WI0600140_GEO THERMAL_20190805

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PS Form 3811-, July 2015 PSN 7530-02-000-9053 Domestic Return. Receipt i
Permit Number
Program Category
Ground Water
Permit Type
WI0600140
Injection Heating/Cooling Water Return Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
201 Sterling Ln {SFR)
Location Address
201 Sterling Ln
Laurinburg
Owner
Owner Name
Ralph
Dates/Events
NC
E
Orig Issue
4/9/2014
App Received
2/21/2019
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
28352
Carter
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
5nt2019
Permit Tracking Slip
Status
In review
Version
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Fayetteville
County
Scotland
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Ralph E . Carter Ill
201 Sterling Ln
Laurinburg
Issue
5/8/2019
Effective
5/8/2019
NC 28352
Expiration
4/30/2024
Requested /Received Events
RO staff report requested
RO staff report received
Streamlndex Number Current Class
2/22/19
4130119
Subbasln
Permit Number
Program Category
Ground Water
Permit Type
WI0600140
Injection Heating/Cooling Water Return Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
201 Sterling Ln (SFR)
Location Address
201 Sterling Ln
Laurinburg
Owner
Owner Name
Ralph
Dates/Events
NC
E
Orig Issue
4/9/2014
App Received
2/21/2019
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
28352
Carter
Draft Initiated
Scheduled
Issuance
Central Files: APS SWP
5/3/2019
Permit Tracking Slip
Status
In review
Version
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Ralph E. Carter Ill
201 Sterling Ln
Laurinburg
Region
Fayetteville
County
Scotland
NC 28352
Public Notice Issue Effective Expiration
Requested /Received Events
RO staff report requested
RO staff report received
Streamlndex Number Current Class
2/22/19
4/30/19
Subbasln
ROY COOPER
Govemor
MICHAELS. REGAN
SeaetarJ
LINDA CULPEPPER
Director
Dr. Ralph and Sandra Carter
201 Sterling Lane
Laurinburg NC 28352
Re: Issuance of Injection Well Permit
Permit No. WI0600140
NORTH CAROLINA
Envlronmmtal Quality
May 8, 2019
Geothermal Beating/Cooling Water Return Well
Scotland County
Dear Mr. and Mrs. Carter:
In accordance with your permit renewal application received February 20, 2019, I am forwarding
Permit No. WI0600140 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 April
30, 2024, 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 March 11, 2019. Laboratory analytical results are sttached with this . \
letter.
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
North Carolina Department of Environmental QuaUty I Division of Water Resources
S12 North Salisbury St~t I 1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919.707.9000
cc: Trent Allen -Jim Barber, Fayetteville Regional Office
Central Office File, WI0600140
Scotland County Environmental Health Department
NORTH CAROLINA
ENVIRONMENT AL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Ralph & Sandra Carter
Scotland County
FOR THE CONTINUED OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER
RETURN WELL(S), defined in Title 15A North Carolina Administrative Code 2C .0224, which will be used for
the injection of heat pump effluent. This injection well is located at 201 Sterling Lane, Laurinburg, Scotland
County, NC 28352, and will be constructed and operated in accordance with the application received February
20, 2019, and conformity with the specifications and supporting data, all of which are filed with the Department
of Environmental Quality.
This permit is for continued operation of an injection well and 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 May 8, 2019, until April 30, 2024, and shall be subject to the
specified conditions and limitations stated therein.
Permit issued this the 8th day of May 2019.
For Linda Culpepper
Director, Division of Water Resources
By Authority of the Environmental Management Commission.
Permit #WI0600140 Geothermal Heating/Cooling Water Return Well
ver. 8-8-2018
Page 1 of5
PART I -PERMIT GENERAL CONDITIONS
I. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (ISA NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [ISA 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 [ISA NCAC 02C .0211(1)].
4. This permit is not transferable without prior notice to, 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 [ISA 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 [ISA 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 requirements of rule ISA NCAC 02C .0107.
2. Any injection well shall be constructed in accordance with requirements of rule 1 SA 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 [ISA 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 ifbentonite is to be used [15A NCAC 02C .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 injection 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 geothermal injection well shall have permanently affixed an identification plate according to [1 SA
NCAC 02C .0107(j)(2)).
Permit#WI0600140 Geothermal Heating/Cooling Water Return Well
ver. 8-8-2018
Page 2 of5
7. A copy of the Well Construction Record (Form GW-1) shall be submitted as described in Part V.5 of this
permit within 30 days after completion.
PART III-OPERATION AND USE CONDITIONS
1. The Permittee shall comply with the conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and rules of 15A NCAC 02C .0200, even
if compliance requires a reduction or elimination of the permitted activity [15A NCAC 02C .02110)].
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 including those actions
that may be required, such as the repair, modification, or abandonment of the injection facility [ 15A NCAC
02C .0206].
J>ART IV -INSPECTIONS [15A NCAC 02C .021 l(k)]
1. Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable time for the purpose of 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 and appropriate samples associated with the injection
facility's activities.
PART V -MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction, repair, or abandonment shall be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on-site and available for inspection [15A NCAC
02C .0224(f)(2), (4)].
2. Monitoring of any well may be required to ensure protection of the groundwater resources of the State and
.compliance with the groundwater quality standards specified in 15A NCAC 02L [15A NCAC 02C
.0224(f)(l )].
3. The Permittee shall report any report any monitoring or other information that indicates noncompliance
with a specific permit condition, that a contaminant 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 Fayetteville Regional Office, telephone number 910-433-3300.
Pennit#WI0600140 Geothermal Heating/Cooling Water Return Well
ver. 8-8-2018
Page 3 of5
(B) Written notification shall be made within 5 (five) days of the occurrence and submitted to the
addresses in Item #5 below; and
(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
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 Fayetteville Regional Office
225 Green St. Suite 714
Fayetteville, NC 28301-5094
PART VI-PERMIT RENEWAL [15A NCAC 02C .0224(c)].
As required by rule, and application for permit renewal shall be made at least 120 days prior to the expiration of
this 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 .Ol 13(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 abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.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
any such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water;
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations;
Permit #WI0600140 Geothermal Heating/Cooling Water Return Well
ver. 8-8-2018
Page 4 of5
(C) Each well shall be thoroughly disinfected, prior to sealing, in accordance with rule 15A
NCAC 02C .011 l(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; and
(F) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
ISA NCAC 2C .0224(f)(4) within 30 days of completion of abandonment to the addresses
specified in Part V.5 above.
Permit#WI0600140 Geothermal Heating/Cooling Water Return Well
ver. 8-8-2018
Page 5 of 5
WATER QUALITY REGIONAL OPERATIONS SECTION-1E
APPLICATION REVIEW REQUEST FORM .E
pia
DEQ/DWR
Date: February 22, 2019 31,11
To: Trent Allen — Jim Barber
MAR 01 2019
From: Shristi Shrestha, WQROS — Animal Feeding erations and GroundwaterT,totextion-Braiic
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
Permit Number: WI0600140
A. Applicant: Ralph & Sandra Carter
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:
COMMENTS:
Date: y/Z'9A
NOTES:
*IOW OcteM
FORM: WQROS-ARR ver. 092614
Page 1 of 1

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Date: 8 A pril 2019
To: Shristi Shrestha
Central Office Reviewer
L GENERAL INFORMATION
Permit No.: WI0600140
County: Scotland
Permittee/Applicant: Dr. Ral ph & Sandra Carter
Facility Name: Carter residence -201 Sterling Lane
1. This application is (check au that apply): 0 New IZ! Renewal
0 Minor Modification D Major Modification
a. Date of Inspection: 11 March 2019
b. Person contacted and contact information: Sandra Carter
c. Site visit conducted by: Jim Barber and Kent White
d. Inspection Report Printed from BIMS attached: 0 Yes IZ! No.
e. Physical Address of Site including zip code: 201 Sterling Lane, Laurinburg NC 28352
f. Driving Directions if rural site and/or no physical address: From the Fayetteville Regional Office
travel to Laurinbu rg via Hwv 401 thru Raeford and Wagram. U pon enterin g Laurinburg ci ty
limits, p ass Scotland High School and Wal-Mart. Turn left onto Lauchwood Circle and cross Hwy
401 Business/Main St onto Lauchwood Drive. Turn ri ght onto Dundee Drive, left onto Montrose ,
ri g ht onto Franklin and left onto Sterling Lane. The Carter residence is on the ri g ht at the end of
Sterling Lane.
g. Latitude: 34.746241 Longitude: -79.471821 (Injection well location , installed on 28 A pril 2014)
Source of Lat/Long & accuracy (i.e., Google Earth, GPS, etc.): Scotland County GIS
JI. DESCRIPTION OF INJECTION WELL (S ) AND FACILITY
1. Type of injection system:
IZ! Geothermal Heating/Cooling Water Return
0 In situ Groundwater Remediation
0 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? IZ! Yes D No.
Provide well construction information from well tag: See attached well construction records and
water su pply well and in jection well lab data.
b. Does existing or proposed system use same well for water source and injection? 0 Yes IZ! 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. See attached documentation.
3. Are there any potential pollution sources that may affect injection? D Yes IZ! No
What is/are the pollution source(s)? NIA
What is the distance of the injection well(s) from the pollution source(s)? N/A
Rev. 6/1/2015 Page 1
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
4. What is the minimum distance of proposed injection wells from the property boundary? 95' south, 155' east,
190' west (see attached site map).
5. Quality of drainage at site: C8'.I Good
6. Flooding potential of site: C8'.1 Low
D Adequate D Poor
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. 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)? D Yes 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.
9. For Non-Discharge groundwater remediation systems only:
a. Are the treatment facilities adequate for the type of waste and disposal system? D Yes D No D N/ A.
Ifno, 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? D Yes D No D N/A. If no, please explain: __
IIL EVALUATION AND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? D Yes C8J 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
D Deny. If Deny, please state reasons:
D Hold pending receipt and review of additional information by regional office
D Issue upon receipt of needed additional information
Rev. 6/1/2015 Page 2
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Issue
5. Signature of report preparer(s): !"1Ri2/ f
Signature of WQROS Regional Supervisor RAIz[ 4!_ FaJL �121;UT 4 L Leri
Date_ y1h 9
IV ADDITIONAL REGIONAL STA FF REVIEW COMMENTSIATTACHMENTS (II Needed)
A site visit was made to 201 Sterling Lane on 11 March 2019 to determine if the information provided b►
Simmons Heating & Air in the original application from 2014 was correct and to determine the exact
location of the geothermal injection well installation.
The project site is in a residential neighborhood in the City of Laurinburg_ Houses in the vicinity of the
project site are of like construction with no unusual uses or features (i.e. auto body shop, mechanical
repair shop, oil change station, etc.) and the neighborhood is served by the City of Laurinburg with
water and sewer service.
It doesn't appear that the proposed activity will have an adverse impact to the surrounding area.
Groundwater flow would appear to be toward an unnamed tributary of Lake Ansley Moore and Bridge
Creek, that is located approximately. 1000' west of the proposed project site. The supply well and the
proposed injection wells are both outside of the 100-year floodplain. In reviewing the NC Floodplain
Mapping website and the floodplain mapping on the Scotland County GIS website, the outerrmust extent
of the 100-year floodplain appears to be at elevation 192 msl (Bridge Creek) and 204 msl (Big Branch to
the east) with the elevation of the Carterpropert►• being_at 209 to 210 msl. The proposed infection well is
in the back yard of the Carter residence and is located as follows: approx. 95' from the south propert►
line, 155' from the east property' line, 190' from the west property line and 320' from the north property
line.
The infection well was constructed by Deese Well Drilling similar to the existing water supply well with
the total depth being 110', screened from 79' to 110' in the Slack Creek aquifer (see attached GW-ls and
regional cross section). Injected water is slowly being assimilated into the Black Creek aquifer based on
some injection water venting from the top of the well seal. This may, be a reflection of the higher than
normal water table due to the excessive amount of rainfall that southeastern NC has received in the last
six months. Even though there is some injection water venting from the well seal (hole in the cap), the
area the infection well is located in consists of very sandy soils (soils mapped in the area of Sterling Lane
and Utility Road and the Carter residence are identified as Wagram1Autryville and Noboco sands which
have a high permeability. and readily allow for water infiltration).
Rev. 6/1/2015 Page 3

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Dcpartmeflt of Environment and Natural Resources- division of Water Quality
WELL CONTRACTOR CERTIFICATION n 3562-A
WELL1..+cO�N, TRACTOR: g. WATER ZONES (depth);
Chad
�es C Iwie CT/ Q u �1t(+G)'op ? Bottom
Top Bottom
Weil Cantractar [Individual} Name
Deese We Drilling Top Bottom
Well Contractor Company Nome
1_9886 Indian reservaian rd.
Street Address
Waaram
City or Town
L910 I M=26O7
Area code Morro number
_. WELL INFORMATION:
WELL CONSTRUCTION PERMITit NI i
OTHER ASSOCIATED PERMITS(f apotlrablei
SITE WELL ID kir applicable]
3. WELL USE (CheckAp
DATE DRILLED
TIME COMPLETED f/n.
4. WELL..LOCA
Top Bottom
Top Bottom
Top Bottom
7. C ING_ Depth Domeier
Top l) Bottom 7 Ft L-)
NC 28396 Top Bottom FL
State Zip Code
Sox): Residential Water Supply
AMO PM Li
COUNTY:')Hi
(Street Name. Mimosas, Community, Subdivision, Lot No., Parcel, bp Code)
TOPOGRAPHIC! LAND SETTING: (cheek appropriate cox)
❑Slope ❑valley ❑Flat []Ridge 1=10I1er
LATITUDE _ 3fi ' CMS OR 3X,X)CoccoDIA DCl
LONGITUDE 75 ' DMS OR 7x.)noo00ocxx DD
Latitude/longitude source: BPS CITopographic map
(location of well must be shown on a USGS ropy map andatieche 1 to
this form if not using GPSi
S. WELL OWNER
Owner Name
Street Address
City or Town
{ ]
Area code Phone, number
State Zip Code
6. WELL DETAILS: ' !�
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ N O id'
c. WATER LEVEL Below Tap or Casing: FT.
(Use "+" if Above `Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated actor below land surface may require
a variance in accLordance with 15A NCAC 2C .0118.
e. YIELD (gpm): Y METHOD OF TEST
f. DISINFECTION:Type Amount
Top Bottom Ft.
Thickness/
tNeight ti�rMaterial
5�
6. GROUT: Depth Material
Top 0 Bottom 28 Ft.
Top Bottom Ft.�_
Top Bottom Ft.
Method
9, SCREEN. Depth Diameter Skit Size Material
Tvp Bottom Ft. fn. in,
Top Bottom Ft. in.
l#ain.
Top? {� Bom//r Ft.
11). SAND/GRAVEL PACK:
!} /} Depth 5i�
Top c4L) Bottom / W7 R. r
Top Bottom Ft.
Top Bottom Ft
11. DRILLING LOG
Top Bottom
1
1
1
1
I
1
1
ha
Formation Description
12. RE KS: 11 V C e
ell J�r,I12,� h ire _iehr\
t DO HEREBY CERTWFYTHAT THIS WEL1_ WAS CANSTROCTED IN
ACCORDANCE WITH 15A NCAC 20, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
SI ATUR O ERTIRE0 WELL CONTRACTOR DATE
'AOC/ (c-e -
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 MaN Service Center, Raleigh, NC 2769a-181, Phone : {918) 8QT-6300
Form GW-1a
Rev. 2i09

NorthCarolina - Department of Environment. Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O, Box 29535 - Raleigh. N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR : Graham & Currie
DRILLER REGISTRATION NUMBER. 537
RECEIVED
JUN 1 is 1999
FAYETTEVILLE
REG. OFFICE
STATE WELL CONSTRUCTION
PERMIT NUMBER:
1. WELL LOCATION: Shaw sketch of the location below)
�t
Nearest Town: �—iTL4. l •T� b i • . 1y County: _CCo r tll La yr° r 4
(Road, Community, or Subdivision and Lot No.)
r- C--4 Q r (S JPP&y We ct
p-gc,�
(Street or Rou8 Po.)
City OF Town State Zip Code
3. DATE DRILLED 4711. USE OF WELL(r°,G,
4. TOTAL DEPTH lye#
5. CUTTINGS COLLECTED YES❑ NO13-
6. DOES WELL REPLACE EXISTING WELL? YEE❑ NO
7. STATIC WATER LEVEL Below Top of Casing : FT
(Use '+' if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface
Casing Terminated al/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC .6118
9. YIELD (gpm): —440 METHOD OF TEST ,-- �n
1f1 WATFP 7(INFS (rlenth1
2. OWNER
ADDRESS
11. CHLORINATION Type Amount
12. CASING
Wall Thickness
Depth diameter or Weightlft. Material
From fir To '% , Ft Li r/ fci, 40 A./C.
From /t ' 9 To /tea' Ft ray-_ 3e4lf c! Ipre
From To Ft
13. GROUT:
Depth Material Method
From 6 To Re/ Ft Cte 4e
Front To Ft
14 SCREEN:
Depth Diameter Slot Size Material
From 9f To /'r Ft CZ', in. 'Jo in. AFC. -
From _ To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PAC:
Depth Size Material
From =7a To _440 v Ft 7Y '' Ito -Pe f
From To Ft
16. REMARKS:
DEPTH
From To
DRILLING LOG
grrjeti Description
5• i4
Ctialr
eAmig
d ,u n s,oivoe nt_c
/oa
4'o
S. /cam
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
fo\oAltv—,
1)1
1 DD HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1Sa NCAC 2C WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OVttER
Signature of Contractor Date

North Carolina Department of Environment and Natural Resources
Division of Water Quality -Aquifer Protection Section
IN.JECTION FACILITY INSPECTION REPORT
PERMIT NO. WI O {p OD/'-//)
DATE OF INSPECTION: / / fll8RCJ.I =<ol't
INsPEcToR: :Jin &caE«R. ~.ull k1:A1, \J.JJ.f1-r£
NAMEOFPERMITTEE(s) b g . R AtP..4-AJIJA .$Aµb/]A. CA12re~
MAILINGADDREssoFPERMITTEE :201 .Sre1tL1JJ1-i.AJJEJ LA"FV,J.:J B\JR G. ./41,c.. 2.a3 s 2.
PHYSICAL ADDRESS OF SITE (if different than above) _ _,:S.:;;..;A:;....:. :..;....~-'-'E_,__ ___________ _
PERSON MET WITH ON-SITE S AJJt>[l,t Cw.re&. ; TELE NO. 'I JO., 2 77-,2 7'i' {J./,tt,E,4':,)
WELL(S) STAIDS:
✓ Existing and operating Class V Well
__ Existing well proposed to be converted to Class V well
__ Proposed/not constructed
'/JO -:J.77-/p508 (cEt.t..ilJ
LAT/LONGOFWELL(S) 31.J, ?4tp.21./I A .tJ b -7i J./11 6~1 {/,µ.JecrlcNJ\
3'/. 1c./(p <1'1'1 ALIA -79_ 472..t>t./2.. {. WA'Tcil... .5..JPP'-Y J
Appx. distance of well to property boundaries: .3-lo '~) /SS 'e, 9 S / S: A AIA l 'l O 'v./
Appx. distance of well from foundation of house/structure: ----"-1-=5',_,,()c.__J _________ _
Appx. distance of well from septic tank/field (if present): ;JD SE.PT/ c. -fY>vJ.J I c, PA L-.SeWEJ2-.setN-e $
Hol'?E .
Appx. distance of well to other well( s) (if present): (rg~rt2.. "tAA o J../oo 1
Appx. distance to other sources of pollution: IV A -~~~--------------
Flooding Potential of Site: _high __ moderate ✓low ( SEE.. ATrACJ-feb l>JA,.,0..)
Comments:
Injection Facility Insp . Report (Rev. Sept 2009) Page 1 of 3 Pages
DRAW SKETCH OF SITE ABOVE (Show property boundaries, buildings, other wells, septic tanks/drain fields, other
potential pollution sources, roads, approximate scale, and NORTH arrow)
SEE Ai r, chtg 1] (b,4/ 5 CIa11-f- THE_ 5Th)F- RF Of?.7r
Draw Schematic of well above showing TD, casing depth, grout, etc.
Sc ATcr/eN - /s Foz 714E k./4T�:.t SuPJ , w5r t_
,ATE-C7")OdJ Brie. try .
Injection Facility Insp. Report (Rev. Sept 2009)
Page 2 of 3 Pages

Well Construction Information
( I AJ:JE '-7.1 O .A..I WE t <..)
Date Constructed:-<S: APRJL ~OI'-/
Well Contracting Company: ]:>EE.SE. WE"-L PTZJI.LJA.J&
Well Driller Name: Cff,4.b l>EESE
NC Well Cert. No.: .:SS(p.2 -A
Address: l'i88/o I/.Jb/A/J Re.sER.vADOJj Ri>-) WA6-R.A~ .,I.), C.., 28311e,
Telephone No.: '110-,.?[p'f-«fe07 ; Cell No.: ~S:~.C..~M'--"'E.___ ___ _
Email Address: -----------
P P 6 fl 8 S ffl Depth of Well(s): ---4/'-4'-L~Dc...1 ____ _
Total Depth: l /0 1 Total Depth of Source Well, if present: ----
Casing:
Depth: ?9 1
; Diameter: 4tt ; Type (gav. steel, PVC, etc.): p\/C, I I ft ; Stick Up: ---
Grout:
Depth: ~o' ; Type (cement, bentonite, etc .): Ccf"\/!!,JJJ ; Placement (pumping, press. etc.): PuriP
Well ID Plate Present (Y or N): __y__; Heat Pump ID plate present (Y or N): /J
Effluent spigot (Y or N): _y_,__ __ Influent spigot (Y or N): Y
Well Sampled? (Y or N): y
Static Water Level:
; If Yes, Lab Sample ID numbers: AC (po 757 -WATER..~tJPl'f ~t,L
AC. (po 7sB -1AJ.7ecr10AJ w1:1..t..
---
Injection Information (if applicable):
Injection Rate: 9 GPM
Injection Pressure: GRAVIT'/ PSI
Injection Volume: /;lJ C/l, Q GPD ( q &pr,, )(' /L/..,D /"J.-,<J./'f>A'( ~
Temperature-Summer: -F0
Temperature-Winter: ____ F0
Comments/Notes ys1 /Y)eTER. 8A.TTER.Jf bteb o,µ-.J/7£.
Injection Facility Insp. Report (Rev. Sept 2009) Page 3 of 3 Pages
IYVIUA Lai UUUILd JJLViMtill VS ■ral.C1 lttr Vu{fie. CL7:'•
Water Sample. Collection Sr_ Submittal Form
Central Laboratory (Water Sciences Section) ,r Ol yip1). -
°
}II��
illl�ll
II
Loc i 's, ripl on:! mre-p. ` rt- � Ij 6�ATez 5, pxy
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•
toroerori.c:ade: ( P 0j 3- to Q `�
AC60757
1
• CourlP �..
5 N
"¢IC orr•;
H .:
M)T"r_..:_:
seriof!
VIg er Motraxi:
<, `ioccuoaJi'706 - A Date Rec 3/12/2019 05:30
DWH R.egioii' ';
t a e t,
❑Ambient
River/Stream LLake
• 1Casedon.tq:xntyy r...a;
J_P
,a;°
}v ;+ '-eh:
ff"'� _
❑ Surface
❑Estuuary ❑Canal
::..;..."."
Re.celved:Ovr (�
{
�.�, f?fRouYlne
l
❑StnrmYYatar
.
:.. .
••River eosin.-
LU, 3i
p w,* ' =':
, ., '
! A I
yYl�
❑Compliance
°ibis
Ground
❑Monitoring Weil Water Supply
State Courier
Notes:
f' `. :z
.•r ::t'
,,_
] a y-��
1) ■ frr••,�
❑ coc
❑ Waste
['Effluent ❑Influent
Deiive - MeiFion: Di -land Delivery
['Other.
❑ Chlorinated ❑Qas-chlorinated in Field
; I .-.
���. �
,'r5-+' ,1
AG Cam oa
U A Ito:
_I01her.
❑Emergency
❑ Blank
❑ Reid clank ❑Trmp Blank•
2FilterBlank
-• ` � -
-TEmpCtsrxrlref'c)_;
QilecOVed analysis: Enter"Do'
❑ Filtered in Feld in check -boxes far rn raatsrs
' ^- �y
r , Y! 'f
❑QA
II Solution
❑Other:
•araArrlva+,:
.
S.. - pi . ';`,.-0. L . .- _'if;' .'
j;
MBAS (surfactants) mg/L
, :
Metels.earameteosc :o.r.1-,t -_. ., d .;,..:_. ; _ ,.i
n
Tin (S } pg/L
Acidity, as CaCO3, to pH 4.5/8.B mg/L
011 and Grease, HEM, Total Recoverable mg/t
Aluminum (AI) pg/L�
Titanium (TI) llg/i.
Alkalinity. asCaCO3,•to pH 4.5/8.3 mg/L
Phenols, Toth Recoverable pig/L
Antimony (5b)
pg/L
Vanadium (V) ' it&/L
BOO: Biochemical oxygen Demand, s-esay mipL
Residua: Total (Total solids) mg/L
x
Arsenic (As)
(Jg/L
Zinc fin) Ng/L
cson: carbonaceous 80D, 5-day mg/L
Residue: Volatile/Fixed, Total mg/I-
Barium (Ea)
1-101
Conform: Fecal MF /100mi
Residue: Suspended (SuspendedSollds) g/L
Beryllium (Be)
Lig/L
Boron (2). Total pg/t
Collform: Total MF /100rn1
Residue: volatile/Fixed, Suspended mg/L
Cadmium (Cd)
pg/L
Mercury 1E31, low-level • ng/L
Coeform: Tube Fecal /2Oom1
)�
TD5 -Total Dissolved Solids li mg/L
Calcium (Ca)
mg/L
Collform: Tube Total /100ml
Silica m
)Chromium
(Cr). Total t N81L
:'; creyiA51C5;PffiramolerS:
Specific Conductance, at 25 °C umhor/cm
Sulfide mg/L
Cobalt (Co) 11g/L
Acid Herbicides
TOC -Total Organic Carbon me/L
Tannin & Lignin mg/t
V
Copper (Cu) lab/L
Orga no chlorine Pesticides
Turbldtty NTU
Iran (Fe) pg/L
organanitrogen Pesticides
.-:
fifli PAri laert ; ... _ •-. .---'r'.i:
Lead (Pb). i e/L
Organophosphons Pesticides
_ ..-:WetCherdisstry llataritejers7'::....... -._ : t .. .._ .
�`•..-'
se
Lithium (Li} pg/L
PCBs (polychlorinated biphenyLs}
Bromide A mg/L
€
aj�
Hardness, Total as CaCO3- bytitration � � et.
Magnesium (Mg) mglL
Chloride mg/L
�
Manganese (Mal 44/1
Semi -Volatile Organics (BNAs)
Fluoride mg/L
Mercury (Fig) µg/l.
TPH Diesel Range
Sulfate mg/L
Itui leiits $$fare d j9 ..: ;,M ±- f''':.' !Y; is
Molybdenum (Mo1 V!g/L
Chlorophylls yrg/L
Ammonia as N (N143-1,1} mg/L
'A.
Nickel /N1) pg jL
Volatile Organics (VKA)
Color: ADM! c.u.
rr��4.
Nit a4H te-Nltritess N (NO3D2-N) L mg/L
-X.PotassihJm
(K) mg/L
Color: Platinum Cobalt c.u.
7
Total I[jeldahl Nitrogen as N (TKO) 4. mg/L
Selenium (Se) Ig/L
TPH Gasoline Range
coo; chemical oxygen Demand mg/L
Total Phosphorus as P (TP) mg/L
Sliver (AC) pg/L
Cyanide, Total mg/L
Nitrite as N (NO2-N) mg/L
Y
K.
Sodium (Na) mgli_
:: IdlalogIraRlir;s
Formaldehyde mg/L
Nitrate as N (NO3-N calculated) rng/L
Strontium (Sr) Erg/L
Phytoplankton / Algae
HaxavaientC2rromium (Cries) mg/L
Orthophosphate as P (PO4) mp/L
Thallium (TI) pg/L
LAB COMMENTS
Revsion:2/06/2C
AA 'ek VOT 1410IQ- )h1IA

AC60757 North Carolina Division of Water Resources Water Sciences Section Laboratory Results
Loe. Descr.: CAR!flR-EFFLUENT Sample ID : AC60757
County: Scotland Collector: .!im1!!.s VlsltlD PO Number#
Region: FayettevUle Report To FRO Location ID: 6P083WI0600140 Date Received: 03112/2019
River Basin !.YM Collect Date: 03l1l/iQ19 Priority ROUTINE Time Received: !!§;l!
Emergency Collect T1me : 1.1.!I! Sample Matrix : GROUNDWATER Labworks LoginlD TASCENZ01
COC Yes/No Sample Depth Loe. Type: WATER S!,!l!l!LY Delivery Method NC courier
Final Report Date: !lll1i
Report Print Date: ~~019
Final Re e ort
If this report is labeled prellminary report, the results have not been validated. Do not use for Regulatory purposes.
Result/ Units Method Anal~sls
CAS# Anal yte Name PQL Qualifier Reference Date Validate!;! l!x
LAB
Sample temperature at receipt by lab 1.9 ·c 3112/19 MSWIFT
NUT
NH3 as N in liquid 0.02 0.02 U mg/Las N EPA 350.1 REV 2 3/14/19 CGREEN
NO2+NO3 as N in liquid 0.02 1.6 mg/Las N EPA 353.2 REV 2 3/14/19 CGREEN
Phosphorus_total as P in liquid 0.02 0.02 U mg/Las P EPA 365.1 REV 2 3/20/19 CGREEN
Total Kjeldahl N as N in liquid 0.2 0.20 U mg/Las N EPA 351.2 REV 2 3126119 CGREEN
WET
Bromide 0.4 0.4 U mg/L EPA 300.0 rev2.1 3/14/19 CGREEN
Chloride 1.0 6,6 mg/L EPA 300.0 rev2 .1 3114/19 CGREEN
Fluoride 0.4 0.4 U mg/L EPA 300.0 rev2.1 3/14/19 CGREEN
Sulfate 2.0 2.6 mg/L EPA 300.0 rev2.1 3/14/19 CGREEN
Total Dissolved Solids in liquid 12 26J2 mg/L SM 2540 C-1997 3/12/19 CGREEN
MET
Al by ICP 50 88 ug/L EPA 200.7 Rev4.4 3/19/19 ESTAFFORD1
As bylCPMS 2.0 2.0 U ug/L EPA 200.8 Rev5.4 3/21119 ESTAFFORD1
Ca by ICP 0.10 1.6 mg/L EPA 200.7 Rev4.4 3/19/19 ESTAFFORD1
Crby ICPMS 5.0 5.0 U ug/L EPA 200.8 Rev5.4 3/21/19 ESTAFFORD1
Cu by ICPMS 2.0 47 ug/L EPA 200.8 Rev5.4 3/21/19 ESTAFFORD1
Fe by ICP 50 50 U ug/L EPA 200.7 Rev4.4 3/19/19 ESTAFFORD1
Hardness by Calculation 1.0 7.9 mg/L SM 2340B-1997 3/20/19 ESTAFFORD1
K by ICP 0.10 0.44 mg/L EPA200.7 Rev4.4 3/19/19 ESTAFFORD1
Mg by ICP 0.10 0.95 mg/L EPA 200.7 Rev4.4 3/19/19 ESTAFFORD1
Mn by ICP 10 17 ug/L EPA 200.7 Rev4.4 3/19/19 ESTAFFORD1
Na by ICP 0.10 3.3 mg/L EPA 200.7 Rev4.4 3119/19 E STAF FORO 1
Ni by ICPMS 2.0 9 .9 ug/L EPA 200.8 Rev5.4 3/21/19 ESTAFFORD1
Pb by ICPMS 2.0 3.5 ug/L EPA 200.8 Rev5 .4 3/21/19 ESTAFFORD1
Vby ICP 10 10 U ug/L EPA 200.7 Rev4.4 3/20/19 ESTAFFORD1
Zn by ICPMS 10 24 ug/L EPA 200.8 Rev5.4 3/21/19 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mall Service 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 PQL.
Page 1 of 3
CAS# Anal yt e Name
:NC ID'Wl{_ La6oratory Sectum ~Cts/Sampfe Comm ents/Quafifier IDefinitions
Sample ID:
PQL
AC60757
Result/
Qualifier
Sample Comments
Units
Method
Reference
Wet:-TDS.J-estimated reported value failed the QC criteria for precision.
NCDEQ-WSS~hemistry Lab Data Qualifiers
Analysis
Date Validated bv
A1 The reported value is an average, where at least one result is qualified with a "U". The PQL is used for the qualified result($) to cal ,
B1 Coliform-Countable membranes with less than 20 colonies. Reported value is estimated or is a total of the counts on all filters repor
B2 Coliform-Counts from all filters were zero . The value reported is based on the number of colonies per 100 ml that would have been
B3 Coliform-Countable membranes with more than 60 or 80 colonies. The value reported is calculated using the count from the smalle
B4 Coliform-Filters have counts of both >60 or 80 and <20. Reported value Is estimated or Is a total of the counts on all filters reported
B5 Coliform-Too many colonies were present; too numerous to count (TNTC). TNTC is generally defined as >150 colonies.
B6 Coliform-Estimated Value. Blank contamination evident.
87 Coliform-Many non-coliform or non-enterococcus colonies or interfering non-coliform or non-enterococcus growth present. In this cc
881 MPN-No wells or tubes gave a positive reaction. Value based upon the appropriate MPN Index and reported as a less than"<" valu
B82 MPN-AII wells or tubes gave positive reactions. Value based upon the MPN Index and reported as a greater than ">" value.
C Total residual chlorine was present in sample upon receipt in the laboratory; value is estimated.
G1 BOD-The dissolved oxygen (DO) depletion of the dilution water blank exceeded 0.2 mg/L.
G2 BOD-The bacterial seed controls did not meet the requirement of a DO depletion of at least 2.0 mg/Land/or a DO residual of at lea:
G3 BOD-No sample dilution met the requirement of a DO depletion of at least 2.0 mg/Land/or a DO residual of at least 1.0 mg/L.
G4 BOD-Evidence of toxicity. This is generally characterized by a significant increase in the BOD value as the sample concentration de
G5 BOD-The glucose/ glutamic acid standard exceeded the range of 198 ± 30.5 mg/L.
GS BOD-The calculated seed correction exceeded the range of 0.6 to 1.0 mg/L.
G7 BOD-Less than 1 mg/L DO remained for all dilutions set. The reported value is an estimated greater than value and is calculated fo1
GB BOD-Oxygen usage is less than 2 mg/L for all dilutions set. The reported value is an estimated less than value and is calculated for
G9 BOD-The DO depletion of the dilution water blank produced a negative value.
J1 Surrogate recovery limits have been exceeded.
J2 The reported value failed to meet the established quality control criteria for either precision or accuracy.
WSS Chemistry Laboratory» 1623 Mall Service 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 2 of 3
J3
J4
J5
J6
J7
JB
J9
J10
J11
J12
M
N1
N2
N3
N4
N5
Q1
02
p
s
u
X1
X2
X3
V
y
Z1
Z2
u, J6
uu
NC©~ £a6oratory Section ~sufts/Sampfe Comments/Q!udifier ©efinitions
Sample ID:
Analyte Name
AC60757
Result/
Qualifier Units
The sample matrix interfered with the ability to make any accurate determination.
Method
Reference
Analysis
Date Validated by
The data is questionable because of improper laboratory or field protocols (e.g., composite sample was collected instead of grab, p
Temperature limits exceeded (samples frozen or >6°C) during transport or not verifiable (e.g., no temperature blank provided): non-
The laboratory analysis was from an unpreserved or improperly chemically preserved sample. The data may not be accurate.
This qualifier is used to identify analyte concentration exceeding the upper calibration range of the analytical instrument/method. Th
Temperature limits exceeded (samples frozen or >6°C) during storage, the data may not be accurate.
The reported value is determined by a one-point estimation rather than against a regression equation. The estimated concentration
Unidentified peak; estimated value.
The reported value is determined by a one-point estimation rather than against a regression equation. The estimated concentration
The calibration verification did not meet the calibration acceptance criterion for field parameters.
Sample and duplicate results are "out of control". The sample is non-homogenous (e.g ., VOA soil). The reported value is the lower•
Presumptive evidence and estimated value. The component has been tentatively identified base on mass spectral library.
There is an indication that the analyte is present, but quality control requirements for confirmation were not met (i.e ., presence of~
This code shall be used if the level is too low to permit accurate quantification, but the estimated concentration is less than the labo
This code shall be used if the level is too low to permit accurate quantification, but the estimated concentration is less than the labo
The component has been tentatively identified based on a retention time standard.
Holding time exceeded prior to receipt by lab.
Holding time exceeded following receipt by lab.
Elevated PQL* due to matrix interference and/or sample dilution.
Not enough sample provided to prepare and/or analyze a method-required matrix spike (MS) and/or matrix spike duplicate (MSD).
Indicates that the analyte was analyzed for but not detected above the reported practical quantitation limit*. The number value repo
Sample not screened for this compound.
Sampled, but analysis lost or not performed-field error.
Sampled , but analysis lost or not performed-lab error.
Indicates the analyte was detected in both the sample and the associated method blank. Note: The value in the blank shall not bes
Elevated POL* due to insufficient sample size.
Inability to analyze the sample.
Questions concerning data reliability.
The laboratory analysis was from an unpreserved or improperly chemically preserved sample. The data may not be accurate.
Indicates that the analyte was not detected by a screen analysis. The number value was determined by a one-point estimation at ti
WSS Chemistry Laboratory» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone]
'Not Detected" or "U" does not indicate the sample is analyte free but that the analyle is not detected at or above the POL.
Page 3 of 3
North Carolina Division of Water Resources llielbin:::.-•
Gerltxal LaboratoryVoter Sciences Section) Water Sample Collection & Submittal l 0rrn ... :- ,. ,j:
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Date Rec 3112/2019 0830
.DWH Region,[.:-`. ;
• o ,`. �
❑Ambient
River/Stream Lake
s.-
.-• -i6:rsc�far!,mw!rYl='
r c
�t:s �. 1�
, ' r
.� 0
❑Surface
Estua Canal
❑ ''Y
j} , rr
.•'Reteivkd.itvi._ 4
'
. -'-k 1�.,
�
I7QRoutine
❑stormwater
--_ lII"'"'"' ��1
'1iiv r 8.i siin
■ p ; �j
;_vol �.ii I�
•:Oa '
11 f A Z- 1 J
rJ t�
Ground
I-�
0Monitoring Well Water Supply
.-State Courier
Notes:-
::
:;..:'
d:,; :_
J
f
LECompllance
O Waste
❑> {fluent
`tlal1veiy.:Methech
Influent I
. Ell -land Delivery
'❑gthet
❑ Chlorinated ❑{7e-chlorinated in Field
!;Grab
a
L;Composife
Other.
❑ Emergency
❑San%
❑Field Blank I�
. ❑TrpBlnkjti43reb
�Fliter B?sink II.
reiivAerirtuie ('_C9 . Cry p•
Dissolved analysis: Enter 'US"
0 Filtered in Field in check -boxes for atamaters
-
'4
Alf
❑OA
❑Solution
❑Ocher:
_
' T
r? . I ' T Ltig `7'l't mod'-3-T
F:•i;
et114 0 :,• = - r ' ,
MBAs [surfactants) mg�L
N14
;
MCTai raiirdeters: � geA.; .;'.:: '_..:Y::. ; :: f"..,
Tin (Sol - - pg/L
•Pit
Acidity, as CaCO3ito pH 4.5/8.3 mg/L
Oil and Grease, HEM, Total Recoverable mg/t
Aluminum J4IL
pg/L
Titanium fill }IBA
Alkatfnity, es CaCO3,'to pH 4.5/8.3 mg/L
Phenols, Total Recoverable pg/L
Antimony (5b)
pg/L
Vanadium On ( Grg/L
�,
boo: eIochemicel Oxygen Demand, 5-day mg/L
Total (Total Solkls) ms/L
Arsenic (As)
pg/Lr
*
Zinc [Zn) .� pg/L
cBOD: Carbonaceous BOD, 5-day mg/L
_Residue:
Residue: Volatile/Fixed, Total mg/L
Barium (ha)
ug/L
N
'�
Conform: Fecal MF /1f�pm1
Residue: Suspended {Suspended Solids} mg/L
Beryllium (Ea)
pg/L
Boron (B), Total µg/L
Conform: Total MF inomi
Residue: Volatile/Fixed, Suspended met
Cadmium (Cd)
}ig/L
Mercury 1631, low-level ng/L�
Coliform: Tube Fecal /LQQml
TDS-Total Dissolved Solids milt
Calcium (Ca)
mg/L
�lform: Tube Total /10Qmi
Silica rng/1
x
Chromium (Cr), Total
Pet
e <
Rd�k.?!p4ii-tieZeix:': `i�.:. ;i:-I `i.
Specific Conductance, at 25 °C umiws/tm
Sulfide mg/L
Cobalt (Co) '
llg/1.
Add Herbicides
TCC-Total Organic Carbon mg/L
Tannin & Ugnin mg/L
Copper (Cu)
pg/L
r
Organochlorine Pesticide/
Turbidity NTu
Iron (Fe) i,e/L
Organonitrogert Pesticides
•
herTairiTilifakst: '.::.." :_'w ';:; .:
Lead (Ph). trg/L
Organophosphorus Pertrades
•, Vigebr j{jstj,ViRefffinete[x s1;✓ .2.r:1 :4::':',::`,'+ ' ?
pli s.u.
V
•Lithium(Li) RP_
PCBs (poiychiarinatedbiphenyls)
Bromide mg/L
hardness, Total asCaCD3-by titration mgfL
Magnesium (Mg) mg/L
Chloride mg/L
Manganese (Mn) - µg1L
Serf-Voiatlie Organics tENAI)
'Fluoride ma
Mercury (Hg] ise/L
TPH Diesel Range
Sulfate mgfL
V'n Na0iffiks9►ifarneteFst r�=r;tc,* 2..�r-3. .:'
Molybdenum (Mo) pg/L
Chlorophyll a Pa
-Ammonia as N (NH3•N) ms/L
Nick& (Ni)
pg/L
Volatile Organics (VOA)
Color:ADMI c,u.
Nitrate -Nitrite as N (NO3+NOZ N) G mgfL
"Thmill
Potesslum (IQ
mill.
Color, Platinum Cobalt C.U.
Total Kjeidahi Nitrogen as N (TKN)
Selenium (Se)
pg/L
TPH Gasoline Range
COD; chemical oxygen Demand mgAL
Total Phosphorus as P (TP) rmg/L
Sliver (AO
pg/L
Cyanide, Total mg/L
Nitrite es N (NO2-N) mg/L
'
Sodhlrn (Na)
/ m111L
,it a:litre isai ;;;•;f .0! _-.i='.;`: _:--
Formaldehyde mg/L
Nitrate as N (NO3-N tieiculet ed) mg/L
Strontium (Sr) }lg/i.
]
P hytopian kton / Algae
Hexevalent Chromium (Cr6+) mg/I
Orthophosphate as P (Po4) - mg/L
Thallium (11) ug/L
r
LAti COMMENTS
1 r��� Pi 444E (aJ N+i 4-$ iJ0.-t.1) ) & L.f-I3 A Tc"K Nt7t4A,r2.) I iV4

AC60758 North Carolina Division of Water Resources Water Sciences Section Laboratoa Results
Loe. Descr.: CARTER-INFLUENT Sample ID: AC60758
County: Scotland Collector: KWHITE VisitlD PO Number#
Region: Fayetteville Report To .EBQ Location ID : 6POB3WI0&00140 Date Received: 03/12/2019
River Basin !MM Collect Date: !!il/]][i019 Priority ROUTINE Time Received : .!!!.B
Emergency Collect Time : 11:15 Sample Matrix : GROUNDWATER Labworks LoginlD TA§CEN~Q]
COC Yes/No Sample Depth Loe. Type: WATER SUPPLY Delivery Method NC courier
Final Report Date: 4/1/19
Report Print Date: 04/02/2019
Final Re ~ort
If this report Is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
Result/ Units Method AnalJr!sls
CAS# AnaM e Name PQL Qual ifier Reference Date :it111idated by
LAB
Sample temperature at receipt by lab 1.9 ·c 3/12/19 MSWIFT
NUT
NH3 as Nin liquid 0.02 0.02 U mg/Las N EPA 350.1 REV 2 3/14/19 CGREEN
N02+N03 as N in liqu id 0.02 1.6 mg/Las N EPA 353.2 REV 2 3/14/19 CGREEN
Phosphorus_total as P in liquid 0.02 0.02 U mg/Las P EPA 365.1 REV 2 3/20/19 CGREEN
Total Kjeldahl N as N in liquid 0.2 0.20 U mg/Las N EPA 351.2 REV 2 3/26/19 CGREEN
MET
Al by ICP 50 87 ug/L EPA 200 .7 Rev4 .4 3/19/19 ESTAFFORD1
As by ICPMS 2 .0 2.0 U ug/L EPA 200 .8 Rev5.4 3/21/19 ESTAFFORD1
Ca by ICP 0.10 1.6 mg/L EPA 200.7 Rev4.4 3/19/19 ESTAFFORD1
CrbylCPMS 5.0 5.0 U ug/L EPA 200.8 Rev5.4 3/21/19 ESTAFFORD1
Cu by ICPMS 2.0 15 ug/L EPA 200 .8 Rev5.4 3/21/19 ESTAFFORD1
Fe by ICP 50 50 U ug/L EPA 200.7 Rev4.4 3/19/19 ESTAFFORD1
K by ICP 0.10 0.44 mg/L EPA200.7 Rev4.4 3/19/19 ESTAFFORD1
Mg by ICP 0.10 0.96 mg/L EPA200.7 Rev4.4 3/19/19 ESTAFFORD1
Mn by ICP 10 18 ug/L EPA 200.7 Rev4 .4 3/19/19 ESTAFFORD1
Na by ICP 0.10 3.3 mg/L EPA200.7 Rev4.4 3/19/19 ESTAFFORD1
NibylCPMS 2.0 7.4 ug/L EPA 200.8 Rev5 .4 3/21/19 ESTAFFORD1
Pb by ICPMS 2.0 3.8 ug/L EPA200.8 Rev5.4 3/21/19 ESTAFFORD1
V by ICP 10 10 U ug/L EPA 200.7 Rev4 .4 3/20/19 ESTAFFORD1
Zn by ICPMS 10 90 ug/L EPA 200.8 Rev5 .4 3/21119 ESTAFFORD1
WSS Chemistry Laboratory>> 1623 Mall Service center, Raleigh, NC 27699-1&23 [phone]
'Nol Detected" or "U" does not ind icate the sample is analyte free but that the analyte is not detected at or above the PQL.
Page 1 of 1
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CARTER SANDRA M
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ttps://laurinburg.conneetgis.com!Map.aspx 4/29/201 c

Dr. Ralph & Sandra Carter
VVID600140 - 201 Sterling Lane, Lauringburg NC 28352
-
Prur'et1,111".r: f' Scotland GIS
1 ,
10 4 .1140t,-,4* sipply o01 '34 746.19q4 -79 .1120421 e
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Base Flood Elevation: NIA More -.-
County. Scotland
Politica I Area: City Of Laurinburg
CID: 370222
Panel: 8356 now/goad
Map Number: 3710835600J
Pane! Effective Date 6/17/2003
Latitude 34,74635
Longitude-7g-4719

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW RE QUEST FORM
Date: February 22, 2019
To: Trent Allen -Jim Barber
From: Shristi Shrestha, WQROS -Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
Permit Number: WI0600140
A. Applicant: Ralph & Sandra Carter
B. Facilitv 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 com pleted 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-W OROS Reviewer: Date: ------------------------
COMMENTS:
NOTES:
FORM: WQROS-ARR ver. 092614 Page 1 of 1
ROY COOPER
Governor
MICHAEL 5. REGAN
Secretary
LINDA CULPEPPER
nfrattor
Ralph & Sandra Carter
201 Sterling Lane
Laurinburg, NC 28352
NORTH CAROLINA
Environmental Quallry
February 22, 2019
RE: Acknowledgement of Application No. WI0600140
Geothermal Heating/Cooling Water Return Well
Scotland County
Dear Mr. & Mrs. Carter:
The Water Quality Regional Operations Section (WQROS) acknowledges receipt
of your permit application and supporting documentation received on February 22, 2019.
Your application package has been assigned the number listed above, and the primary
reviewer is Shristi Shrestha
Central and Fayetteville 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 fte-r receipt of a complete app]icalian you have any questions, please
• contact Shristi Shrestha at 919-707-3662 or email at [e-mail].
Sincerely,
For Debra J. Watts, Supervisor
Animal Feeding Operations &
Groundwater Protection Branch Division
of Water Resources
North Carotlna Department of Environmental Quality j Division of 1Naler Resources
Sl2 North Salisbury Street 4 1636 Mail Service Center 4 Raleigh North Carolina 27699 1636
919,7079000

cc: Fayetteville Regional Office, WQROS
Permit File WI0600140
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 ofa 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 I and 4 (signature page) only
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: _______ ,20__ PERMIT NO. wl 0 '0O f ~geave blank if New Application)
A. CURRENT WELL USE AND OWNERSHIP STATUS (leave Blank if New Application)
B.
1. CurrentUseofWell /
a. Continue to use as _V_. _ r!.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).
0 Yes, I wish to rescind the permit
IVED/NCO'EQIOWR
2. Current Ownership Status RECE ~
Has there been a change of ownership since permit last issued? D YES _ . ~
If yes, indicate new owner's contact information: rEB -
Name(s) ____________________ ~_,.,_~r_~~-~l=1f!/....,, _____ _
. ,-~-.,ion& ~
Mailing Address: ________________ R_89_1_00_
8
_
1
""_'_· ________ _
City: __________ State: __ Zip Code: ______ County: ____ _
Day Tele No.: Email Address.:
STATUS OF APPLICANT (choose one) ✓
Non-Government: Individual Residence __ Business/Organization __
Government: State Municipal __ County__ Federal
C. WELL OWNER(S)/PERMIT APPLICANT -For individual residences, list owner(s) on property deed. For
all others, list name of entity and name of person delegated authority to sign: __________ _
fu,r'-<' H +-S /tt,JO nA eJm::re(L
Mailing Address: '20 ( $i-ed,.(..t ~Ci. f-<C
City: L-"2-4,J P,.v,.t.6 State#C-.zip Code: ze ?{''2.. County: Sc 0 TUcwD
DayTeleNo.: 'if (O•Z17•''17~ CellNo.: 'f1 0•2'7'7•'So8
EMAILAddress:S ~~+~l,\~6,..e2aof. l'dfe.\ FaxNo.: &fto ,2'77• Lf'2.'t'f
Geothermal Water Return Well Permit Application (Revised Jan 2015 ) Page 1
D. WELL OPERATOR (if different from well owner)-For individual residences, list owner(s) on property
deed. For all others, list name of entity and name of person delegated authority to sign on behalf of the business
or agency: _____________________________ _
Mailing Address: ______________________________ _
City: ____________ State: __ Zip Code: ______ County: _____ _
Day Tele No.: Email Address.:
E. LOCATION OF WELL SITE -Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well 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 Address: __________ _
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 Name: ___________________________ _
NC HVAC Contractor License No.: ________________________ _
Company Name: _______________________________ _
Contact Person_: _______________ EMAIL Address: __________ _
Address: ________________________________ _
City: _________ Zip Code: _____ State: __ County: _________ _
Office Tele No.: Cell No.: Fax No.: ----------------
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES __ _ NO ___ _
YES ----NO ___ _
I. WELL CONSTRUCTION REQUIREMENTS-As specified in 15A NCAC 02C .0224!d l :
(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:
Geothermal Water Return Well Permit Application (Revised Jan 2015 ) Page2
(a) For screen and gravel-packed wells, the entire length of casing shall be grouted from the top
of the gravel pack to land surface;
(b). For open-end wells without screen, the casing shall be grouted from the bottom of the casing
to land surface.
(3) A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
____ *EXISTING WELLS ---~PROPOSED WELLS
*For existing wells, please attach a copy of the Well Construction Record (Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
( c) Casing depth below land surface
(d) Casing height "stickup" above land surface
(e) Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited for sealing water-bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .0107(/)(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. OPERATING DATA
(1) Injection Rate: Average (daily) gallons per minute (gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average (daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) __ ° F.
L. SITE MAP-As specified in ISA 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 ISA NCAC 02C .0107 (a J{2 1 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) Page 3
NOTE: In most cases an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand Also, a `laver' can be selected showing topographic contours or elevation
data
M. CERTIFICATION (to be signed as required below or by that person's authorized agent)
1 s A NC rrc-. 1 I ' + , 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 nersonj .] listed on the properi deed.
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
`'] hereby certify, under penalty of Iaw, 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, 1 believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and ail related appurtenances in accordance with the approved specifications and conditions of the
Permit."
Ski ature of roperty Owner/Applicant
1�4t �K eito-TcYZ-
Print or Type Full Name
Siarr-,04-4C
i aature of Property Owner/,\pplicant
r+ND, .lid. elfere-dit
Print or Type Pull 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 { .. vwnd larrwl+ i ) Page 4

ROY COOPER
Governor
MICHAEL S. REGAN
Secretory
LINDA CULPEPPER
ffrerror
.1 1 ALL e 0 � ���
o� t3 to 1�� ..� t}i(ev'
NORTH CAROLINA �� I'�` lr
Enr(rortmentei Quaiity E.r o lC
#c ‘r*
ebruary S, 2019 = 1 0.4- K
,,ey, \o:1„..,,,,. _J.. \t„,dc __,..,
ct-e-, 40- s'..
,),,, , ‘P /
4 icv 13'(''I
lk)k- 4/
ei'
CERTIFIED MAIL # 7017 0190 0000 1635 3160
RETURN RECEIPT REQUESTED
Ralph & Sandra Carter
201 Sterling Ln
Laurinburg, NC 28352
Subject: Notice of Expiration (NOE)
Geothermal Water ReturnlOpen-Loop injection Well
Permit No. WI0600140
Scotland County
Dear Mr. & Mrs. Carter:
The Underground Injection Control WIC) 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 i wien ern ovate on your
i s ctt an May 1, 2014 and expires on Apri130, 2019. Per permit conditions and requirements per \
1 SA 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
p - erty.
If Your Geothermal Water Return Well is Still Currentk Being Used for Iniection:
hi 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:llnortal.ncdenr.orglweblwglapslgwprolperinit-applications.
If Your Geothermal Water Return Well is NO LONGER Being Used for Injection:
If the well is no longer being used for injection, you do not have to renew your permit. Check the
box in Part A of the attached renewal application that you wish to rescind the permit and indicate
the current status of the well (i.e., used as water supply well, irrigation well, inactive, plugged and
abandoned, etc.). If it is no longer being used for any purpose, it must be permanently abandoned
Nr}r!h Cal 1r:41.lmerlt orEnvironmenlal Quality ❑ivisfmr of Waier RC uurCL
S12 Nor1h Salfsbliry SIrtvl 1163h Mali Servlrt Cenlc-r I Ralciyh, Nor 4Ir Caroline 27104-llr3b
914.707.9000

ROY COOPER
Governor
MICHAEL S. REGAN
Seavtwy
LINDA CULPEPPER
Director
EnoRT�lCARQuality
February 8, 2019
CERTIFIED MAIL # 7017 0190 0000 1635 3160
RETURN RECEIPT REQUESTED
Ralph & Sandra Carter
201 Sterling Ln
Laurinburg, NC 28352
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No. WI0600140
Scotland County
Dear Mr. & Mrs. Carter:
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 May 1, 2014 and expires on April 30, 2019. 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 Stall Currently. Being Used for Injection:
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit the enclosed renewal
application (Application for a Permit to Construct or Operate Injection Wells — Geothermal
lieating/Cooling Water Return Wells). The form is also available on-line at our website
http://portal.ncdenr. orglweblwglapslgwprolpermit-applications.
If Your Geothermal Water Return Well is NO LONGER Seine Used for Injection:
If the well is no longer being used for injection, you do not have to renew your permit. Check the
box in Part A of the attached renewal application that you wish to rescind the permit and indicate
the current status of the well (i.e., used as water supply well, irrigation well, inactive, plugged and
abandoned, etc.). If it is no longer being used for any purpose, it must be permanently abandoned
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North Carolina Department of Environmental Quality 1 Division of [Hater Resources
512 North Salisbury Street k Ib36 Mall Service Center I Raleigh, North Carolina 27699-1636
919.707.9000

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.
If There has been a Change of Ownership oldie 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.shresthaicimcdenr.gov.
Regards,
ciareoia
Shristi Shrestha
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: Fayetteville- Regional Office — WQROS w/o enclosures
Central Files - Permit No. WI0600140 w/o enclosures

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201 STERLING LN
LAURINBURG, NC 28352
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RALPH & SANDRA CARTER
201 STERLING LN
LAURINBURG, NC 28352
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