WI0500918_GEO THERMAL_20160612

Permit Number
Program Category
Ground Water
Permit Type
WI0500918
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SWRule
Permitted Flow
Facility
Facility Name
Brian Hrudka and Claire Preston-Hrudka SFR
Location Address
707 Cd Farms Rd
Hillsborough
Owner
Owner Name
Brian
Dates/Events
Orig Issue
NC
C
App Received
3/30/2016
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
27278
Hrudka
Draft Initiated
Scheduled
Issuance
Central Files: APS SWP
6/12/2016
Permit Tracking Slip
Status
In review
Version
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Brian C. Hrudka
205 Collinson Dr
Chapel Hill
Region
Raleigh
County
Orange
NC 27514
Public Notice Issue Effective Expiration
Requested /Received Events
Additional information requested
Additional information received
RO staff report requested
RO staff report received
Streamlndex Number Current Class
3131/16
4/3/16
4/5/16
617!16
Subbasin
PAT MCCRORY
Governor
DONALD R . VAN DER VAART
Water Resources
ENVIRONMENTAL QUALITY
Brian Hrudka and Claire Preston-Hrudka
205 Collinson Dr.
Chapel Hill, NC 27514
Re: Issuance of Injection Well Permit
Permit No. WI0500918
June 16, 2016
Geothermal Heating/Cooling Water Return Well
Orange County
Dear Greetings:
Secretary
S . JAY ZIMMERMAN
Director
In accordance with your permit application received March 30, 2016, and additional information
received March 31 .and April 3, 2016 , I am forwarding Permit No. WI05 00918 for the construction
and operation of geothermal heating/cooling water return well(s) located at 707 CD Farms Road ,
Hillsborough, Orange County, NC 27278. This permit shall be effective from date of issuance until
May 31, 2021, and shall be subject to the conditions and limitations stated therein .
Please Note:
• A well construction variance was granted by the Raleigh Regional Office on May 5, 2016,
for this well. 15A NCAC 2C .0222(e)(l 1) requires grout to be placed the entire length of
the well casing. The length of casing in .this well is to 84 feet below land surface (BLS),
but is only grouted to 20 feet BLS. However, since 1.) the well appears to be otherwise
properly constructed, 2.) was originally drilled as a water supply well, and 3.) is located in
an area that does not currently pose a potential threat to groundwater quality, the
variance was granted.
• Please contact Laura Robertson with the Raleigh Regional Office (919-791-4200) within
30 days after the geothermal well becomes operational to arrange to collect samples
from the influent and effluent sampling ports. Laboratory analytical results will then be
forwarded to you when it becomes available. ·
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit 120 days prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water Resources. If you have any questions regarding your permit or the Underground
Injection Control Program please call me at [phone].
Stale of North Carolina Environmental Quality i Wai.er Resources
1611 Mail ser-.ice Center I Raleigh, Nonh Carolina 27699-16 l i
919 707 9000
PART I -PERMIT GENERAL CONDITIONS
1. The Permittee shall comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is grounds
for enforcement action as provided for in N.C.G.S. 87-94
2. This permit is effective only with respect to the naiure, 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 pennit 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 permanently affixed an identification plate [15A NCAC 02C .OJ 07(i)(2)].
Permit #Wi05009 ! 8 UJC/5A7
ver. JJ/15/2015
Page 2 of 5
7. A completed Well Construction Record (Form GW-1) shall be submitted as described in Part V.5 ofthis
'perm.ii.
PART III-OPERATION AND USE CONDITIONS
1. A well constructio.n variance was granted by the Raleigh Regional Office on May 5, 2016, for this well.
15A NCAC 2C .0222(e)(ll) requires grout to be placed the entire length of the well casing. The length
of casing in this well is to 84 feet below land surface (BLS), but is only grouted to 20 feet BLS.
However, since the well appears to be properly constructed, was originally drilled as a water supply
well, and is located in an area that does not currently pose a potential threat to groundwater quality,
the variance was granted.
2. 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 lG)].
3. 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 immedfate corrective actions that may be required,
such as the repair, modification, or abandonment of the injection facility [15A NCAC 02C .0206].
PART IV-JNSPECTIONS[l5ANCAC 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 REQIDREMENTS
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)(l )].
Permit #Wl05009 l 8 UIC/5A7
ver_ 11/15/2015
Page 3 of5
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 .021 l(r), noncompliance notification shall be
as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence, to the Raleigh Regional Office, telephone number 919-791-4200.
(B) Written notification shall be made within five days of the occurrence and submitted to the addresses
in Item #5 below.
(C) The written notification shall contain a description of the noncompliance and its cause; the period of
noncompliance, including dates and times; if the noncompliance has not been corrected, the
anticipated time it is expected to continue; and any steps taken or planned to reduce, eliminate, and
prevent reoccurrence of the noncompliance.
4. 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(£)(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
1628 Mail Service Center
Raleigh, NC 27609
PART VI-PERMIT RENEWAL [15A NCAC 02C .0224(c)]
As required by rule an application for permit renewal shall be made at least 120 days prior to the expiration
date of the permit. This permit condition does not apply if the Permittee chooses to discontinue operation
of the well for injection of effluent from the geothermal heating and cooling system associated with this
permit.
PART VII-CHANGE OF WELL STATUS [15A NCAC 02C .0240)
l . 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 v.11th 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 87-8.8(c).
3 . If a well is taken completely out of service temporarily, the Perrnittee shall install a water-tight cap or well
seal that cannot be removed without the use of hand or power tools .
Pennit #WI0500918 UIC/5A 7
ver. l l/15/2015
Page 4 of 5
4 . When injection operations have ceased at'the facility and a well will no longer be used for any purpose, the
'Per!I).i'ttee shall permanently abandon that injection well in accordance with the procedures specified in 15A
NCAC 02C .0l 13(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 ll(b)(l)(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 Perrnittee shall submit a \\1ell Abandonment Record (Form G\\1-30) as specified in
15A NCAC 2C .0224(£)(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 #WJ05009 l 8 UIC/5A7
ver. 11/15/2015
Page 5 of5
Rogers, Michael
From: Robertson, Laura R.
Sent: Tuesday, June 14, 2016 1:47 PM
To: Rogers, Michael
Cc: Watts, Debra
Subject: RE: WI0500918 Hrudka
Hi Michael.
Yes, I had conducted the site visit and staff report before the variance was issued.
Thank you,
Laura R. Robertson, L.G.
Hydrogeoiogist
Water Quality Regional Operations Section
Division of Water Resources
Department of Environmental Quality
919 791 4247 office
919 788 7159 fax
laura. robertson [e-mail]
3800 Barrett Drive, Raleigh, NC 27609
1628 Mail Service Center, Raleigh, NC 27699-1628
�lN0thing Compare -
Email correspondence to and from this address is subject to the North Carolina Public Records Law and he disclosed
to third parties
From: Rogers, Michael
Sent: Tuesday, June 14, 2016 1:31 PM
To: Robertson, Laura R. <[e-mail]>
Cc: Watts, Debra <cfebra,[e-mail]>
Subject: WI0500918 Hrudka
Hi- On your staff report for the above you indicated additional info was needed. Were you referring to the variance that
was needed?
Michael Rogers, P.G. (NC & FL)
Underground Injection Control (UIC) Program Manager - Hydrogeologist
NCDEQ - DWR
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699
Direct No. 919-807-6412

htt p://de q .nc.gov /about/divisions /water-resources/water-resource-s-permits/wastewater-branch /g round-water-
p rotection/g round-water-a pp lications
NOTE : Per Executive Order No . 150, all e-mails sent to and from this account are subject to the North Carolina Public
Records Law and may be disclosed to third parties.
2
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Permit No. WI0500918 ---
Date: 05-03-2016 ---County: _Orange _________ _
To: _Michael Rogers __
Central Office Reviewer
Permittee/ Applicant: _Brian & Claire Hrudka_
Facility Name: _ Hrudka Geothermal WSW_
L GENERAL INFORMATION
1. This application is (check all that apply): ~ New D Renewal ECE\"ED'NCDEQ/OWR D Minor Modification D Major Modification R '\I 1 ·
a. Date oflnspection: 04-28-2016 JUN O 7 2016
b. Person contacted and contact information: Brian Hrudka. 919-929-6680
c. Site visit conducted by: Laura Robertson
d. Inspection Report Printed from BIMS attached: D Yes ~ No.
Water Q~ality Re~!onal
Operattons Sec.icn
e. Physical Address of Site including zip code: 707 CD Farms Road. Hillsborough, NC 27278
f. Driving Directions if rural site and/or no physical address: First driveway on the right along portion of CD
Farms Road that is beyond gate.
g. Latitude: 36.011087 Longitude: -79.118820
Source of Lat/Long & 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
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:
Were samples collected from Influent/Effluent sampling ports? D Yes D No.
Provide well construction information from well tag: __
b. Does existing or proposed system use same well for water source and injection? D 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? D Yes ~ 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: ~ Good D Adequate D Poor
6. Flooding potential of site: ~ Low D Moderate D High
Rev. 6/1/2015 Page 1
WQROS REGIONAL STAFF REPORT FOR
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 ❑ 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
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
4. Recommendation
❑ Deny. If Deny, please state reasons:
❑ i lold pending receipt and review of additional information by regional office
® Issue upon receipt of needed additional information
❑ Issue
5_ Signature of report preparer(s):
'�ILIN�G. /N°L�-Cth4
Signature of WQROS Regional Supervisor:
Date: Le
Rev. 6/ 1 /2015 Page 2

WQROS REGIONAL' STAFF REPORT FOR
UTC Program Support
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS aIINeededd
A variance is needed to facilitate construction of the Geothermal s\stem in the currently non -operational water
supply well.
The drinkink water supply well is approximately 100 feet east-northeast of the geothermal well on the property
The Qeothermal well is housed in a locked storage building with a cement slab poured around its construction.
The home was not vet constructed as of April 28, 2016.
Rev. 6/1/2015 Page 3

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PAT lvfCCRORY
DONALD R. VAN DER V AART
Water Resources
1\IIRONMENTAL QUALITY
Brian Hrudka and Claire Preston-Hrudka
205 Collinson Drive-
Chapel Hill, NC 27514
May 5, 2016
Subject: Variance to Rule 15A NCAC 2C .0222(e)(l 1)
Permit Application.# V!I0500918
Hrudka Property
707 C D Farms Road
Chapel Hill, NC Orange County
Dear Mr. & Mrs. Hrudka:
S. JAY ZIMMERMAN
Dir<.1cto-r
.... ,..... , L'l1 , f-{eg1onat
·.;.:,.:: .... , $ectior
The . Raleigh Regional Office received your application for an individual geothe1mal
heating/cooling water return well on April 11, 2016. The current construction of the well does not
meet the well construction rules in 15A NCAC 2C .0222( e)(l 1) that are applicable to a geothermal
well. This rule requires that grout shall be placed the entire length of the well boring from the
bottom of the boring to the land surface or, if completed below land surface, to the well header or
manifold connection.
The current well has a casing to a depth of 84 feet, although grout is only to a depth of 20
feet, as the weli was originally intended to be used as a water supply well. This well is now intended
to only be used for a single open loop geothermal heating/cooling return well. A second well has
been drilled on the property to be used as the potable water source for the property at 707 C D
Farms Road in Chapel Hill, NC. Other than the length of grout along the casing, the well appears
to be properly constructed, and it is located in an area that does not currently pose a potential threat
to groundwater quality.
Based upon the in.formation provided by Mr. Hrudka and the site inspection that was
conducted by Laura Robertson on April 28, 2016, a variance to the above-cited rule is granted.
The variance is granted in order to facilitate construction of the geothermal system in the currently
non-operational water supply well. The variance will be effective on the date of issuance of this
letter and only for the address indicated. Since the well will not meet the regulatory requirements,
the following minimum additional construction requirements will be necessary to mitigate any
potential problems that could affect public health and/or the well's effective operation:
1 The wells shall be marked with a permanent sign or tag indicating that it is only
intended for use as a geothermal open loop \:vater return well, and cannot be used
as a potable water source.
State of Nenh Carolina Environment.a:i Qua!ii}· ! v,:c.ter Resources
1628 Mail Service Center i Raleigh, Nonh 27699-1628
919 791 4200 .·,,·~~~---------------------------------------
Well Construction Variance
Hrud.ka Property-\VI0500918
May 5, 2016
Page2of2
It is my finding that the factors specified above will be sufficient to satisfy the conditions
for approval of a variance as defined in 15A NCAC 2C.0241. A copy of this variance should be
attached to the required Well Construction Record (GW-1).
The granting of this variance is for the construction of the well only, and in no way relieves
the owner or agent from other requirements of the North Carolina Well Construction Standards,
or any other applicable law, rule or regulation that may be issued by other agencies. If you are
dissatisfied with this decision, you may commence a contested case by filing a petition under G.S.
150-23 within sixty (60) days after receipt of the decision.
If you have any questions regarding this variance, please contact me at [phone].
Sincerely,
kl?
Rick Bolich, L.G.
Assistant Regional Supervisor
NC Dept. of Environmental Quality
Division of Water Resources
Water Quality Regional Operations Section
Raleigh Regional Office
cc: Orange County Environmental Health
Michael Rogers, NCDEQ DWR, 163 6 MSC Raleigh, NC 27699-1611
Rr<o -~ "'-.)IP rW? ~; l-e5
WATER QUALITY RECIONA.1 OPERATIONS SECTION
APPLICATION REVIEW REQUEST FORM
Date: April 5, 2016
To: Danny Smith — Rick Bolick
From: Michael Rogers_ WQROS — Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
A. Permit Number: WI0500918
B. Applicant: Brian and Claire Hrudka
C. Facillit,. Name:
D. Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: New
E. Comments/Other Information:
❑ I would like to accompany you on a site visit.
n
,,.
3
73 3)...n iri ,i3
6
fO aas
i
3
3
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-WQROS Reviewer:
COMMENTS:
Date: 4- t'- 114
NOTES: Please check with Shristi to see if she would want to go out during the site
inspection. Please record all well construction indicated on the well tag. Also. It
appears that the well construction of the existing well does not meet 2G .0200_ Are
you in favor of a variance if needed? Thanks.
RECENED!CDEWR
APR 2 1 lU 6
Water Quality Reg ion al
Operations Sector;
FORM: WQROS-A RR per. 092614 Page 1 of 1

WATER Q UALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW REQ UEST FORM
Date: April 5, 2016
To: Danny Smith -Rick Bolich
From: Michael Rogers, WQROS -Animal Feeding Operations and Groundwater Protection Branch
A.
B.
C.
D.
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
Permit Number: WI0500918
Applicant: Brian and Claire Hrudka
Facility Name:
Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: New
E. Comments/Other Information:
D I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a com pleted W OROS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy of
this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact person
listed above.
Date: RO-W QROS Reviewer: -------------------------
COMMENTS:
NOTES: Please check with Shristi to see if she would want to go out durin g the site
ins pection. Please record all well construction indicated on the well ta g . Also . It
app ears that the well construction of the existin g well does not meet 2C .0200. Are
you in favor of a variance if needed? Thanks.
FORM: WQROS-ARR ver. 092614 Pagel of l
PAT MCCRORY
Water Resources
ENVIRONMENTAL QUALITY
April 5.2016
Brian Hrudka and Claire Preston-Hrudka
205 Collinson Drive
Chapel Hill, NC 27514
RE Acknowledgement of Application No. W10500918
Geothermal Heating/Cooling Water Return Well
Orange County
Dear Brian and Claire:
Governor
DONALD R. VAN DER VAART
sgerefav
S. JAY ZIMMERMAN
❑ire.:Ior
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit application on March 30, 2016. and supporting documentation received on April 3; 2016.
Your application package has been assigned the number listed above, and the primary reviewer is
Michael Rogers.
Central and Raleigh Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the 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 Iong as 60 to
90 days after receipt of a complete application. If you have any questions, please contact Michael
Rogers at 919-807-6412 or [e-mail].
Sincerely,
6'o.Y Debra J. Watts, Supervisor
Animal Feeding Operations & Groundwater
Protection Branch
Division of Water Resources
cc: Raleigh Regional Office, WQROS
Permit File W1050(19 l 8
State 01 North Caraurra 3 En.nronnlentaS Qoaluy Warier Resnurr
161 S Mail service Center I Raleigh. Nnoh Carolina 27699- 1611
919 707 9000

Ro g ers, Michael
From:
Sent:
To:
Subject:
Attachments:
Michael,
Brian Hrudka <[e-mail]>
Sunday, April 03, 2016 10:17 AM
Rogers, Michael
Re: Hrudka Geothermal Well Application
Signature page.pdf; ATT00001.txt; Well1 w11-00062 well grout notification.pdf; ATT00002.txt
Thank you for contacting me regarding the additional information required. Attached please find the corrected signature
page.
The well grout notification (also attached) is dated in 06/28/2011, and the casing depth is 84 feet which, I assume, is the
grout depth?
Thanks and regards,
Brian
1
P.O.
Orange County Health Department
Enyironineoial Health Division
Box 8181,131 West Margaret Lane, Suite 100
Hillsborough, NC 27278
Phone [phone] Fax [phone]
rv►r►v.co.orange.ne,us
WELL GROUT NOTIFICATION
Pin: 9862429750 TMBL: 7
Application Date: 04l2012011 Permit number: W11-00062
APPLICANT: LIR1]t3KA IBRIAN C OWNER: HRUDMCA BRIAN C
ADDRESS: 205 COLLINSON DR ADDRESS: 205 COLLINSON DR
CHAPEL HILL NC CHAPEL HILL NC
27514-6746 27514-6746
PHONE: [phone] / PHONE: /
Property Desc: 3 C l FARMS P60/157
Property Address: 701 C D FARMS RD OCPL
Permit Type: PRIVATE WELL
Lot Site: 10.14
Facility Type: NEW WELL
WW System: On -Site System
Permit Issued: 05/02/2011
Grouting Inspection: 06/28/2011
WELL CONTRACTOR: HtUDSON-WELL CO,
ENV!AONMENT ,HEALTHSPizCIALLST PR'
ENVIRONMENTAL, HEALTH- SPECIALIST PR)'
WELL GROUT INSPECTION
TOTAL DEPTH: 645 CASING DEPTH: 84
YIELDS(gpm) (a) WATER ZONE DEPTH ifeet]
0.25 , 210 STATIC WATER LEVEL: 540
0 , 0 GROUT TYPE: Sand Mix
0 , 0 GPS #,
0 , 0 LINER DEPTH: 0
IMPORTANT INFORMATION
Your well has been drilled and the grouting inspection has been performed. Before our office can
conduct a final well inspection, the pump and well seal must be installed.
Please contact our office (919-245-2360) when the above work has been completed so that a final
inspection can be scheduled.
If you have any questions regarding this, please do not hesitate to contact us.
For more information on wells, please visit our website at:
www.co.orange.nc.usienvhlth
EH }YP 4/30102 Pict up Iliad _ File
Well Grant Cei-iif+cnre for well perndis issued mod drilled after 11112008
Reviewed

'I 3/►/u
Rogers, Michael
From: Rogers; Michael
Sent: Thursday, March 31, 2016 2:08 PM
To: 'weller4paul a©gmaiI.com'
Subject: FW: 707 CD Farms rd well log
Attachments: ❑ocFile-1 PDF
Paul- I received the GW-1. Thanks
Original Message
From: Joan Melton[mailto:[e-mail]]
Sent: Thursday, March 31, 2016 1:45 PM
To: Rogers, Michael <[e-mail]>
Subject: 707 CD Farms rd well Jog
Document: [Blank], [Blank], 9852429750, 707 C D FARMS RD, [Blank] Associated Fite(s): DocFile-1.PDF

Ro gers, Michael
From:
Sent:
To:
Subject:
Attachments:
Joan Melton <[e-mail]>
Thursday, March 31, 2016 1:45 PM
Rogers, Michael
707 CD Farms rd well log
DocFile-1. PDF
Document: [Blank], [Blank], 9862429750, 707 C D FARMS RD, [Blank] Associated File(s): DocFile-1.PDF
1
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELLS
These wells inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
(check one) _x_New Application
Renewal * Modification
* For renewals complete Parts A-D and i_ the signature naae.
Print or Type Information and Mail to the Address an the Last Page.
DATE: March 15 , 2016
PERMIT NO. r �0318 (leave blank if New Application)
Illegible Applications Will Be Returned As Incomplete.
RECEIVEDINCDEQIDWR
MAR 302018
Water Quality
A. STATUS OF APPLICANT (choose one) Regional Operations Saalks1
Non -Government: Individual Residence x Business/Organization
Government: State Municipal County Federal
B. WELL OWNERIPERNIIT APPLICANT - For individual residences, list owner(s) an property deed, For all
others, list name of entity and name of person delegated authority to sign on behalf of the business or agency: _
Brian C. Hrudka 4
Mailing Address: 205 Collinson Dr.
City: Chapel Hill State: NC Zip Code: 27514
County: Orange
Day Tele No.: 919-929-6680 Cell No.: 919-794-1473
EMAIL Address: bhrudka(i'tigmail_com
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: same as well operator
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:
(1) Parcel Identification Number (PIN) of well site: 9862429750 County: Orange
(2) Physical Address (if different than mailing address): _ _ 707 CD Farms Road
r3041 gq.119
GPUMC 5A7 Permit Application (Revised 5/23/2014) Page 1

City: Hillsborough
State: NC Zip Code:5
E. WELL DRILLER INFORMATION
Well Drilling Contractor's Name: Hudson Well Co. Inc
NC Well Drilling Contractor Certification No.: 3176 1).)
Company Name: Hudson Well Co. Inc
p Y
Contact Person: Paul Weller EMAIL Address: tr--) i 'i' 1 - +�►
Address: 2316 Cathran Rd
City: Rougemont Zip Code: 27572 State: NC County:
Office Tele No.: q 1 q —' 1 — (S/ ? Cell No.: Fax No.:
F. FIVAC CONTRACTOR INFORMATION (if different than driller)
HVAC Contractor's Name: To be determined
NC HVAC Contractor License No.:
Company Name:
Contact Person: EMAIL Address:
Address:
City: Zip Code: State: County:
Office Tele No.:
Cell No.: Fax No.:
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 NO
(2) Personal consumption? YES NO x
H. WELL CONSTRUCTION REQUIREMENTS — As specified in 15A NCAC 02C _0224 d1:
(1) The water supply well shall be constructed in accordance with the water supply well requirements of
15A NCAC 02C .0107.
(2) If a separate well is used to inject the heat pump effluent, then the injection well shall be constructed
in accordance with the water supply well requirements of 15A NCAC 02C .0107, except that:
(a) For screen and gravel -packed wells, the entire length of casing shall be grouted from the top
of the gravel pack to land surface;
(b) For open-end wells without screen, 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.
GPUIUIC 5A7 Permit Application (Revised 5/23/2014) Page 2

I. WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
*EXISTING WELLS ------1 ----~PROPOSED WELLS
*For existing wells, please attach a copy of the Well Construction Record (Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
( c) Casing depth below land surface
( d) Casing height "stickup" above land surface
(e) Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited for sealing water-bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .0107{0(8 )
(t) Length of well screen or open borehole and depth below land surface
(g) Length of sand or gravel packing around well screen and depth below land surface
J. OPERATING DATA
(1)
(2)
(3)
(4)
Injection Rate:
Injection Volume:
Injection Pressure:
Injection Temperature:
Average (daily) _5_gallons per minute (gpm).
Average (daily) _2,600_ gallons per day (gpd).
Average ( daily) _10_ pounds/square inch (psi).
Average (January)_ 45_° F, Average (July) _85_ ° 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:
(l) 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)
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.
GPU/UIC 5A7 Permit Application (Revised 5/23/2014) Page 3
L. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .021 lie) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner (person(s) listed on the property deed).
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"1 hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
far 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."
Bc 2-ti, �
Signature of Property Owner/App
Brian C. Hrudka
Print or Type Full Name
i.cant
Signature of Property Owner/Applicant
Brian C. I lrudka
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:
Underground Injection Control Program
NC Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/U C 5A7 Permit Application (Revised 5/23/2014) Page 4

GLc'P w13 f 1(0
L. CERTIFICATION i to he signed as required below or by that person's authorized .agent r
\t'A .. a,t _1 ! 1 t.' requires that ail permit applications shall he 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. respecti vel- ;
for a municipality or a state. federal. or other public agency: by either a principal executive
officer or ranking publicly elected official:
d, for all others. try the well owner (person(s) listed on the properr. 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 beret)) certify. under penalt} of law. that II base personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquu1 of those individuals
immediately responsible for obtaining said information. 1 believe that the information is true, accurate and
complete. 1 um aware that there are significant penalties. including the possihilit) of fines and imprisonment,
for submitting falae 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 OwnerApplicant
Arian C. l lrudka
Prins nr Type 1- ull_hlwiP
/4 /(
Signature of Proper) Owner. Applicatat
Claire A. Preston-i irudka
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:
Underground Injection Control Program
NC Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
ori..'1 it J 4'r Vernal Application rRevtscd 5/21, tea] 4 Pape 4
oar

GEOTHERMAL HEATING/COOLING WELL CONSTRUCTION DETAIL
Choose applicable Injection Well design and check the appropriate boxes. Fill in depths and details of well construction on
the blank lines provided. Use additional sheets as needed
011'0 cold ki2.44 , ;A/ +Ai I i be pu ed cr,.AF -fi
e bOl+ `�T -j ,4 u 2t
c �.uu��•� V.Lotkalcaizie."4.4") ca ► ic4 pi Yinh�c- ivy* ci f-
f t •� c1 � C I .
Den-H�le W ll Design Screened Well Design
[Proposed Well
n Proposed ❑ Existing
[-Injection; ❑ Supply; iAJe it eJ E i j"I" ❑ injection; ❑ Supply;
❑ Dual Purpose Ue S -6>e" h ❑ Dual Purpose
o-r /psi S.
and Surf. -
Record Depths Below
Land Surface on Lines
Provided
1 Ft.1
4
}
Io
(Ft)
4
Return or Supply Line
Casing
Grout
WELL DETAILS }}��,,
Casing Material: 9 IV 1 IZ&1I . -eef
Casing Diameter (ins.): 6
Casing Thickness (in.): C2' 1 g.5
Grout Type: Ce e
(cement, bentonite, or mix)
Screen Material: _ R1 A
Screen Slot Size (in.): f iu
Sand/Gravel Pack
Material: Y1 Rt.
r,
Bedrock
Open Hole
Bentonite Seal
(if present)
Sand/Gravel Pack
Screen
■
■
(Ft)
Record Depths Below
Land Surface on Lines
Provided
(Ft.)
(Ft.)
(Ft.)
(Ft.)
NC Certified Well Driller Name .A A so A w Q } G.9. :1/► C. Certification # \ 1

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PROPERTY OF
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CLAIRE P. HRUDKA
P000001 :1' ADDRESS: CD FARMS' ROAD
LOT 3, CO FARMS
Pik 9862-42-9750
PUT D05K REFERENCE 60-157
DEED BOOK REFERENCE: 4829-401
ClWEL HILL TOWNS}UP
ORANGE CO:INFY
NORTH FARDOONA
SCALE: 1' = 110'
1041RCN 21. 2012
FREEHOLD LAND SURVEYS, INC.
115 W. 4.05 MEET
V.R. bpi 166, 50000R0, NO 27510
AXONE 914-124-0019
FA% 919-012-0696
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323535

Orange County, NC - Display Individual Well Permit
6/16/15 8,23 PM
Well Permit Summary
Permit Number: W11-00062
Status: GROUTED
General Information
Property Owner:
Applicant:
HRUDKA BRIAN C
HRUDKA BRIAN C
205 COLLINSON DR
205 COLLINSON DR
CHAPEL HILL NC
CHAPEL HILL NC
27514-6746
27514-6746
Property Address:
707 C D FARMS RD
PIN:
9862429750
Legal Description:
3 C D FARMS P601157
Jurisdiction:
OCPL - ORANGE COUNTY, NC
Link to GIS
Application/Permit Information
Permit Type:
NEW
Well Type:
PRV
Date Applied:
4/20/2011
Application Assigned To:
PHIL VILARO
Date Issued:
5/2/2011
Date Expires:
5/2/2016
Date Approved:
Well Information
Date Water Sample Collected:
Zone 1
Zone 2
Zone 3
Zone 4
Total
Yield (gpm)
0.25
0.25
Depth (ft) 1210
645
Casing Depth:
Liner Depth:
84 feet
0 feet
http; 11web.co.orange.nc.us/Enviieaith-iframel WeIIPermitsl PermitDetall.asp?txtPermitNum=W11-00062
Page I of 2

Orange County, NC -Display Individual Well Permit 6/16/15 8:23 PM
I Static Water Level: 11 540 feet
~==========!
I Well Contractor: II HUDSON WELL CO.
If the information on this page appears to be incorrect, please contact the Orange County Health
Department at 919-245-2360.
http:/ /web.co.orange .nc.u s / EnvHealth-ifram e /Well Perm its/ Perm itDetai I .asp?txtPerm itN um =Wl 1-00062 Page 2 of 2
RESIDENTIAL WELL CONSTRUCTION RECORD
C � d Enviamract cadi Taai RamourtdDirer of Dirof Wabor QwS�
WELL CONTRACTOR CERTIFICATION 1
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-7
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STATE WELL PERMTS 1 appicablal
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DATE r_LEG �4i t �7 N %� 3 t5r r�ti
XG TOLE GLPLEiED �: ►W (7r f ;�7
1 WELL LOCAT1C-it
are: [ 5 t COUNTY z <i
oarwt norm, Pauxis.c.. Gmareehs. Sirlar.aen. Lol Mrh., Pare Zap Co*
TOPOGRAPHIC F LMW SETTING:
°Slope OVeoy OF1=4❑Ftidpo Draw
{chid app op oh xod
May be dnirmr.
LATITUDE 3 6 nri . y1- 5 `r A( ` from& n
LoNGrruo€7/°c 7 167. 'f''14) is ■ dwwl ior.rra
La inddlongitvde source_ ❑Gi5 ❑Tapaghic map
faappt#ar d rref :rust be shorn art R tJSGS kapo Fri* and
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4. WEI_LOWP65R
OviNERS NAME itik,d ) # i C�
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City v Town SUM. rip Cods -
i
Area coda - Phone ran>bar
IL WELL DETAILS:
a` TOTAL OEPTHt: ys
b. =ea WELL REPLACE COSTING WELL? YES
WATER LEVEL Nana Top cr C nkos: 9 4 Q Ft
(Use-4' f Atom Tap of DWG)
i)
d TOP OF CAa,M tz #' 1 FT- A xime Lind sur er
'Tap of catry loam Wor brrowtrrd indans any molars
a wartarrca hhoosdanon rah 1SA !CAC 7C _Dim
▪ YIELD Lek ' — METHC Cr OF TEST avt,
R DINDIFECT1DOt Typo I If Aroa 4/1"6"t#41
. WATER MIES (i �d+
FarnA I a To J o 4'4 ran+
Fria! To Fran+
Fran To Frain To
FrunP/ n) FL d:r_.
Fran To FL 57-c,
Fran To FL
To
To
7. GROUT: Dam te.arar of
FTUIlt To
Fran To FL
From To Ft,
Math*
lR =REM o pCr t7clrurbrr Sari, Size • Material
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Fran
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Ft aL h_
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Size
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From To FL
10. DRLL?40 LOG
From To
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ry
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11. REMARKS:
For Description
fan
Ctrs,
a co htatoT VT TKO Rat %B.L rawCOPOSTICLGTED DI DCOWCYWCX FUN
OD. %CDC 2C_ WWI COW5nra,L7134 BT+wQ1Y¢eL AFC Thal' A MIFF OF 1365
DEEM 'ro T E WELL owra3l
aF CERTTFTEOWa COKTRACTOR DATE
�I"r✓� -rD
PRINTED Kn OF PERSON CONSTRUCTING THE WELL
SizbrnK the artirsal to the Diris[orl of Water Quality within 30 days- Attu: irafa rnatior► Mgt,
1617 Slag S*tYica Center - R alhistr. NC I7693-1517 Mono No. (91 S) 733-7015 art 562_
Form GW-la
Rom. TA5