a timely and complete response to any additional
information requests.
Please note that processing standard review permit applications may take as long as 60 to
90 days after receipt of a complete application. If you have any questions, please contact Shristi
Shrestha at .919-807-6406 or email at [e-mail] .
cc: Raleigh Regional Office, WQROS
Permit File WI0500414
Sincerely,
For Debra J. Watts, Supervisor
Animal Feeding Operations & Groundwater
Protection Branch Division of Water
Resources
State of North Carolina I Environmental Quality I Water Resources
1611 Mail service Center I Raleigh, North Caroliua 27699-1611
919 707 9000
Director
PAT MCCRDRY
Governor,
❑ONALD R. VAN DER VAART
Wry ter h esources
ENV190NMENYAL QUALITY
June 16, 2016
CERTIFIED MAIL # 7015 1520 0000 7838 3880
RETURN RECEIPT REQUESTED
James Bartram & Jane Bailey
410 Whitehead Circle
Chapel Hill NC 27514
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No. WI0500414
Orange County
Dear James & Jane:
seerelary
S. JAY ZIMMERMAN
Dhvemr
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 September 6, 2011, and will expire on August 31, 2016. Per permit conditions and
requirements per 15A NCAC 2C .0224(c), the renewal application must be submitted at least 120
Calendar days prior to expiration of the permit if you wish to continue operating the injection well
on your property.
If Your Geothermal Water Return Well is Still Curreuttv Being, Used for Iniection:
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;llportal.ncdenr.org/web/wq/aps/gwpro/perrnit-applications.
If Your Geothermal Water Return Well is NO LONGER Being"U sed for In fiction:
If the well is no longer being used for injections, you do. not have to renew your permit. Check the
box in Part A of the attached renewal application that you wish to rescind the permit and indicate
the current status of the well (i.e., used as water supply well, irrigation well, inactive, plugged and
abandoned, etc.). If it is no longer being used for any purpose, it must be permanently abandoned
according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C, Section
.0240. When the well is plugged and abandoned, a well abandonment record (Form GW-30) must
be submitted to our office to certify that the abandonment was properly conducted.
State of !North Carolina j Enviroamcrttai "Iity { Water Rcsoar=
l(il I NWit &uviu C,uuu ItZal�ixla NuIrStCrr�,Sil 27G99-1G1I
9197079000

Page 2 &f 2
If There has been a Chanze of Ownership of the Propert► :
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change" Form must also be submitted in addition to the renewal application.
This form is not enclosed but can be found at the website listed above. Please submit the applicable
forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms in a timely manner may result in the assessment of civil
penalties in accordance with North Carolina General Statute 87-94. Thank you in advance for
your cooperation and timely response. If you have any questions, please contact me by phone at
[phone] or by email at shristi.shresthafa ncdenr.gov.
Regards,
RIa
Shristi Shrestha
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: Raleigh- Regional Office — WQROS w/o enclosures
Central Files - Permit No. W10500414 w/o enclosures

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1. Articte Addressed to:
lames Bartram & Jane Bailey
410 Whitehead Circle
Chapel HiP NC 27514
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Permit N.umber WI0500414
Program Category
Ground Water
Permit Type
..
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael. rogers
Coastal SW Rule
Perm itted Flow
Facilit
Facility Name
James Bartram and Jane Bailey SFR
Location Address
410 Whitehead Cir
Chapel Hill
Owner
Owner Name
James
Dates/Events
NC 27514
Bartram
Ori g Issue
09/06/11
App Received Draft Initiated
07/28/11
Scheduled
Issuance
Central Files: APS_ SWP_
09/02/11
Permit Tracking Slip
Status
In review
Version
Project Type
New Project
Permit Classification
Individual
Permit Contact Afflllatlon
Major/Minor
Minor
Region
Ra leigh
County
Orange
Facility Contact Affiliation
·owner Type
Individual
Owner Affiliation
James Bartram
Owner
410 Whitehead Cir
Chapel Hill NC 27514
Public Notice Issue
09/06/11
Effective
09/06/11
Expiration
08/31/16
Reaulated Activities Reo uested/Received Events --------------------------
He at Pump Injection Additional information requested
Outfall NJ;...L
Waterbody Name
RO staff report requested
Additional information received
RO staff report received
Stream Index Number Current Class
08/10/11
08/11/11
08/11/11
08/25/11
Subbasin
Permit Number WI0500414
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
James Bartram and Jane Bailey SFR
Location Address
410 Whitehead Cir
Chapel Hill
wner
Owner Name
James
Dates/Even ts
NC 27514
Bartram
Orig Issue App Rece ived Draft Initiated
07/28/11
Reg ulated Activities
Heat Pump lnjectior:i
Outfall NULL
Scheduled
Issuance
Central Files : APS_ SWP_
08/30/11
Permit Tracking Slip
Status
In review
Project Type
New Project
Version Permit Classification
Ind ividual
Permit Contact Affiliation
Major/Minor
Minor
Region
Raleigh
County
Orange
Facility Contact Afflllatlon
Owner Type
Individual
Owner Affiliation
James Bartram
Owner
410 Whitehead Cir
Chapel Hill NC
Public Notice Issue Effective
Reo uested/Received Events
Additional information requested
RO staff report requested
Additional information received
RO staff report received
27514
Expiration
08/10/11
08/11/11
08/11/11
08/25/11
Waterbody Name Stream Index Number Current Class Subbasin
HCDENR.
North Carolina aepartmenf of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
September 6, 2011
James Bartram and Jane Bailey
41.0 Whitehead Cir.
Chapel Hill, NC 27514
Re: Issuance of Injection Well Permit
Permit No. WI0500414
Issued to James Bartram and Jane Bailey
Orange County
Dear Mr, Bartram and Ms. Bailey:
❑ee Freeman
Secretary
In accordance with your application received July 28, 2011, 1 am forwarding Permit No. WI0500414 for
the construction and 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 August 31, 2016, and shall be subject to the conditions and limitations stated therein.
Per Permit Condition Part 11.2, please notify Jay Zimmerman with the Raleigh Regional Office
(919-791-4200) within 30 days after the well becomes operational in order for water samples can be
collected from the geothermal system.
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,
f
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
cc: Jay Zimmerman, Raleigh Regional Office
Central Office File, W10500414
Orange County Environmental Health Dept.
AOUiF=_P. PROTECTION SECTIon
1635 Mail sari[* � enter. Ralagh, North Carolina 27694.1636
LecamR- 2728 Capital Bmi evard, Raleigh,140:) CBm9na 27604 QnC P nona, 917-7333221 I FA,'; 1. 91u-'13-058B: FAX 2' 919-715$OAE l Customer Smi211-8i1'-fi-M?48 6ffhC' arolti1�
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NOR-TH 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
James Bartram and Jane Bailey
FOR THE CONSTRUCTION AND 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 410 Whitehead Cir., Chapel Hill, Orange County, NC 27514, and will
be constructed and operated in accordance with the application. July 28, 2011, and conformity with the
specifications and supporting data, all of which are filed with the Department of Environment and Natural
Resources and are considered a part of this permit.
This permit is for Construction and 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 August 31, 2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
S('t'"
Permit issued this the 3t day of __ ~-.-=---_.,, 2011
(ko-J. ~
~f\coleen H. Sullins, Director r Division of Water Quality
By Authority of the Environmental Management Commission.
WI0500414
<-·l
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be permanently labeled with a warning that it is for injection purposes and the entrance to each well
must be sealed with a watertight cap or well seal, as defined in G.S. 87-85(16).
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.0213(g).
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to:
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699
919-791-4200
GW-ls must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight ( 48) hours prior to constructing each injection well, the Permittee shall notify the
Aquifer Protection Section-Underground Injection Control (UIC), Central Office staff, telephone number
[phone] and the Raleigh Regional Office Aquifer Protection Section (APS) Staff, telephone
number 919-791-4200.
2. Within 30 days of injection well completion, Permittee must contact the Raleigh Regional Office APS
Staff in order to have samples collected at the source well and injection well.
2
3. Continued operation of the injection system will be contingent upon the effluent not impacting
groundwater quality. The water quality of the effluent cannot be that of a lower quality than the influent,
which results in a degrading of water quality of the aquifer.
4. The injection well system must be constructed with sampling ports so that system influent and effluent
may be sampled.
5. The injection well must be constructed to a depth such that it is injecting water into the same aquifer that a
source well, if present,.is drawing from.
PART III -OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
PART IV-' PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwat~r which will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
WI0500414 3
3. At least forty-eight (48) hours prior to the initiati6n of the operation of the facility for injection, the
Permittee must notify by telephone the Aquifer Protection Section-Underground Injection Control (UIC),
Central Office staff, telephone number [phone] Notification is required so that Division staff can
inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
PART VI -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 VII-MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Raleigh Regional Office, telephone number 919-791-4200, any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VIII -PERMIT RENEW AL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
W I05G0°(l 4 4
PART IX -CHANGE OF WELL STATUS ..
I. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(l), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in I SA NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of · gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Pennittee shall submit a Well Abandonment Record (Form GW-30) as specified in
ISA NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
WI0500414
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
5
Ro gers, Michael
From:
Sent:
To:
Subject:
[e-mail]
Thursday, September 01, 2011 4 :07 PM
Rogers, Michael
Yahoo! Auto Response
Steve Bowman will be out of the office Thursday 9/1/11 and returning afternoon Tuesday
9/6/11.
1
A.TA
NCDENR
North Carolina Department ofEnvirorunent and Natural Resources
Beverly Eaves Perdue
Governor
Division of Water Quality
Coleen H. Sullins
Director
August 23, 2011
MEMORANDUM
To:
Through:
From:
Michael Rogers, The Central Office, APS
Jay Zimmerman
Lin McCartney
Dee Freeman
Secretary
Subject: Staff Report-WI0500414, James Bartram, 5A7 Geothermal Well
Aquifer Protection Section
1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Location: 3800 Barrett Dr., Raleigh, North Carolina 276@9
Phone: [phone] \ FAX: [phone] \ Customer Service: 1-877-623-6748
Internet: www.ncwaterguality.org
An Equal Opportunity\ Affirmative Action Employer
RECEIVED / DENR / DWQ
AQUIFl=R·PRnTFr.Tl0M SECTION
AUG 2 6 2011
Nirthcarolina
/Vaturatlu
AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: 08-23-2011
To: A quifer Protection Central Office
Central Office Reviewer: Michael Ro gers
Regional Login No: __ _
L GENERAL INFORMATION
1. This application is (check all that apply): [8] New D Renewal
County: Orange
Permittee: James Bartram
Project Name: UIC-5A7
Application No.: WI0500414
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Recycle D High Rate fufiltration D Evaporation/Infiltration Lagoon
D Land Application of Residuals
D Distribution of Residuals
D Attachment B included
D Surface Disposal
D 503 regulated D 503 exempt
D Closed-loop Groundwater Remediation [8] Other fujection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? [8] Yes or D No.
a. Date of site visit: 08-19-2011
b. Person contacted and contact information: James Bartram and Jane Bailey, 919-240-7738
c. Site visit conducted by: Lin McCartney
d. fuspection Report Attached: [8] Yes or D No.
2. Is the following information entered into the BIMS record for this application correct?
[8] Yes or D No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions: __
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude: __
e. Regulated Activities/ Type of Wastes (e.g., subdivision, food processing, municipal wastewater): __
For Dis posal and Injection Sites:
(If multiple sites either indicate which sites the information applies to . co py and p aste a new section into the
document for each site . or attach additional pages for each site )
a. Location(s): 410 Whitehead Circle . Chapel Hill . NC 27514
b. Driving Directions: Take I-40 W for 16 miles, merge onto NC-54 via Exit 273A, merge onto US-15 S/US
501 S, turn right onto Oteys Rd., turn left Mason Rd., turn left Whitehead rd., turn right Whitehead Circle.
c. USGS Quadrangle Map name and number: __
d. Latitude: 35-53-49 Longitude: 79-03-0.7
IL NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed fo r renewals or minor
modifi cations , skip to next section )
Description Of Waste (S) And Facilities
1. Please attach completed rating sheet. Facility Classification: __
FORM: staff.report-Bartram 1
RECEIVED / DENR I DWQ
AQUIFl=R·PROTFr.TIOM SECTION
AUG 2 5 2011
.
AQUIFER PROTECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description OfWell(S) And Facilities-New, Renewal, And Modification
1. Type of injection system:
IZ! Heating/cooling water return flow (5A7)
D Closed-loop heat pump system (5QM/5QW)
D In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5L/"Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? D Yes
3. Are there any potential pollution sources that may affect injection? IZ! Yes
[gl No
□No
What is/are the pollution source(s)? Sanitary Sewer Line. What is the distance of the in jection well(s) from the
pollution source (s)? 24 ft.
4. What is the minimum distance of proposed injection wells from the property boundary? 56 ft.
5. Quality of drainage at site: [gl Good D Adequate D Poor
6. Flooding potential of site: [gl Lo~ D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? IZ! Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
In jection Well Permit Renewal And Modification Onlv:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes [gl No. If yes , explain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes D No. If y es , ex plain:
3. For renewal or modification of groundwater remediation permits (of any type), will
continued/additional/modified injections have an adverse impact on migr ation of the p lume or management of
the contamination incident? D Yes D No. If y es , explain:
FORM: staff.report-Bartram 4
AQUIFER PROTECTION REGIONAL STAFF REPORT
4. Drilling contractor: Name: Glen Darch
Address: 13109 Bold Run Hill Road , Wake Forest. NC 27587
Certification number: 3900 A
5. Complete and attach Well Construction Data Sheet.
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet -if needed information is available
3. Do you foresee any problems with issuance/renewal ofthis permit? D Yes IZI No. If yes, please explain
briefly.
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
'
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
'
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
FORM: staff.report-Bartram 5
AQUIFER PROTECTION REGIONAL STAFF REPORT
7. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information;
Issue; ❑ Deny. If deny, please state reasons:
S. Signature of report preparer(s):
i ))} �[~ �
r
Signature of APS regional supervisor:
Date:
ADDITIONAL REGIONAL S TA FF RE VIE W ITEMS
A pre -construction inspection was conducted on August 19, 2011.
A review of the construction data indicates that the proposal to construct the well meets the
injection well construction criteria in accordance with N.C. State Regulations (Title 15A NCAC
2C), Well Construction Standards.
The following items were checked:
9. Well Casing
• Casing Type: Galvanized steel
• Casing thickness: 0. 25, Diameter: 6.00 inches
Casing depot: from surface to 60 feet, Casing extends above ground 12 inches.
2. Grout
• Grout type- Cement
• Grout surface and grout depth- Around well casing from surface to 60 feet.
3. The location of the well
• The sewer lime was approximately 24 feet from the well location.
• The minimum distance of the well from the building is about 65 feet
We recommend that the Central Office proceed to issue the applicant a permit for geothermal
well construction so that the contractor could start construction. However, once the system is
constructed, the permittee shall notify the Raleigh Regional Office so that a post construction
inspection and sampling of the well water can be performed.
FORM: staffreport-Bartram 6

Permit: WI0500414
SOC:
County: Orange
Region: Raleigh
Effective:
Effective:
· Contact Person: James Bartram
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 08/19/2011
Primary Inspector: Lin McCartney
Secondary lnspector(s):
Reason for Inspection: Routine
Compliance Inspection Report
Expiration:
Expiration:
Title:
Owner: James Bartram
Facility: James Bartram SFR
410 Whitehead Cir
Chapel Hill NC 27514
Phone: [phone]
Certification: Phone:
Entry Time: 01 :00 PM Exit Time: 02:00 PM
Phone: [phone]
Ext.4243
Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Heating/Cooling Water Return Well (5A7)
Facility Status: ■ Compliant O Not Compliant
Question Areas:
■Other
(See attachment summary)
Page: 1
Permit: WI0500414
Inspection Date: 08/19/2011
Inspection Summary:
Owner -Facility: James Bartram
Inspection Type: Compliance Evaluation
A Pre-construction inspection was conducted on August 19, 2011 .
Reason for Visit: Routine
A review of the construction data indicates that the proposal to construct the well meets the injection well construction
criteria in accordance with N.C. State Regulations (Title 15A NCAC 2C), Well Construction Standards.
The following items were checked:
1. Well Casing
Casing type: Galvanized steel
Casing thickness: 0.25 inches, Diameter: 6.00 inches
Casing depth: from surface to 60 feet, casing extends above ground 12 inches
2. Grout
Grout type: Cement
Grout surface and grout depth: around well casing from surface to 60 feet
3. The location of the well
The sewer line was approximately 24 feet from the well location
The minimum distance of the well from the building is about 65 feet
The minimum distance of the well from the property line is about 56 feet
We recommend that the Central Office proceed to issue the applicant a permit for geothermal well construction so that the
contractor could start construction. However, once the system is constructed, the permittee shall notify the Raleigh
Regional Office so that a post construction inspection and smpling of the well water can be performed.
Other
Comment:
Yes No NA NE
Page: 2
A QUIFER PROTECTION SECTION
APPLICATION REVIEW RE QUEST FORM
Date: August 11, 2011
To:. D Landon Davidson, ARO-APS
0 Art Barnhardt, FRO-APS
0 Andrew Pitner, MRO-APS
[8J Jay Zimmerman, RRO-APS
From: Michael Ro gers Groundwater Protection Unit
Telephone: (919 ) 715-6166
E-Mail: Michael.Ro e:[e-mail]
A. Permit Number: WI 0500414
B. Owner: Bartram.
C. · Facility/Operation: __
IZJ Proposed D Existing
D. Application:
0 David May, WaRO-APS
□ Charlie Stehman, WiRO-APS
0 Sherri Knight, W-SRO-APS
Fax: (919 ) 715-0588
D Facility D Operation
1. Permit Type: D Animal D SFR-Surface Irrigation□ Reuse D H-R Infiltration
D Recycle D 1/E Lagoon D GW Remediation (ND)
[8J UIC -SA 7 Well
For Residuals: D Land App.
0 503
0 D&M
D 503 Exempt
2. Project Type: [8J New D Major Mod. D Minor Mod. D
E. Comments/Other Information: D
NOTE:
D Surface Disposal
0 Animal
Renewal D Renewal w/ Mod.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within, please take the following actions:
IZ! Return a Completed APSARR Form and attach laboratory analytical results, if applicable.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
D Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: Date: _____ _
FORM: APSARR 07/06 Page I of I
Rogers, Michael
From:
Sent:
Steve Bowman [[e-mail]]
Thursday, August 11, 2011 8:04 AM
To: Rogers, Michael
Subject: Re: Bartram WI0500414
Depending on where we hit bedrock will determine casing,but let's say 50' as others in the area are hitting rock
at around 30-40' Kind of hard to determine before we drill.
I have the name listed under her name, Jane Bailey, is why I did not recognize. Sorry for your trouble.
Thanks!
Stephen M. Bowman
President, Bowman Mechanical Services Inc.
145 Technical Court
Garner, NC 27529
919 772-2759/ 7726460
Fax [phone]
[e-mail]
www.bowmanmechanicalservices.com
"A society that puts equality before freedom will get neither. A society that puts freedom before equality will get
a high degree of both." Milton Friedman
From: "Rogers, Michael" <michael.rogers (6l ncdenr.gov>
To: "stevebowmanbms @bellsouth.net" <[e-mail]>
Sent: Wed, August 10, 201112:33:15 PM
Subject: Bartram WI0500414
Steve-
We received the 5A7 geothermal permit application for the above site. However, I need some additional info on the well
construction.
Is the well proposed or existing?
Length of casing?
The attached well schematic is good and helpful. For future schematics, can I also suggest you add the length of casing
and the depth of grout.
Thanks for your cooperation.
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
http://portal.ncdenr.org/web/wq/aps/gwpro/permit-applications#geothermApps
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
1
MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves perdue Coleen H. Sullins
Governor Director
August 9, 2011
James Bartram
Jane Bailey
410 Whitehead Circle
Chapel Hill, NC 27514
Subject: Acknowledgement of Application No. WI0500414
James Bow -tram SFR
Injection Heating/Cooling Water Return Well (5A7)
Orange
Dear Mr. Barham:
Glee Freeman
ecretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on 07/2812011. This application package bas been assigned the number listed above and will be reviewed by
Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary, To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days after receipt of a complete
application.
If you have any questions, please contact Michael Rogers at 919-715-6166, or via e-mail at Michael.rogers&cdenr.gov. If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to hitp://h2o.enT.state.nc.us/documents/d3yq_o7-echart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Si4erely,
for Debr J. atts
Supel
cc: Raleigh Regional Office, Aquifer Protection Section
Glen A Darch (Glen A Darch Well Drilling, LLC,13109 Bold Run Hill Rd., W ake Forest, NC 27587)
Steve Bowman (Bowman Mechanical Services Inc., 145 Technical Ct., Garner, NC 27529)
AQUIFER PROTECTION` SECTION
1s36 PAail SeN ce Center, Rajef k Ncr*, Carai!na 27699-1636
Lo ,at'bn 272E Capital eonlevard. Raleigh. Nflnl1 Garoifna 27504 One
Pnone, 915 7333221 1 FAY, 1, 919.715•Q588. FAY, 2- 91S-715.6046 t nummer Service 1-977-623-5748 NC]1"d�l aI'Q�]11c�
Iniemat: wm. nemiera ua lh ,cm
AiEajal4wrrir ; Affirm. �:q=Hc=E*rivoyeT Nas ally

RECEN5D 1 DFNR 1 DM
Aqu?fP' Prr,l,N,rO Rfton
NOR`fH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES JUL 28 201i
APPLICATION FOR A PERNQT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0200
OPEN -LOOP GEOTHERMAL INJECTION' WELLS
These wells discharge groundwater directly into the subsurface as part of a geothermal heating and cooling system
(check one) VNew Application Renewal` Modification
* For renewals complete Parts A-C and the signature page.
Print or Type Infarraation and Mail to the -Address on the Last Page. Illegible applications Will Be Returned As Incomplete.
DATE: rl- 07 rl 20 r l
PERMIT NO. (leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Non -Government: Individual Residence l` Business/OrQAn37ation
Government: State Municipal County Federal
B. PERMIT APPLICANT — For individual residences, list each owner on property deed. For all others,
state name of entity and name of person delegated authority to sign on behalf of the business or agency:
C?"-e-
3hne eel; le- V
Mailing Address: l�J U i W Vx ULT L&SL -
City. ' t AAI State: NC Zip Code:_ I L[ County:
Day Tele No.: _ ff / 9) Z- Y0 — 77 30 Cell No.. _T _
I�►11111.rCR�
C. LOCATION OF WELL SITE — Where the injection wells are physically located-
(1) Parcel Identification Number (PIN) of well site: CYi,? 9 4 19 3 Y -2 County: Or a,. �,, -
(2) Physical Address (if different than mailing address):
City:
State: NC Zip Code:
D. WELL DRILLER INFORMATION
Well Drilling Contractor's Name: C— ten Iq Dar G (Ale -
NC Well Drilling Contractor Certification No.: _s a O -�
Company Name: Pen "q wep1►iiz L C C
Contact Person: � 1 e ^ C/ EMAIL Address:
Address: / 3/0 9 130 l/ joe un .4',1� n!
City: Wa�(R- ('Vrf Zip Code: Z-7ST-7 State: ,�►�
/VC County-, -e
Office Tele No.: l �4, & gr�-303r7 Cell No.: ,'�9) 9 LZ —g 931 Fax No.: �-'Wl1 sY-r—ago
GPU/UIC 5A7 Pcrmit Application {Revised 311&70It) Pap i

]l<r. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: 9 0 &Vm [ �'_ G " ■ e Cif O' tCtd .stp.- M,ce S X" C
Contact Person., S'7�e v e Ro w EMAIL Address:
Address: /YS- C/
City: !clg-ner
Zip Code: T7 S Z 7 State: zyC County:
wa k
Office Tele No.:
(")^1
772— 2759 Cell No..
Fax No.: 1%9' 739 9Z9
F. WELL USE Will the injection well(&) also be used as the supply well(s) for the following?
(I) The injection operation? YES V NO
(2) Personal consumption? YES c,--' NO
G. WELL CON STRUCTION DATA
_ PROPOSED Well(s) to be constructed for use as an injection well. Provide the data in (1) through
r" �l (6) below as PROPOSED constnxctiara specifications. Submit Form GW-I after construction.
EMSTING Wells) being proposed for use as an injection well. Provide the data in (1) through (6)
below to the best of your knowledge. Attach a copy of the Well Construction Record (Form
GW-1) if available.
(1) Well Construction Date: Number of borings:
Depth of each. boring (feet):-
(2) Well casing type: Galvanized steel 'k Black steel Plastic Other (specify)
Casing thickness (in.): —�A Diameter (in.):
Well depth: from: Q to:��b feet below land surface
Casing extends above ground _ 1 Z inches
(3) Grout material surrounding well casing:
(a) Grout type: Cement -k Bentoruie* Other (specify)
'By seieeii% hentenite grout, a variance is hereby requested to 15A NCAC 2C .4213(d)(1)(A), wkiob requaw a cement type grout,
(b) Depth of grout around well casing (relative to land surface): from 5� to t Q feet
(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. Is therea faucet on:
(a) Influent line? Yes No (b) Effluent line? Yes No
(6) Source Well Construction Information. If the water source well is a different well than the injection
well, attach a copy of the well construction record (Form GW-1). If Form GW-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 1F THIS
INFORMATION IS OTHERWISE UNAVAILABLE.
G.P`U/ 1C 5A7 Pewit Application (Revised 3/1812011) Pace 2

H. OPERATING DATA
(1)
(2)
(3)
(4)
Injection Rate:
Injection Volume:
Injection Pressure:
Injection Temperature:
Average (daily) 8 gallons per minute (gpm).
Average (daily) ZpoO gallons per day (gpd).
' Average (daily) l/ O powids/square inch (psi).
Average (January) if.I} ° F, Average (July) _£Ji_° F.
I. WELL LOCATIONS-Maps must be scaled or otherwise accurately indicate distances and orientations of
features located within 1000 feet of the injection well(s). Label all features clearly and include a north arrow.
( 1) Attach a site-specific map showing the locations of the following:
* Proposed injection wells * Buildings * Property boundaries
* Surface water bodies * Water supply wells
* Septic tanks and associated spray irrigation sites, drain fields, or repair areas
* Existing or potential sources of groundwater contamination
(2) Attach a topographic map of the area extending 1/4 mile from the injection well site that indicates the
facility's location and the map name.
NOTE: In most coses, 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.
GPU/UIC 5A7 Permit Application (Revised 3/18/2011) Page3
J. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 42C .0211(b) requires that all permit applications shall be signed as follows:
I. for a corporation; by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner (which means all persons listed on the nroperiN_deed).
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf,
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisomment,
for submitting false information. I agree to construct, operate, maintai 1, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of
the Permit,"
Signature of Property QwnerlAppllcant-
J-gN-r-- oP l u- -`-
Print or Type Full
Signature of Property Owner/Applicant
Print or Type Full. Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
REMvED I DENR i i)m
Aquifer Prot"ran <Sertlan
JUL 2$ nff
GPUIUIC 5A7 Permit Application (Devised 3118l2011) Pale 4

N 59°20'07" E
159.22'
N 52a25'36
8 a
SAN. SEWER LIME
C/L DRAINAGE D 7�W �.`Cl
'DRglNA G
PIPED DRAINAGE DITCH W
o
4
t3`8�7►�� 'lee BASEMENT log � 1 � r
04I0 75.14'
�a �a�e
a to " -3n
ORANGE COUNTY HEALTH DEPARTNIF-W,
IRRIGATION WELL PERM SATE MAP
Wil-W074 TMBL 7.71.C.17 SCALE: 1"xW
#5 a 7HTHFPEHHAD CIRCLE REV P4177
APK3CANWMER;JAMES KNIVETON BART AVI
BY: Philip R Vifam R-F-H-S W25=111
Lc
w
03
a

Orange County Health Department
Y Environmental Health Divis€on
P-O, Box 8181, 131 IWO 1largnrcl Lane, Sul It 100
Ifiltshorough, NC 27278
Phone [phone] Fax [phone]
IV 0 w.eo urhrl Le.11e.115
WELL PERMIT
Pill: 9788418347
Applicarioo Dale: 05IM2011
APPLICAN .- BARTRANI JAMES KNIVETON
ADDRESS' 4101VHiTEIIEAD CIR
CHAPEL HILL NC
27514
PHONE: [phone]
TNIBL: 7
Permit tittntber: WI
OWNER: BARTRANI JA€IIES K1 IVETON
ADDRESS: 410 1VHITEITRAD C1R
PHONE:
C11 APE HILL NIC ,
27514
Properry Desc: S & 7 1VMT>";1iEAD CIRCLE DGV P4177 Lot Size. 1.02
Property Address: 410 NVIIITEHEAD CiR CHPL
Weli Type: 1RRIGA 7ON WW System: Sewer Svsteill
NEW WELL
Co l n Illell ts1Ca III] it iDit S.
1: CROSS -CONNECTION OF THIS NVELL TO OIVASA WATER SUPPLY IS PROMBITED.
2: S PROPERTY LINE SETHACK REDUCED TO 10' TO MAINTAIN FOUNDATION AND SEIVER LINE SETBACKS.
ISSUED: 05/25/2011 I`-/4/ EX PIKES: 05125/2016
EK1' L1MNIE.1NTAL IfKALTll ftECIALIST
PERIINIIT CONDITIONS:
• it Emit TO THE' ATI*ACIIED SITE PLAN SIIO11'ING T11E WELL AND PAC iLITY LOCATION S AND OTHEIt SPrC:lF[CATIONS
• THIS PERMIT AIAV BECOME INVALID AND A[AV HE REVOKED IF:
• The Iafnrrnallon submltted on the appiica(ion is Incorrect, fnislfled a changes,
. The site is littered, or
• The trell is not completed berere [lie expiration date.
" THE WELL SHALL HE CONSTRUCTED OR REPAff>:ED IN ACCORDANCE WITH:
0rantve Can aty Groundwater Prow1joit Rill as adopted by the Orange Can illy BOArd or Hea1€11.
NC Well Construction StandsrrZ&, as applicable and
Orange County F is vi ran n ien lot HealIIt DFvlsloit 11ollrtc3
* THE WLLL SITING IS RASED ON SETBACK DISTANCES FROM KNOWN FEATURES AND DOES NOT FNDICATE NOR GUARANTEE THAT AN
QUANTITY OR QUAL 1.1'Y Op WATER WlI-L nE PROVIDED RV A %VFLL CONSTRUCTEIt IN TIL. 'I' AREA.
• The well must be ioented In +sell -drained areas IIto I are not subject I hooding. Some of llte witsuek distances includes
40 feet from any property line.
SO feet from any banding (am aedatlou; sewer Ellie; swimming pool, pitinp room, or storage aeca:or 5t9rage bni$iting,
100 file$ from A sepIIs syslcm a repair area or abler paten IIill suurce of contatuinnIIais.
If it Is oat prissible to itchleve Ihese distances, a tell need selhack tit Ely he granted provIded sped tic condlIIon s itre atct.
• Ground surface shanld be rnflintnIned In dtred surface wnIor nway fruit the trell.
w Srlhacks for Pit bile Water Supplies $nay be Increased.
" Ali net► or repaired sells must be Ihornngbly ithiarcaed after cunatruction. All traees of tlgotin e musl be Rushed out of the system al least 48 hours prlai- to
sampling,
* ►Pater samples may he oaken upon request by subinlil'eng a proper application mod nppraprlalc fees.The Orange County Health Deltarlment does not provide
watrr sampling for use as a tatafitioo of purchase, loan approval, or a property IransactIon. Thesc services are provided by Ilse Isrlvatelerlor.
Any changes to Ilia proposed plans must he approved by The 001R
Wells must be constructed, repaired, and abandoned by n person wlw holds a valld cerillicillon fl'ont the STlile and who Is also registered tit Orioge County
for well eoa51ritMon.
' A list or registered will drlllers is available apoA request.
■ Tit IVell c01111ruc11010 inusl he Inspreled by OCIID at ecrisin stages during lite Ins [Al a11on,
! Tile per sidIee is responsitile for abills lnfog the Approprinte permits to the wlrlog of pump tltstallAtJobs from Ilse Orange Call nly 8161lditIit Inspcclt9us Office.
* I Is the iesponsi61My of the }cell tan Iructor to call the OCItD to schedule the ins laitntIon Inspect to as.
. After the Installat[on is rornpleled, some settling or the grant oraleHal ill Fly take place. If It has settled subsla:tINIly, please rail Iite well cant ractor to complete
I I i e grouting-ollie rtsise, Its cold can he Illied with ccitienI grout irlien a slab to poured,
" 'I'Ity owner 1s rrsponslbfe for marking lilt propert►• lines and corners. The Contractor is r"Isonslbie for eit sit rinn that rite well or septic system Is irLsiIli 1ed in IItr
proper IucatIon aitit That all gel backs ore suet.
Ell II`,P 41.40102 M1 w fr _ =Ilail FVv ReviewX41 -

Street Wo
Town
Count ''r�►��
Customer Tug• p s_ _Aow,-
Equi
wx
rM
Depth
Ss v

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