WI0600153_GEO THERMAL_20200430

ROY COOPER
Governor
MICHAELS. REGAN
Secretary
S. DANIEL SMITH NORTH CAROLINA
Environmental Quality Director
April 30, 2020
CERTIFIED MAIL# 7018 0040 00011449 6900
RETURN RECEIPT REQUESTED
Brenda W. Bullard
8630 Shannon Rd.
Shannon NC 28386
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No. WI0600153
Robeson County
Dear Ms. Bullard:
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 July 31, 2015, and expires on June 30, 2020. Per permit conditions and requirements
per 15A NCAC 2C .0224(c), the renewal application must be submitted at least 120 calendar days
prior to expiration of the permit if you wish to continue operating the injection well on your
property.
If Your Geothermal Water Return Well is Still Currently Being Used for In jection:
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit the enclosed renewal
application (Application for a Permit to Construct _or Operate Injection Wells -Geothermal
Heating/Cooling Water Return Wells). The form is also available on-line at our website
http://portal.ncdenr.org/web/wq/aps/gwpro/permit-applications.
If Your Geothermal Water Return Well is NO LONGER Being Used for In jection:
If the well is no longer being used for injection, you do not have to renew your permit. Check the
box in Part A of the attached renewal application that you wish to rescind the permit and indicate
the current status of the well (i.e., used as water supply well, irrigation well, inactive, plugged and
abandoned, etc.). Ifit is no longer being used for any purpose, it must be permanently abandoned
according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C,
Section .0240. When the well is plugged and abandoned, a well abandonment record (Form GW-
3 0) must be submitted to our office to certify that the abandonment was properly conducted.
~l9~ North Carolina Departmf'nt of Environmental Quality I Division of Water Resources
512 North Salisbury Street I 1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919.707.9000
If There has been a Change of Ownership of the Prorserw
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change' Form must also be submitted in addition to the renewal application.
This form is not enclosed but can be found at the website listed above. Please submit the applicable
forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh., NC 27699-1636
Failure to submit the applicable forms 30 days before the expiration of the permit may result in
the assessment of civil penalties in accordance with. North Carolina General Statute 87-94. Thank
you in advance for your cooperation and timely response. If you have any questions, please contact
me by phone at [phone] or by email at shristi.shrestha4imedenr.gov.
Regards, ^
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: Fayetteville- Regional Office — WQROS w/o enclosures
Central Files - Permit No. W10600153 w/o enclosures

Rogers, Michael
From:
Sent:
johnny.strickland <johnny.strickland@hth .co. robeson. nc. us>
Wednesday, September 07, 2016 2:43 PM
To: Rogers, Michael
Subject: RE: Brenda Bullard geothermal system
No problem
From: Rogers, Michael [mailto:[e-mail]]
Sent: Wednesday, September 7, 2016 10:05 AM
To: Barber, Jim <jim:[e-mail]>; [e-mail]
Cc: Henson, Belinda <[e-mail]>; White, Kenneth B <[e-mail]>
Subject: RE: Brenda Bullard geothermal system
Thanks for handling this.
From: Barber, Jim
Sent: Wednesday, September 07, 2016 9:26 AM
To: johnn v.strickland @hth.co.robeson.nc.us
Cc: Henson, Belinda <belinda.henson @ncdenr.gov>; Rogers, Michael <michael.ro gers @ncdenr.11,ov>; White, Kenneth B
<kenneth.white @ncdenr.gov>
Subject: FW: Brenda Bullard geothermal system
Jim Barber
Environmental Engineer
NCDEQ-DWR-WQRO
Fayetteville Regional Office
910-433-3340 voice
910-486-0707 fax
iim.barber@ ncdenr.g ov
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
may be disclosed to third parties.
~ Go Green! Print this email only when necessary. Thank you for helping NCDENR be environmentally responsible.
*******************
From: Barber, Jim
Sent: Wednesday, August 31, 2016 5:15 PM
To: '[e-mail]' <iohnn y .strickland @hth.co.robeson.nc.us>
Cc: '[e-mail]' <cindy .council @hth.co.robeson.nc.us>; Henson, Belinda
{beHnda.henson @ncdenr.gov) <belinda .henson @ncdenr.gov>; White, Kenneth B <kenneth.white @ ncdenr gov>; Rogers,
Michael <michael.ro gers @ncdenr.gov>
Subject: Brenda Bullard geothermal system
1
Johnny Strickland;
I visited Ms. Brenda Bullard's residence this afternoon to follow up on our conversation from last Thursday concerning
your upcoming court date with Ms. Bullard.
The Division of Water Resources issued a Geothermal Heating/Cooling Water Return Well permit to Ms. Bullard last year
(permit dated 31 July 2015). At the time the permit was applied for and ultimately issued; Ms. Bullard relocated the
discharge water from her HVAC system from the north side of her residence (between her residence and the neighbors,
see attached GIS map that indicates the former discharge area) to a location in her backyard. At the time of permit
submittal and continuing today, Ms. Bullard is discharging the HVAC water onto her backyard grass (see attached map
and photos). This practice is acceptable and is considered "pump and dump" and is therefore considered "permit by
rule" as long as there are no impacts to surface waters or others in the area and the requirements in the pump and
dump are met ( https://de a .nc.gov /about/divisions/water-resources/water-resources-p ermits /wastewater-
branch /g round-water-p rotection /geothermal ). Ms. Bullard's current operation of her water supply well and HVAC
system discharging into her backyard is acceptable at this time. The discharging water from the vertical riser is wetting
an area of approximately 15' wide by 65' long. The distance to the neighboring home to the wetted area is
approximately 150'.
It is Ms. Bullard's intention to install a HVAC discharge return well in her backyard in the near future to remove the
unsightly wet area in her backyard. I spoke with Ms. Bullard extensively while at her residence this afternoon and she
indicated that she will make contact with Mike Cribbs (910-316-2332 -Cribbs Well Drilling, Fairmont NC) to get an
estimate on the cost of installing a return well to manage the water being discharged. I will also make contact with Mike
Cribbs early next week when I'm back in the office to offer assistance concerning the installation of the return well.
ff you have any questions or wish to discuss, please give me a call Tuesday 6 September at 910-433-3340. If you need to
discuss before next Tuesday, please contact Kent White at 910-433-3338 tomorrow or Friday.
Jim Barber
Environmental Engineer
NCDEQ-DWR-WQRO
Fayetteville Regional Office
910-433-3340 voice
910-486-0707 fax
[e-mail]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
may be disclosed to third parties .
.!,_ Go Green!Print this email only when necessary. Thank you for helping NCDENR be environmentally responsible.
*******************
2
Permit Number WI0600153
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SWRule
Permitted Flow
Facility
Facility Name
Brenda W. Bullard SFR
Location Address
8630 Shannon Rd
Shannon
Owner
Owner Name
Brenda
Dates/Events
NC
w
Orig Issue App Received
5/12/2015
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
28386
Bullard
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
7/27/2015
Permit Tracking Slip
Status
In review
Version
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Fayetteville
County
Robeson
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Brenda W. Bullard
8630 Shannon Rd
Shannon
Issue
NC
Effective
28386
Expiration
Requested /Received Events
RO staff report requested
RO staff report received
Strearnlndex Number Current Class
5113115
7127115
Subbasin
NA MCDEMR
North Carolina Department of Environment and Natural R.esources
Pat McCrory
Governor
Brenda W. Bullard
&630 Shannon Road
Shannon, NC 28386
Re: Issuance of Injection Well Permit
Permit No. WI0600153
July312015
Geothermal Heating/Cooling Water Return Well
Robeson County
Dear Ms. Bullard:
Donald R. van der Vaart
Secretary
In accordance with your permit application received May 12, 2015, I am forwarding Permit No.
WI0600153 for the construction one (1) geothermal heating/cooling water return well(s) located at
the above referenced address. This permit shall be effective from date of issuance until June 30,
2020, and shall be subject to the conditions and limitations stated therein.
Please Note:
• Per Permit Condition Part 11.7, a copy of the Well Construction Form(s) (GW-1),
which is completed and signed by the well contractor, must be submitted to this
office and the Fayetteville Regional Office within 30 days of completion of the
well(s). Copies of the GW-1 shall be retained on-site and available for inspection.
• Per Permit Condition Part 111.2, within 30 days of injection well completion and
operation, Permittee must contact the Fayetteville Regional Office APS Staff (910-
433-3300) to have influent and effluent samples collected.
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].
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: [phone] I lntemet: http://www.ncwater.org
An Equal Opportuniiy \ Affirmative Action Employer -Made in part by recycled paper
Brenda Bullard
Best Regards, -~ ~.!--
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
Division of Water Resources, NCDENR
Water Quality Regional Operations Section
cc: Belinda Henson & Trent Allen, Fayetteville Regional Office
Central Office File, WI0600153
Robeson County Environmental Health Department
Page 2 of2
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143; and other applicable
Laws,. Rules, and Regulations
.PERMISSION rs HEREBY GRANTED TO
Brenda W. Bullard
FOR THE CONSTRUCTION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER RETURN
WELL(S), defined in Title 15A North Carolina: Administrative Code 02C .0224(a), which will be used for the
injection of heat pump effh1ent. The injection well(s) located at 8630 Shannon Road, Shannon, Robeson
County, NC 28386 will be constructed in accordance with the application submitted May 12, 2015, and
conformity with the specifications and supporting data, all of which are filed with the Department of
Environment and Natural Resources and are considered a part of this permit.
This permit is for construction of an injection well shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until June 30, 2020, and shall be
subject to the specified conditions and limitations set forth in this permit.
Permit issued this the 31st day of July 2015.
·\-41 S. Jay Zimmerman, P.G. \J · Director, Division of Water Resources
By Authority of the Environmental Management Commission.
Permit #WI0600153 UIC/5A7
ver. 04/15/2015
Page 1 of5
PART I -PERMIT GENERAL CONDITIONS
1. The Permittee shall comply with all conditions ofthis permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94
2. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [15A NCAC 02C .021 l(a)].
3. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data [15A NCAC 02C .0211(1)].
4. This permit is not transferable without prior notice and approval. In .the event there is a desire for the
facility to change ownership, or there is a name change of the Permittee, a formal permit amendment
request must be submitted, including any supporting materials as may be appropriate, at least 30 days
prior to the date of the change [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 [15A NCAC 02C .0203].
PART II -WELL CONSTRUCTION GENERAL CONDITIONS
1. The well supplying water for the geothermal heating and cooling system shall be constructed m
accordance with the requirements of rule 15A NCAC 02C .0107 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 [l SA NCAC 02C .0107G)(2)].
Pennit #W l06001 53 UIC/5A7
ver. 04/15 /20 15
Page 2 of5
7. A completed Well Construction Record (Form GW-1) shall be submitted as described in Part VI.5 of this
permit.
PART III -WELL CONSTRUCTION SPECIAL CONDITIONS
I. At least forty-eight ( 48) hours prior to constructing each injection well, the Permittee shall notify the
Underground Injection Control (UIC) Central Office staff, telephone number 919-807-6496 and the
Fayetteville Regional Office Staff, telephone number 910-433-3300. [15A NCAC 02C .021 l(k)].
2. Within 30 days of injection well completion/operation, the Permittee shall contact the Fayetteville
Regional Office Staff in order to have samples collected at the source well and injection we~l. [15A
NCAC 02C .021 l(k)]
PART IV-OPERATION AND USE CONDITIONS
I. The Permittee shall comply with the conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and the rules of 15A NCAC 02C .0200,
even if compliance requires a reduction or elimination of the permitted activity [15A NCAC 02C
.021 l(i)].
2. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface
water or groundwater resulting from the operation of this facility. In the event that the facility fails to
perform satisfactorily, including the creation of nuisance conditions or failure of the injection zone to
adequately assimilate the injected fluid, the Permittee shall take immediate corrective actions that may be
required, such as the repair, modification, or abandonment of the injection facility [15A NCAC 02C
.0206].
PART V -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 samples of the injection facility's activities.
PART VI -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(£)(2), (4)].
Permit #WI0600153 UIC/5A7
ver. 04/15/2015
Page 3 of5
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 monitoring or other information that indicates noncompliance with a
specific permit condition, that a contaminant may cause a violation of applicable groundwater quality
standards, or that a malfunction of the injection system may cause the injected fluids to migrate outside
the approved injection zone or area. As specified in rule 15A NCAC 02C .0211(r), noncompliance
notification shall be as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence, to the Fayetteville Regional Office, telephone number 910-433-3300.
(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(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 Offic_e
Systel Building, 225 Green St., Suite 714
Fayetteville, NC 28301
PART VII-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 VIII-CHANGE OF WELL STATUS [lSA NCAC 02C .0240]
1. Procedures for temporarily or permanently abandoning a well are the same as those specified in rule l SA
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 pennanently abandoned according to
rule ISA NCAC 02C .0113(6) 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.
Pem1it #Wl0600153 UIC/5A7
ver. 04/15/2015
Page 4 of5
4. When injection operations have ceased at the facility and a well will no longer be used for any purpose,
the Permittee shall permanently abandon that injection well in accordance with the procedures specified in
15A NCAC 02C .0113(b), which include, but are not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly· disinfected prior to sealing in accordance with rule 15A
NCAC 02C .0111 (b )(1 )(A),(B), and (C).
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In those cases when a subsurface cavity has been created as a .result of the injection
operations, each well shall be abandoned in such a manner that will prevent the
movement of fluids into or between underground sources of drinking water.
(F) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0224(f)(4) within 30 days of completion of abandonment.
5. The written documentation required in Part VIII (4)(F) shall be submitted to the addresses specified in
Part VI.5 above.
Permit #Wl0600J 53 UJC/5A7
ver. 04/15/2015
Page 5 of5
Rogers, Michael
From: Barber, Jim
Sent:
To:
Monday, July 27, 2015 12:48 PM
Rogers, Michael
Cc: mcribbs0621 @gmail.com
Subject: RE: Bullard "open-loop" geothermal injection well WI0600153
Attachments: WI0600153 Bullard residence injection well.pdf; WI0600153 Bullard cross section Shannon
area .pdf; P7070002.JPG; P7140008.JPG; P7140007.JPG; P7140009.JPG
Michael;
Here's the staff report for the Bullard residence. I've also attached some photos of the site. The driller and homeowner
are going to discuss the installation of a new injection well in conjunction with spraying the HVAC effluent in the
backyard of the residence. They wish to have the injection well as a backup for wet weather.
If you have any questions, please give me a call at 910-433-3340.
Jim Barber
From: Rogers, Michael
Sent: Monday, July 27, 2015 9:38 AM
To: Barber, Jim
Subject: RE: Bullard "open-loop" geothermal injection well WI0600153
That's fine. Thanks.
From: Barber, Jim
Sent: Friday, July 24, 2015 5:27 PM
To: Rogers, Michael
Subject: RE: Bullard "open-loop" geothermal injection well WI0600153
Michael;
Got tied up and sidetracked with a couple of things today. Have most of the staff report complete, just need to put
together final comments and maps . Will scan and email copy to you first thing Monday morning when I get in.
Jim Barber
From: Rogers, Michael
Sent: Friday, July 24, 2015 10:22 AM
To: Barber, Jim
Cc: Henson, Belinda
Subject: RE: Bullard "open-loop" geothermal injection well WI0600153
10-4. Thanks.
From: Barber, Jim
Sent: Friday, July 24, 2015 9:56 AM
To: Rogers, Michael
Cc: Henson, Belinda
Subject: RE: Bullard "open-loop" geothermal injection well WI0600153
Michael;
1
I will hopefully have a staff report for you this afternoon. I was able to meet with the driller last week (after several
weeks of trying to schedule a site meeting) to resolved the issues I had with the supply well and the homeowner is
currently spraying the water on their yard. The driller was going to meet with the homeowner to discuss the cost of
installing another well for injection, hence the need to continue with the permit. The homeowner wants to irrigate with
the effluent and intends to go that route, but wants to have the injection well aspect as a back-up.
Jim
From: Rogers, Michael
Sent: Wednesday, July 22, 2015 5:00 PM
To: Barber, Jim
Subject: FW: Bullard "open-loop" geothermal injection well WI0600153
Jim-
What was the outcome of Mrs. Bullard . I can't remember. The app is still showing in BIMS.
From: Slusser, Thomas
Sent: Monday, June 01, 2015 2:52 PM
To: johnny .strickland @hth.co.robeson.nc.us
Cc: Rogers, Michael; Barber, Jim
Subject: Bullard "open-loop" geothermal injection well
Greetings Johnny,
This email is to confirm that it is permissible to construct and operate a geothermal injection well such that the
heat pump effluent is returned to the well supplying the influent water to the heat pump system. This
configuration of "open-loop" geothermal well systems is more common than those that have a separate well
only used for injecting the heat pump effluent. Both types of" open-loop" geothermal well systems are
described on our website at h ltp :// p ortal.ncdenr.org/web /w q/a p s /g-wp ro /uic#g eotherm and require an
individual permit issued pursuant to 15A NCAC 02C .0224 by the NCDENR Division of Water Resources
(DWR).
Regarding Brenda Bullard' s circumstance, DWR issued a regulatory notice about the permitting requirements
of "open-loop" geothermal well systems with instructions to return to compliance by discontinuing injection
without a permit or to submit an application for a permit to operate the injection well system. DWR received a
permit application on May 12, 2015, and staff from the Fayetteville Regional Office scheduled a site visit for
June 1, 2015.
Please let us know if you have additional questions or need anything else. As always, we appreciate your
efforts and our partnership with the county health departments.
Take care,
-Thomas Slusser, L.G.
Underground Injection Control Program Manager
thonias.slusser@ncdenr.g ov I ph# 919-807-6412 I fax# [phone]
Mailing Address: NCDENR Division of Water Resources I 1636 Mail Service Center I Raleigh, NC 27699-1636.
Physical Address: Room 640M, Archdale Building, 512 N. Salisbury St., Raleigh, NC 27604.
Internet Address: htt :// ortal.ncdenr.or<> web/w /a sf _ w ...IQ
[-rra.'/ correspr:nde.':CE i!J B.fld frtHTJ tlll~r:; Bddress lTJBV le su/lfD! fa ihe /iorth C2roh:-1a P1.1bkr: t?Bcords Lav/ ar,d,rra,v be o\r;:;c,¼7std tn tl11>d pari/Es 1:nlet-s t.hl7 co,1teni ls
exer:1pi by st2tutE ot 2thEr regu,0tiun.
2
PLEASE NOTE: EFFECTIVE JUHE 8. 2015, I WILL Nl1 UlNBER BE WORKING WITH INJECTION WELLS OR THE DIVISION OF WATER
RESOURCES.
PLEASE DIRECT ALL CDRRESP □NDENCE TO MICHAEL.R □[e-mail] □V and [e-mail] □V.
3
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Permit No. W10600153
Bate: 07/21/15 County: Robeson
To: Michael Roomers Permittee/Applicant: Redell and Brenda Bullard
Central Office Reviewer Facility Name: Bullard Residence
I. GENERAL 1AWORMATTON
I. This application is (cheek ail that aWy): X❑ New ❑ Renewal
❑ Minor Modification ❑ Major Modification
a. bate of Inspection: 07/14/2015
b. Person contacted and contact information: Redell Bullard and Mike Cribbs
c. Site visit conducted by; Jim Barber
d. Inspection Report Printed from RIMS attached: ❑ Yes X❑ No.
e. Physical Address of Site including zip code: 8630_Shannon. Road. Shannon NC 28386
f. Driving Directions if rural site and/or no physical address: From the intersection of Hwy 71 and. Shannon
road, drive approx. 2 miles and 8630 is on the left,
g. Latitude; 34.821665 Longitude:-7%121742.isupply well location its backyardi
Source of Lat/Long & accuracy (i.e., Google Earth, GPS, etc.):_Gqogle Earth
II. DESCRIPTION OF INJECTION WELLS AND FACILITY
i , Type of injection system:
X❑ Geothermal Heating/Cooling Water Return
❑ In situ Groundwater Rernediation
❑ Non -Discharge Groundwater Retnediation
❑ Other (Specify:�)
2. For Geothermal Water Return Well(s) only
a. For existing geothermal system:
Were samples collected from IttfiuerttlEffluent sampling ports? ❑ Yes X❑ No.
Provide well construction information from well tag: 0 to 50' casing. 50' to 120' well screen.
h. Does existing or proposed system use same well for water- source and injection? ❑ Yes X0 No
if No, please provide source/supply well construction info (i.e., depth, elate drilled, well contractor,
etc.) and attached neap and sketch locat inn of supply well in relation to injection well and any other
features in Seclrorr IV of this Staff Report.
3 Are there any potential pollution sources that may affect injection? ❑ Yes X❑ No
What Ware the pollution source(s)? Fionie septic_sy stern is spi_axiinalelyl 50' froni the su p ly weIi and the
pro_poscd_injection well .tifconstructedj will be 100' from the septic sIstern,
What is the distance of the injection well(s) from the pollution source(s)?
4. What is the minimutrt distance of proposed injection wells from the property boundary? 1 Q'-from --- t� -- eM
line.
5. Quality of drainage at site: X❑ Guod ❑ Adequate ❑ Poor
Rev. 611 /2015 Page 1

WATER QUALITY REGIONAL OPERATIONS SECTION REjEDWR
APPLICATION REVIEW RE UEST FORM,
Late: May 13, 2015
To: FRO-WQROS: Belinda Henson and Trent Allen
O,}�fdl�QA51 �eCit�rt
Faye eWHO Reglolljll0MGti
From: Michael Rogers, WQROS — Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Afail: [e-mail]
A. Permit Number: WI06001-53
B. Applicant: Brenda Bullard
C. FaciliIN Name;
D. AlMlicatiou:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type. New Project
E. Comments/Other information:
❑ I would like to acconilmny you on a site visit.
Attached, you will find all inforn-atioa submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, ])lease return a Completed WQROS Staff
Report.
When you receive this request forth, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Oiiice Groundwater Protection Branch contact
person listed above.
7 f
RO-vr OROS Reviewer: �� JA--- �� i�����" Date:
COMMENTS:
NOTES_ Please record the well information on well Leg and -put in staff report,
Thanks.
FaitKf. WQKOS-ARIZ ver. 092614 Paec 1 of I

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
6. Flooding potential of site: XO Low D Moderate D High
7. For Groundwater Remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. If No,
attach map of existing monitoring well net\vork 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)? XO Yes D No. If No, or no 111ap, please attach a sketch of the site. Show prope1ty boundaries,
buildings, wells, potential pollution sources, roads, approximate scale, and north arrow. See ma p attached with
staff re port pre pared after visitin g the site.
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.
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? D Yes D No D N/A. If no, please explain: __
III. EVALUATION AND RECOMMENDA110NS
l. Do you forese.e any problems with issuance/renewal of this permit? 0 Yes XO No. If yes, explain. __
2. List any items that you would like WQROS Ce1itral Office to obtain through an additional informatio1i 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:
0 Hold pending receipt and review of additional information by regional office
0 Issue upon receipt of needed additional information
XO Issue
5. Signature of repo1i preparer(s ):
Rev . 6/1/2015 Page2
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Signature of WQROS Regional Supervisor:
Date:
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS ([(Needed)
Initiall y the homeowner intended to discharg e HYAC effluent to the supply well. Do to the inefficienc y of this
practice ; the homeowner in consulting with the driller (Mike Cribbs} intends to irri e.ate the HY AC effluent onto
the v ard of the residence. The homeowner also ,van ts the o ption to in ject the HV AC effluent back into the
ground (aquifer) durin g wet weather and when the bermuda e.rass is dormant (t vp icall y earl y s prin g and late
fa ll), hence the y are proceedin g with the in iection permit
The site is verv sand v, with Wakulla sand being the prin1ary soil t yp e which is fairl y common in Robeson
County . When the HY AC effluent is evenly distributed by several s prinklers, ponding should be g reatl y
reduced or eliminated. Currentl y the HVAC effluent is being discharn.ed thru a line vent in one location that can
cause ponding.
Durin g the site visit on 14 Jul y 2015 the well driller was present to re pair the well. A new bentonite seal was
glaced and the well ta g was re p laced. Well ta g, information for the su p ply well is as follows:
Total De pth: 120'
Casin g De pth:+ I' to -50'
Screen De pth: -50' to -120'
Grout and bentonite: O' to 20' (grout seal had settled after initial construction and a 3' bentonite seal was
installed. A concrete pad will be constructed.
Driller: Mike Cribbs -certification #2654A
New in'ection well (when constructed} will be a p proximatel y 70' to 75' dee p, with screen from 51' to bottom
of well. See revised well detail schematic and geolo g ic cross section for the Shannon area of Robeson County.
Rev. 6/1/2015 Page 3
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 sheers as needed
O ole WdJ Desigg
ffP�6posed MrExisting
❑ Injection, ❑ SnpplY;
❑ Dual Purpose
Record Depths Below
(t .
Lund Surface ou Lines
Provided
r
A
Retum or Supply Line
Casing
�.. - . Grout_- - -
L DETAILS
Casing Material: ��,•
iJ
Casing Diameter (in.)- j
Casing Thickness (in.): ECG
Grout Type:
(Cement, bentoni or mix)
Screen Material:
Screen Slot Size (in-.):
Sand/Gravel Park
Material: _
Open Hole
l3entonite Seal
f f prescn - -
SandlGravelPack
Screen -
Scroeb ed Well Desif n
Proposed ❑ Existing
❑ Injection; ❑ Supply;
❑ Dual Purpose
/l
(FL)
(r
Record Depths Below
Land Surface an Lines
Provided
G
UFL)
(Fr.)
NC Certified Well Driller Name -CA- i
Certification #

C}i ncctGIS
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Tax Card
Map Number too not use Spates):
220602006
Owner Name (Last Name First Name):
BULLARD BRENDA W
Owner Name 2:
Deed Book:
02M
Deed Page:
0161
Owner Address:8630 SHANNON ROAD
Owner State:
NC
Owner Zip:
283860000
Deeded Acres:
12.1
NSHD Code:
22001
Land Value-
18900
Improvement Value_
369200
Phy Street Address-8625
SHANNON RD
Legal Description_ A FOD1E LOCKLEAR
Current Owner 1&
112195000
Owner Id:
11219SOM
Owner Address 2:
PIN:
936839473100
Date Sold:
20080225
District Code:
24
Town Code:
22
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Map Unit Description: Wakulla sand, 0 to 6 percent slopes---Robeson County, North Carolina
Hydro/ogic Soil Group: A
Data Source Information
Soil Survey Area:
SuNey Area Data:
l ISDA Natural Resources
~:iiiii Conservation Service
Robeson County, North Carolina
Version 12, Sep 12, 2014
Web Soil Survey
National Cooperative Soil Survey
6/1/2015
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Veb Soil Survey Page 1 of
MIMII
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�
lMap ;,snit Legend
Robeson County, North Carolina
(NC155)
Map Unit
Map Unit blame
Acres
Percent
Symbol
in AQI
of A01
NvA
Norfolk loamy sand, 0 to
2.0
20.1%
2 percent slopes
WaB
Wagram loamy sand, 0
5.0
51.20/c
to 6 percent slopes
WkB
Wakulla sand, 0 to 6
2.8
28.6%
percent slopes
Totals for Area of Interest
9.7
300.00/a
Soil Map
V
Warning: Sail Map may not be valid at this scale. J
You have zoomed in beyond the state at which the sail ,-slap for this area is intended to be used. Mapping of soils is done at a
particular scale. The soil surveys that comprise your AOI were mapped at 1:20,000. The design of map units and the level of
detail shown in the resulting soil map are dependent on that map scale,
Enlargement of maps beyond the scale of mapping can cause misunderstanding of the detail of mapping and accuracy of sail
line placement. The maps do not show the small areas of contrasting soils that could have been shown at a more detailed
sca le.
FOIA I Accessibility Statement I Privacy Policy I Nan-❑iscriminatlon Statement I Information Quality I USA.gov I White House
tip://websoltsurBey.nres.usda.gov/app/WebSoilSurvey.aspx 6111201

Map Unit Description: Wakulla sand , Oto 6 percent slopes-Robeson County, North Carolina
USDA "iir
Robeson County, North Carolina
WkB-Wakulla sand, O to 6 percent slopes
Natural Resources
Conservation Service
Map Unit Setting
National map unit symbol: 3vg5
Elevation: 80 to 330 feet
Mean annual precipitation : 38 to 55 inches
Mean annual air temperature: 59 to 70 degrees F
Frost-free period: 210 to 265 days
Farmland cfassmcation: Not prime farmland
Map Unit Composition
Wakulla and similar soils: 90 percent
Estimates are based on observations, descriptions, and transects of the
mapunit.
Description of Wakulla
Setting
Landform: Ridges on marine terraces, broad interstream divides on
marine terraces
Landform position (two-dimensional): Shoulder, summit
Landform position (three-dimensional): Crest
Down-slope shape: Convex
Across-slope shape: Convex
Parent material: Sandy and loamy marine deposits and/or eolian
sands
Typical profile
A -O to 7 inches: sand
E -7 to 24 inches: sand
Bt -24 to 42 inches: loamy sand
C -42 to 85 inches: sand
Properties and qualities
Slope: 0 to 6 percent
Depth to restrictive feature : More than 80 inches
Natural drainage class: Somewhat excessively drained
Runoff class: Very low
Capacity of the most limiting layer to transmit water (Ksat): High to
very high (1.98 to 19.98 in/hr)
Depth to water table : More than 80 inches
Frequency of flooding: None
Frequency of ponding: None
Available water storage in profile: Very low (about 2.7 inches)
Interpretive groups
Land capability classification (irrigated): None specified
Land capability classification (nonirrigated): 3s
Web Soil Survey
National Cooperative Soil Survey
6/112015
Page 1 of 2
WATER QUALITY REGIONAL OPERATIONS_SECTION
APPLICATION REVIEW RE BEST FORM MAT 15 Jula
Date: May 1 3, 2015 ftwoft
To: FRG-WQROS: Belinda Henson and Trent Allen
From: Michael Rogers, WQRGS — Animal Feeding Operations and Groundwater Protection Branch
Telephone. [phone] Fax: [phone] F h ail: [e-mail]
A. Permit Number: W10600153
B. Applicant: Brenda Bullard
C. Facility Name:
D. Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type. New Proj ect
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 WORDS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, mare a copy
of this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact
person listed above. �7
RO-WOROS Reviewer: J1--- 1 L 7r/� _ Date:
CUMMENTS:
NOTES_: Please reo6rd the WbIl information on w611 tact dnd`p6t in staff report_
T'hailts: -
FORM: WQRGS-ARR ver. 092614 Page 1 of 1

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Permit No. WI0600153
Date: 07/21/15 County: =R=o=b=es=--=o-=n"----------
To: Michael Ro gers Permittee/Applicant: Redell and Brenda Bullard
Central Office Reviewer Facility Name: Bullard Residence
L GENERAL INFORMATION
1. This application is (check all that apply): XO New D Renewal
D Minor Modification D Major Modification
a. Date oflnspection: 07/14/2015
b. Person contacted and contact information: Redell Bullard and Mike Cribbs
c. Site visit conducted by: Jim Barber
d. Inspection Report Printed from BIMS attached: D Yes XO No.
e. Physical Address of Site including zip code: 8630 Shannon Road, Shannon NC 28386
f. Driving Directions if rural site and/or no physical address: From the intersection of H wy 71 and Shannon
road. drive a pp rox. 2 miles and 8630 is on the left.
g. Latitude: 34.821665 Longitude: -79.121742 (su pp ly welllocationinbacky ard)
Source of Lat/Long & accuracy (i.e., Google Earth, GPS, etc.):--=G~o~o_ul~e~E=a=rt~h _____ _
II. DESCRIPTION OF INJECTION WELL (S ) AND FACILITY
1. Type of injection system:
XO 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 XO No.
Provide well construction information from well tag: 0 to 50' casin g. 50' to 120' well screen.
b. Does existing or proposed system use same well for water source and injection? D Yes XO No
If N.Q, 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 XO No
What is/are the pollution source(s)? Home se ptic sy stem is a pp roximately 150' from the su pply well and the
pro posed in jection well (if constructed) will be 100' from the septic s stem.
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? 10' from back pro perty
line.
5. Quality of drainage at site: XO Good
Rev. 6/1/2015
D Adequate D Poor
Page 1
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
b. Flooding potential of site: X❑ Low ❑ Moderate ❑ 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? ❑ 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)? X❑ 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, Sec malt attached with
staffjeppijpfqpAm!d after visiting the site.
9. For Non -Discharge groundwater remediation systems only:
a, Are the treatment facilities adequate for the type of waste and disposal system? ❑ Yes ❑ No ❑ NIA,
If no, please explain:
b. Are the site conditions (soils, topography, depth to water table, etc.) consistent with what was reported by
the soil scientist and/or Professional Engineer? ❑ Yes ❑ No ❑ NIA. If no, please explain:
III. EVALUATIONAND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes X❑ 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
4. Recommendation
Reason
❑ Deny. If Deny, please state reasons:
❑ Hold pending receipt and review of additional infonnation by regional office
❑ Issue upon receipt of needed additional information
JC❑ Issue it fr J j
5. Signature of report preparer(s): �! 1 �'� I �'�(2-6
Rev: 6/1/2015 Page 2

WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Signature of WQROS Regional Supen+isor:
Date: 7— S
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTSIATTACHMENTS {If Needed
Wtia% the homeowner intended to disebarg-e HVAC effluent to the sLapply well. Do to the inefficiency of this
practice: the homeowner in consulting with the driller (Mike_Cribbs) intends to irrigate the RVAC effluent onto
the vard of the residence. The homeowner also wants the option to infect the HVAC effluent back into the
ground lacluiferLdurin&wet_weather and when the Bermuda grass is dormant �ttipicall�_ear)y.s Ir and late.
fall), hence they are proceedinu with the injection permit.
The site is very- sandy. with Wakulla sand being the primarN soil hype which is fairly common in, Robeson
Count. When the HVAC effluent is evenly, distributed bG several sprinklers.yonding should be vreatl►
reduced or eliminated. Currently the HVAC effluent is being discharged thru a line vent in one location that can
cause raonnding.
During the site visit on 14 ]u15 2015 the wall driller was present to repair the well, A new bentonite seal was
placed and the well tap was Wlaced. Well tag information for the supple well is as follows:
Total Depth: 120'
Casing Depth: +F to -50'
Screen Depth: -50' to -120'
Grout and bentonite- 0' to 20' >igrout seal had settled after initial construction and a_3'_hentonite_seal was
installed. A concrete dad will be constructed.
Driller: Mike Cribbs — certification 92654A
New injection well_lwhen canstructedl will be a roximately 70'. to 75' deep. with screen from 51' to bottom
of well. See revised well detail schematic and geologic cross section for the Shannon area of Robeson Count,—
Rev. 6/1/2015 Page 3

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6
+ Owner Name {Last Name First Name):
MOM NNum�ber (Do not use Spaces) ` `� ' f BULLARD BRENDA W
PIH �...___._ 5 • � a , Owner Name 2:
+. ti Deed Book: 02008
u �` ■ +_. • e' Deed Page: 0161
Owner Name {Las! Name First t S •.' r ' '{ `� t ` Owner Address: 8630 SHANNON ROAD
fName� ! h 3 . + ' owner State: NC
} - _ __ `+ �] • Owner Zip: 283860000
Owner Address fr ' „ Deeded Acres: 12.1
•�
�' ••1 • ^ NBHD Code- 22001
sy 'lra� Land Value: 18900
• F - tiy� �1' : _ + .► '! improvement Value: 369200
i \ + Phy Street Address:8625 SHANNON RD
1` . • _ •.� •. r�� 4 •'� Legal Description: A FODiF LOCKLEAR
.S' '-� . r e �• �" Current Owner Id: 112195000
Owner Id: 112195000
Owner Address 2:
PIN: 936839473300
Date Sold: 20080225
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District Cade: 24
Town Code: 22
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ttp:llwww.gis.co.rbeson.nc.us/ConnectGIS_v6/Map.aspx?p=Robeson 611I241 `_

GEGTSERMAL HEATINGICOOLING WELL CONSTRUCTION DETAIL
Choose applicable Injection Well design and check the appropriate bares. Fi11 m depths and detads of weH construction on
the blank Imes provided Use additional sheets as needed
Opga=Hole MLeR Design
;posed ITExisting
❑ Injection; ❑ SuppIy;
❑ Dual Purpose
Record Depths lselow
Land Surface on Uses
Provided r
ONE'
(Ft)
PA= or Supply line —
Casing
Scrjwned Well Design
Proposed Q Existing
❑ Injection; ❑ SupPIY
❑ Dual Purpose
WELL DETAILS
Casing Material:
i�
Casing Diameter (in.):
Casing Thickness (in.):
Grout Type:
(ce uentl i entonit or mix)
Screen Material:.
Screen Slat Size. ( -):
SandlGravelPack
Material:
Open Hole
Ja
(FL)
Record Depths Relaw
i.aad SufacG on L•ioes
Provided
e-
Bentonite Seal
Sand/Gravel Pack
Screen -
.7 ,
- � � N _Certification 4t
NC Certified Well Driller Name _ � —

Veb Soil Survey I+I Page l of l
SIX
Dontact Us Subscribe E, , Archived Soil Surveys Soil Survey Status Glossary Preferences Link Logout Help A A A
Area of Interest AQI Soil Map Soil Data Explorer Download Soils Data Shopping Cart (Free)
Printable versionj . Add to Shopping can
Search
Map Unit Legend
Robeson County, forth Carolina (NC155)
Map Unit Map unit Name
Acres
Percent
symbol
in AOI
of Ani
NoA Norfolk loamy sand, 0 to
2.0
20.1%
2 percent slopes
Wa6 Wagram loamy sand, 0
5.0
51.2%
to 6 percent slopes
WkS Wakulla sand, 0 to 6
2.8
28.6%
percent slopes
Totals for Area of Interest
9.7
100.0%
Soil Ma
K N d MA J J 0 A J scale {not to scale} v
ri a)
J Warning: Soil Map may not be valid at this scale. J
You have zoomed in beyond the scale at which the soil map for this area is intended to be used. Mapping of soils is done at a
particular scale. The soil surveys that comprise your A0I were mapped at 1:20,000. The design of map units and the level of
detail shown in the resulting soil map are dependent on that map scale.
Enlarggement of maps beyond the scale of mapping Gan cause misunderstanding of the detail of mapping and accuracy of soil
line p3acement. The maps do not show the small areas of contrasting soils that could have been shown at a more detailed
scale.
FOIA I Accessibility Statement I Privacy Policy I Non-discrimination Statement I Information Quality I t1SA.gov I White House
ttp://websoilsu;vey.nres.usda.gov/app/WebSoilSurvey.aspx 6/1/201

Map Unit Description: Wakulla sand, Oto 6 percent slopes--Robeson County , North Carolina
Robeson County, North Carolina
WkB-Wakulla sand, 0 to 6 percent slopes
USDA Natural Resources
'"'rifi Conservation Service
Map Unit Setting
National map unit symbol: 3vg5
Elevation: 80 to 330 feet
Mean annual precipitation: 38 to 55 inches
Mean annual air temperature: 59 to 70 degrees F
Frost-free period: 210 to 265 days
Farmland classification: Not prime farmland
Map Unit Composition
Wakulla and similar soils: 90 percent
Estimates are based on observations, descriptions, and transects of the
mapunit.
Description of Wakulla
Setting
Landform: Ridges on marine terraces, broad interstream divides on
marine terraces
Landform position (two-dimensional): Shoulder, summit
Landform position (three-dimensional): Crest
Down-slope shape: Convex
Across-slope shape: Convex
Parent material: Sandy and loamy marine deposits and/or eolian
sands
Typical profile
A -0 to 7 inches: sand
E - 7 to 24 inches: sand
Bt -24 to 42 inches: loamy sand
C -42 to 85 inches: sand
Properties and qualities
Slope: 0 to 6 percent
Depth to restrictive feature: More than 80 inches
Natural drainage class: Somewhat excessively drained
Runoff class: Very low
Capacity of the mostlimiting layer to transmit water (Ksat): High to
very high (1.98 to 19.98 in/hr)
Depth to water table: More than 80 inches
Frequency of flooding: None
Frequency of ponding: None
Available water storage in profile: Very low (about 2.7 inches)
Interpretive groups
Land capability classification (irrigated): None specified
Land capability classification (nonirrigated): 3s
Web Soil Survey
National Cooperative Soil Survey
6/1/2015
Page 1 of 2
Map Unit Description: Wakulla sand, o to 6 percent slopes--Robeson County, North Carolina
Hydrologic Soil Group: A
Data Source Information
Soil Survey Area:
Survey Area Data:
USDA Natural Resources -= Conservation Service
Robeson County, North Carolina
Version 12, Sep 12, 2014
Web Soil Survey
National Cooperative Soil Survey
6/1/2015
Page 2 of 2
tire discharge line to injection well with valve for sprinklers
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shown on plate 14
1-2
HCDEHR
North Carolina Department of Environment and Natural Resources
Pat McCrary
Governor
May 13, 2015
13renda Bullard
8630 Shannon Road
Shannon. NC 28386
RE: Acknowledgement of Application No. W106001531
Geothermal Heating/Cooling Water Return Well
Robeson County
Dear Ms, Bullard:
Donald R. van der Vaart
Secretary
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit application and supporting documentation received on May 12. 2015. Your application
package has been assigned the number listed above, and the primary reviewer is Michael Rogers.
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 after receipt of a complete application. 1f you have any questions, please contact
Michael Rogers at [phone] or [e-mail].
Sincerely,
Debra I. Watts, Supervisor
Animal Feeding Operations & Groundwater
Protection Branch
Division of Water Resources
cc: Fayetteville Regional Office, WQROS
Permit File WI06001531
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phane: 919M7-64641 Internet: http:llwww.mcwater,org
An Equal Opportunity 1 Arfirmallve hctian Employer - Made in pan by racyr led paper

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW RE QUEST FORM
Date: May 13. 2015
To: FRO-WQROS: Belinda Henson and Trent Allen
From: Michael Rogers, WQROS -Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
A. Permit Number: WI0600153
B. Applicant: Brenda Bullard
C. Facilitv Name:
D. Application:
Permit Type: Geothermal Heatin,g/Cooling Water Return Well
Project Type: New Project
E. Comments/Other Information:
D I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a com pleted W OROS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact
person listed above.
RO-W OROSReviewer: __________________ Date: _____ _
COMMENTS:
NOTES: Please record the well information on well tag and put in staff re port.
Thanks.
FORM: WQROS-ARR ver. 092614 Page 1 of 1
NORTH CAROLINA DEPARIWfENT OF ENVIRONMENT AND NAnIRAL RESOURCES
APPLICATION FOR A PERAUr TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0224
GEOTHERMAL BEATINGICOOLING W.
WELLS
These wells inject g(oundwater directly into the subsurface as part of a geothermal heating and cooling system
(check one) -4 New Application Renewal* Modification
*. For renewals complete Parts A-D and L the signature page.
Print or Type Irrformadon and Mail to the Address on the Last Page. Illegible Applications Will He Returned As Incomplete.
DATE: 20
PERMIT NO. (leave blank if New Application}
watarQualay Re lotliii
A_ STATUS OF APPLICANT (choose one) ()WratMn� S9C ,Q!►
Non-Government7 Individual Residence BusineWOrganization
Government: State MuLd6pal County Federal
B. WELL OWNERIPERMIT APPLICANT — For individual residences, list owner(s) on property deed. For all
others, list name of entity and name of person delegated authority to sign on behalf of the business or agency: _
Mailing Address: 'Z (Q
City: State_ CAC -,Zip Code a�Covtnty:
Day Tele No.: _ Cell No.:
f ►�1T�iTN.T1,f rZ,
C. WELL OPERATOR (if different from well owner) -- For individual residences, list owner(s) on property
deed For all others, list name of entity and name of person delegated authority to sign on behalf of the
business or agency -
Mailing Address:
City:
State:
Zip Code:
Day Tele No_: Cell No.:
EMAIL Address:
County:
D. LOCATION OF WELL SITE -- Where the injection wells are physically located—
(1) Parcel Identification Number (PIN) of well site:J _ County:
(2) Physical Address (if different than mailing address):
City: sk w w►_ y d'�
State: NC Zip Code:
GPUARC 5A7 Permit Application (Revised 5/23/2014) Page 1

to �7-ezz,_ /`
F_
F.
WELL DRILLER INFORMATION
WeE Drilling Contractor's Name: bv ' +f!
NC Well Drilling Contractor Certification No_:
Company Name:
Contact Person: EMAIL Address:
Address: F
City.
Office Tele No.:
Zip Code:
Cell No.:
State: County:
Fax No..
HVAC -CONTRACTOR INFORMATION (if different Haan. driller}
HVAC Contractor's Name: D ► ry 11 C
NC HVAC Contractor License No.:
Company
ContactPerson: �.__��•_EMAIL Address:
Address:
City: :Zip Code: �. State County: f1 cYl�
Office Teie No.: 9lta - 1 ]210 CeIl No_: IJ 6 -12- - IM Z Fax No.:
Q WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES NO
(2) Personal consumption? YES NO
H. WELL CONSTRUCTION REQUIREMENTS —As specified in 15A NCAC 02C _02244di:
(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 Iength of casing shall be grouted from the top
of the gravel pack to land mvface;
(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 SA7 Permit Application (Revised 5123/2014) Page 2

L WELL CONSTRUCTION SPECIFICATIONS
( I) Specify the number and type of wells to be used for the geothermal heating/cooling system:
/ *EXISTING WELLS I 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.lcoo1ing 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 req:uirements 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" ab.ove land :surface
-.. --(e) -Grout mate:rial(s) surrounding casing and depth below ~il~~ac~ -
· Note: bentonite grouts are prohibited/or sealing water-bearing zones with 1500
mg/L chloride or greater p'er 15A NCAC 02C .0107(0(8)
(f) Length of well screen or open borehole and depth below land surface
(g) Length of sand or gravel packing around well screen and depth below land surface
J. OPERATING DATA
(1)
(2)
(3)
(4)
Injection Rate:
Injection Volume:
Injection Pressure:
Injection Temperature:
Average ( daily) 9:? tJ Lgallons per minute (gpm).
Average (daily)ji:J4 6 gallons per day (gpd).
Average (daily).;/ opS 1p~unds/square inch (psi).
Average (Janruey) ts ° F, Average (July)tl_ ° F.
K. SITE MAP -As specified in 15A NCAC 02C .0224(b)( 4 ), attach a site-specific map that is scaled or otherwise
accurately indicates distances and orientations of the specified features from the injection well(s). The site map
shall include the following:
(1) All water supply wells, surface water bodies, and septic systems including drainfield, waste
application area, and repair area located within 250 feet of the iaj~cfio!_! _w~JJ.f~ ). __ .. _ .. _ _ _ _ _
(2) Any other potential sources of contamination11sted in 15A NCA.C 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. Tire location of t/1e wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can tl,en be drawn in by /rand. Also, a 'layer' can be selected slrowing topographic contours or
elevation data.
GPU/UIC 5A7 Permit Application (Revised 5/23/2014) Page3
L. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .O21 l(e ) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership-or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a mllilicipality 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).
H an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abam;lon the
injection well and all ·related appurtenances in accordance with the approved specifications and conditions of
the Permit." / _ w
~--s•r. ature ofProp;rty wner/A;plicant
/jye,,yyt/4-, i(S ~110~
Print or Type Full Name
Signature of Property Owner/Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
Underground Injection Control Program
NC Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/UIC 5A7 Penrtit Application (Revised 5/23/2014) Page.4
GEOTHERMAL HEATING/COOLING WELL CONSTRUCTION DETAIL
Choose applicable Injection Well design and check the appropriate boxes- pill in depths and details of well construction on
the blank lines provided Use additional sheets as needed
O e Hale Well Desi n Screened Well Design
2-Proposed El Existing 0 Proposed ❑ Existing
❑ Injection; ❑ SupplY; ❑ Injection; ❑ supply,
[] Dual purpose ❑ Dual Purpose
Record Depths Below
Land Sw fam an Lines
Provided
M
7 — (FQ'
(Ft)
Return or Supply Line
Casing
WELL D
ETAILS
Casing Material I -
Casing Diameter (in.): Z=+
, 0
Casing Thickness (in.): G
Grout Type:
(cement; b�ni� or mix)
Screen Material:
Screen Slat Size (UL):
Sand/GravelPack
Material:
Open Hole
(FL)
Record Depths Below
Land Surbee on Lines
Provided
Bentonite Seal -- (FL)
-
(Ft-)
(FI-)
Sand/Gravel Pack
Screen
NC Certified Well Drifter Name Certification #

`�u,MP'�����_
- - — -- ��.s��
__
r_.-
-�

NCDENR
North Carolina Department of Environment and Natural Resources
Pai McCrory
Governor
April 28, 2015
Brenda Bullard
8630 Shannon Road
Shannon, NC 28336
Ref: Permit Required to Inject Heat Pump Effluent
Notice of Deficiency # NOD-2015-OP-00115
Dear Ms. Bullard:
Donald R, van der Vaail
Secretary
CERTIFIED MAIL -RETURN RECEIPT RECQESTEQ.
Tracking 1d.# 7012-3450-0003-5794-4067
Thank you for speaking with me today regarding your geothermal heating/cooling system, I understand
from our conversation that your geothermal heating/cooling system has been modified such that the
water coming out of the system, known as effluent, is no longer discharged to the land surface but now
travels through a pipe back to the well. As discussed, this type of operation requires an injection well
permit issued by the North Carolina Division of Water Resources.
Operating an injection well without a permit is a violation of rule 15A NCAC 02C .0211 of the NC Well
Construction Standards. Dne of the following actions is required to comply with this requirement:
1. Disconnect the pipe discharging geothermal heating/cooling system effluent to the well, or
Obtain a permit to lawfully discharge geothermal heating/cooling system effluent to the
welt. A permit application is attached in case you choose this option.
You are required to take one of these actions within 30 days of the date of this letter. If you choose
option #1, then supporting documentation or a site visit by staff is required for verification. If you
choose option ##2, then submit the attached permit application to the address on the form.
Failure to comply with this request within the specified time or an approved alternate deadline may
result in enforcement action including the assessment of civil penalties of up to $1,000 per day as
provided for in G.S. 87-94 of the NC Well Construction Act,
1636 Mail Service Cen?er, Raleigh, North Carolina 27699-1636
Phone' 919-807-6464 l Internet httP 1Awm.ncwater.org
An Equal Opporto ily i Affirmative Acison Employer — Wde in part by recycled paper

..
Brenda Bullard
NOD-2015-OP-O00S
April 28, 2015
Page 2 of 2.
If you have any questions you can call our Water Quality Regional Operations staff in the Fayetteville
Regional Office at ph# 910-433-3300, you can call me at ph# 919-807-6412, or you can send email to me
at [e-mail].
Best Regards,
~~J~.
Thomas Slusser, LG.
Underground Injection Control Program Manager
Division of Water Resources
Attachment: Geothermal Heating/Cooling Water Return Wells permit application
cc: Belinda Henson -WQROS Fayetteville Regional Office (without attachment)
Johnny Strickland -Robeson County Health Dept. (without attachment)
Postal
CERTIFIED MAIL�, RECEIPT
—0
-(Domestic Mail Only;
n
4100 15-
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Postage
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Certified Fee
Astum ROa Glpr Fea
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Total Postage & Fees
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■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front ff space permits.
1. Article Addressed by
�r.er+do_ 8 u I/a rd
$630'S�anr?on P8.
S�Lahn an , 'VC zj� 3,96
J,
A. ure
❑ Agent
Addressee
B. by ( it Name) CZ
fary
D. Is delivery address different from KwVy 13
If YES, enter delivery address below; ❑ No
3. Service Type
0 GaMed Mail ❑ Exptsss Mail
❑ Registered ❑ Return Recelpt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Deliver)? (Extra Fee) ❑ Yes
2. Article Number
(r=sW from service laba!)
Ps Form 3811, February 2004 Domestic Return Recelpt 102595-02-10-1540

FEET
700
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126 Bladenboro
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71 YVL+ I Id
CL 8
AWL+ 12
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L + 109
600
500
400
300
200
100
SEA LEVEL
Bills]
-200 `
-300