WI0700176_GEO THERMAL_20200514

ROY COOPER
Governor
MICHAELS. REGAN
Secretary
S. DANIEL SMITH
Director
Thomas & Lana Brunk
1002 Coopers Ct.
Trent Woods, NC 28562
NORTH CAROLINA
Environmental Quallty
May 14, 2020
Re: Issuance of Injection Well Permit
PermitNo.WI0700176
Geothermal Beating/Cooling Water Return Well
Craven County
Dear Mr. and Mrs. Brunk:
In accordance with your permit renewal application received April 27, 2020, I am forwarding Permit
No. WI0700176 for the continued operation of geothermal heating/cooling water return well(s) located
at the above referenced address. Please note that this renewed permit shall become effective on May
14, 2020 until April 30, 2025, 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 will
be collected at a later date when the DWR laboratory resumes normal operations.
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
W atei Quality Regional Operations Section
North Carollna Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street I 1636 Mall Service Center I Raleigh, North Carolina 27699cJ636
919.707.9000
...
cc: David May -Randy Sipe· Regional Office
Central Office File, WI0700176
Craven County Environmental Health Department
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Thomas & Lana Brunk
Craven County
FOR THE CONTINUED OPERATION OF TWO (2) 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 pUDlp effluent. This injection well is located at 1002 Coopers Ct., Trent woods, NC 28562,
and will be constructed and operated in accordance with the application received April 27, 2020, and conformity
with the specifications and supporting data, all of which are filed with the Department of Environmental Quality.
This pemrit 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 pemrit shall be effective, unless revoked, from May 14, 2020, until April 30, 2025, and shall be subject to
the specified conditions and limitations stated therein. . ,
Permit issued this the IA th day of May, 2020.
(";DocuSlgned by.
~!2!!~1 ...
For S. Daniel Smith
Director, Division of Water Resources
Permit WI0700176
By Authority of the Environmental Management Commission.
Pennit#WI0700176 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
Page 1 of5
PART I -PERMIT GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is grounds
for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit 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 .0224(b)].
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 .021 l(e)].
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 [15A NCAC 02C .021 l(o)].
5. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met [15A NCAC 02C .0203].
PART II -WELL CONSTRUCTION GENERAL CONDITIONS
1. The well supplying water for the geothermal heating and cooling system shall be constructed in accordance
with requirements of rule 15A NCAC 02C .0107.
2. Any injection well shall be constructed in accordance with 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
ifbentonite is to be used [15A NCAC 02C .0225(h)(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 [15A
NCAC 02C .0107(j)(2)].
Permit#WI0700176 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
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 Ill'-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 .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 including those actions
that may be required, such as the repair, modification, or abandonment of the injection facility [15A NCAC
02C .0206].
PART IV -INSPECTIONS [ISA NCAC 02C .021 l(j)]
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, ot 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(p), 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 Washington Regional Office, telephone number 252-946-6481.
Permit#WI0700176 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
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.
(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 Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
PART VI-PERMIT RENEW AL [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 .0113(b) in order to prevent the well from deteriorating and acting as a source or conduit
of contamination, which is prohibited by General Statute 87-88(c).
3. If a well is taken completely out of service temporarily, the Permittee shall install a water-tight cap or well
seal that cannot be removed without the use of hand or power tools. ·
4. When injection operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall 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 ensure freedom from
obstructions that may interfere with sealing operations.
Permit #WI0700176 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
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(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.
(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 to the addresses specified
in Part V -~ above.
Permit#WI0700176 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
Page 5 ofS
RECEIVO
y Carolina Department of Environmental Quality — Division of Water Resources
AP
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELL(S)
K pEp�p1A1R
offloo In Accordance With the Provisions of 15A NCAC 02C .41224
GEOTHERMAL HEATINGICOOLIlYG WATER RETURN WELLS}
These well(s) inject groundwater directly into the subsurface as part of a geothermal beating and cooling system
CHECK ONE OF THE FOLLOWING:
New Application Renewal* Modification Permit Rescission Request's
;For Permit Renewals or Rescission Request, complete Sections_A thru E. and M (signature page) only
Print or Type Information and Mail to the Ad&ess on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: 2-1 , 20 Z 0 PERMIT N01A/a70V f 7� (leave blank if New Application)
M
B.
CURRENT WELL USE & OWNERSHIP STATUS (Leave Blank if New Well/Permit Application)
1. Current Use of Well /
a. I wish to continue to use the well as 216"cothermal Well ❑ Drinking Water Supply Well
❑ Other Water Supply Use- Indicate use (i.e., irrigation, etc.)
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 (G W-30).
❑ Yes,1 wish to rescind the permit
2. Current Ownership Status
Has there been a change of ownership since permit last issued? ❑ YES [ CIO
If yes, indicate New Owner's contact information:
Name(s)
Mailing Address.
City: _ State:
Day Tele No.: _
_Zip Code: _
Email Ac
County:
STATUS OF APPLICANT (choose one)
Non -Government: Individual Residence Business/Organization
Government: State Municipal County Federal
C. WELL OWNER(S)IPERMIT APPLICANT - For single family residences, list all persons listed on the
property deed. For all others, list name of business/agency and name of person and title with delegated authority
to sign:
Mailing Address: 106 2- Cod'xRS C 1
City: 1 R E NT w v dDS�
Day Tele No.:
State: NC- Zip Code: z Sr IXz Counnty<R4 flew
Cell No.:2s`2- `7/Y-o1S9
EMAIL Address: (,8 li3 VA( k465VA RA1Wn11V- i ►JI 7-Fax No.:
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 1

D. WELL OPERATOR (if different from well owner) -For single family residences, list all persons listed on
the property deed. For all others, list name business/agency and name of person and title with delegated authority
to sign: ____________________________ _
Mailing Address: _______________________________ _
City: ____________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: ----------------=E~m.,,a=il'---"A=d=dr=es=s,_,_.: ___________ _
E. PHYSICAL LOCATION OF WELL(S) SITE
(I) Parcel Identification Number (PIN) of well site: B' -2'>3 -/-00 2-County: C fill f/ 8. N
(2) Physical Address (if different than mailing address): ________________ _
City: _____________ County _________ Zip Code: ____ _
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name: _________________________ _
NC Well Drilling Contractor Certification No.: ____________________ _
Company Name: _______________________________ _
Contact Person . .a..: _______________ .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 . .a..: _______________ 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 ):
(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 I SA NCAC 02C .0 I 07 , except that:
Geothermal Water Return Well Permit Application Rev. 4-15-2016 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;
(h) 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 Comtruction Record (Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
beating/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:
fovfip
� pR 6Z, Im
C' ow
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
(c) Casing depth below land surface
Casing height "stickup" above land surface
Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited far sealing water -bearing zones with 1500
mg1L chloride or greater per 1 jA _Nc_'r1C U2C 0
Length of well screen or open borehole and depth below land surface
Length of sand or gravel packing around well screen and depth below land surface
K. OPERATING DATA
(1) Injection Rate:
(2) Injection Volume:
(3) Injection Pressure:
(4) Injection Temperature:
Average (daily) Tallons per minute (gpm).
Average (daily) gallons per day (gpd).
Average (daily) pounds/square inch (psi).
Average (January) ° F, Average (July) ° F.
L. SITE MAP — As specified in 15A NCAC 02C 02F4{1A4), 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 E iA NC_ 02C _(.)1 f ]7t a il? + 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 Rev. 4-15-2416 Page 3

it ", v1%
b,�R
In most cases an aerial photograph of the property parcel showing property lines and structures can be
Pefreed and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then be drawn in by hand. Also, a 'layer' can be selected showing topographic contours orekevalion
data
M. CER11'ICATION (to be signed as required below or by that person's authorized agent)
1 SA NCAC 02C ,021l 1Isi� requires that ail 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 Verson(a) listed on the propeM 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 behaIff
"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, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of the
Permit."
fr�� � �i-t•s:�.
Signature of Property Owner/Applicant
��v r aM 5 kt��l
�Zd Print or Type Full Name and Title
A �
" Slignatu • of Property C]ti oerlApplicant
LEA r/4�
Print or Type Full Name and Title
Signature of Authorized Agent, if any
Print or Type Full Name and Title
Submit two copies of the completed application package to:
Division of Water Resources - UIC
Water Quality Regional Operations Section[ (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 4

ROY COOPER
Governor
MICHAELS. REGAN
Secretary
S. DANIEL SMITH NORTH CAROLINA
Environmental Quality Director
April 30, 2020
Thomas & Lana Brunk
1002 Coopers Ct.
Trent Woods, NC 28562
RE: Acknowledgement of Application No. WI0700176
Geothermal Heating/Cooling Water Return Well
Craven County
Dear Mr. & Mrs. Brunk:
The Water Quality Regional Operations Section (WQROS) acknowledges receipt
of your permit application and supporting documentation received on April 27, 2020. Your
application package has been assigned the number listed above, and the primary reviewer
is Shristi Shrestha
Central and Washington Regional Office staff will perform a detailed review of the
provided application, and may contact you with a request for additional information. To
ensure maximum efficiency in processing permit applications, the Water Quality Regional
Operations Section (WQROS) requests your assistance in providing a timely and complete
response to any additional information requests.
Please note that processing standard review permit applications may take as long
as 60 to 90 days after receipt of a complete application. If you have any questions, please
contact Shristi Shrestha at 919-707-3662 or email at [e-mail].
cc: Washington Regional Office, WQROS
Permit File WI0700176
Sincerely,
For Rick Bolich, Chief
Ground Water Resources Section,
NCDEQ Division of Water Resources
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street I 163b Mail Service Center I Raleigh, North Carolina 27699-1636
919.707.9000
0
• ,'
AW&R
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
April 22, 2016
Thomas and Lana Brunk
1002 Coopers Court
Trent Woods, North Carolina 28552
SUBJECT: Groundwater Sampling Results
UlC Permit No- W10700176
Issued to Thomas and Lana Brunk
Trent Woods, Craven County, North Carolina
Dear Mr_ and Mrs. Brunk:
Donald R. van der Vaart
Secretary
On March 25, 2015, staff from the Washington Regional Office of the Water Quality Regional
Operations Section collected samples of the influent (supply well) and effluent (injection well) from your
geothermal heat pump system. The samples were analyzed for metals, nutrients, and other inorganic
constituents by the Division of Water Resources laboratory. A summary table of the analytical results, as
well as the laboratory reports, field sampling forms, and definitions of laboratory data qualifiers are attached
to this letter. The following two constituents were detected above state groundwater standards in both
samples from your system:
Parameter Units NC Groundwater Results
l J Standard
Iron uglL 300 i 550 (supply well -influent)
570 (injection welkegliu t
PH Standard Units 6.5 to 8.5 6.0 (supply well -influent)
6,009je} ction well -effluent)
The exact source of these exceedances is unknown; however, Iron and pH exceedances in
groundwater are often due to naturally occurring conditions- These exceedances should not affect the
operation of your geothermal heat pump system; however, it is recommended before using the water from
these wells for personal consumption that you consult with the Craven County Environmental Health
Department. If you have any questions regarding the sampling results or your permit, please feel free to
contact me at [phone].
Sincerely,
P L
Dwight Randy Sipe, P.G.,�v�o,dreologist
Water Quality Regional Operations Section
Division of Water Resources. NCDENR
AttachymeisRELEIVED1DENRrn� p
cc: chael Rogers - DWR Groundwater Protection Unit, Central office
Craven County Environmental Health Department
fi,•
WaRq
1.nW1 9` OUS"T'- .
Division of Water Resources - Water quality Regional Operations Section - Wash riglon Regional Qfte -
943 Washington Square Mall, Washington, NC 27889
Phone: [phone] Fax: [phone] &Internet wmv.ncdenr.gov
An Equal Oppork nil } Affirmative Action Empioyar — Made in parl by racyrfad paper

ROY COOPER
G,911er7Jr)r
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
April 16, 2020
CERTIFIED MAIL # 7009 2250 0000 8057 1580
RETURN RECEIPT REQUESTED
Thomas & Lana Brunk
1002 Coopers Ct.
Trent Woods, NC 28562
Subject: Notice of Expiration (NOE)
Geothermal Water Retum/Open-Loop Injection Well
Permit No. W10700176
Craven County
Dear Mr. & Mrs. Brunk:
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (D WR) 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 April 8, 2015, and expires on May 31, 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 eingUUsed for Injection:
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit the enclosed renewal
application (Application for a Permit to Construct or Operate Injection Wells -- Geothermal
Heating/Cooling Water Return Wells). The form is also available on-line at our website
http:llportal .nodenr. orglweb/wglaps/gwprolpermit-applications.
If Your Geothermal Water Return Well is NO LONGER Being Used for Inject tion_
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
according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C,
�,� tq NurthCaralina arparnr�ent Uf Er,vitnnmental eZ�salRy f7rvESlnn at Watrr kess�urtes
�I St,7 ?4orth Saus" street J Ib36 Mai Service Centrr Ral60. North Caro Ima 27ih9"636

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 Ownershin of the Proyeirty:
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.shrestha'ti ncdenr.Lov_
Regards,
pPlia
Sbristi Shrestha
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: Washington- Regional Office — WQROS w/o enclosures
Central Files - Permit No. W10700176 w/o enclosures

Permit Number WI0800176
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System �50W)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
i=acilif,
Facility Name
Matthew Radack SFR
Location Address
6910 Finian ❑r
Wilmington
NC 28409
Owner
Owner !Name
Matthew Radack
Dates[Events
Scheduled
Orig Issue App Received Draft initiated Issuance
11 /19/09 11 /16/09
Regulated Activities
Heat Pump Injection
Private residence, single family
❑utfall NULL
Central Files! AP5 5WP
11/19/09
Permit Tracking Slip
Status
Project 'type
Active
New Project
Version
Permit Classification
I.00
Individual
Permit Contact Affiliation
Matthew Radack
Owner
6910 Finian Dr
Wilmington
NC 28409
Major]Minor Region
Minor Wilmington
County
New Hanover
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Matthew Radack
Owner
6910 Finian Dr
Wilmington
Public, Notice Issue
11 / 19/09
NC 28409
Effective Expiration
11/19/09
Waterbody Name Stream Index Number Current Class Subbasin

NA
NCDENR
North Carolin a Departmen t of Environment and Natura l Resources
Division of Wa ter Quali ty
Beverly Eaves Perdue
Governor
Matthew Radack
6910 Finian Dt.
Wilmington, NC 28409
Coleen H. Sullins
Director
11/19/2009
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No . WI0800176
6910 Finian Dr.
Wilmington, NC 28409
Dear Mr. Radack:
Dee Freeman
Secretary
In accordance with the application submitted to the Underground Injection Control (UIC) Program that was received on
11/16/2009, the Aquifer Protection Section (APS) acknowledges your intent to construct a closed-loop geothermal water-
only injection well system for the operation of a ground-source heat pump located at 6910 Finian Drive, Wilmington,
New Hanover County, NC 28409. This system is deemed permitted by rule (North Carolina Administrative Code Title
15A, Subchapter 2C, Section .02ll(u)(2)). ,
However, it is recommended that you contact the New Hanover County Health Department, as they may have additional
construction or permitting requirements for this type of system. If you modify your system at any time, including the
addition of antifreeze, corrosion inhibitors, or any other substances to the circulating fluid, you must contact the APS to
verify compliance with applicable rules .
Thank you for submitting this notification. If you have any questions please call me at [phone].
3'lm' ~
for Micha~ogers
Environmental Specialist
GPU-Aquifer Protection Section
cc: Wilmington Regional Office -APS
APS Central Files -Permit No. WI0800176
New Hanover County Health Dept.
Jim Cornette (Applied Resource Management, P.C., P.O. Box 882, Hampstead, NC 28443)
Chris James (Taylors Heating & Air, P.O. Box 826 , Carolina Beach, NC 28428)
AQUIFER PROTECTION SECT!ON
1636 Mai! Service Center. Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Ra leigh . North Carolina 27604
Phone: [phone] I FAX 1: 919-715-0588; FAX 2: 919 -715-6048 \ Customer Service: 1-877-623-6748
Internet: www.ncwate rau ali rv .o ro
An Equal Opportunity i Affirmativs Action Emoloyer
;.pnehC . hort arolma
/vatura/~lf
i,JjOgbO 19 6
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL
WATER -ONLY INJECTION WELL SYSTEM:
TYPE 5—QW WELLS)
In Accordance with the provisions ofNCAC Title 1 SA: 02C.0200, please
complete this notification and mail to address on the back page (please Print or Tyne in€ormation)..
DATE: November 12, 2009
Well Type Confirmation: Does the proposed system circulate potable water onIN (no additives) in
continuous piping that completely isolates the fluid from the environment (i.e.
closed -loom?
Yes X Continue completing this form.
No Do Not complete this form. Complete other UIC application farms for installing
either a 5A7 well (Wen -loop well infecting potable water into the aquifer) or a 6QM well (closed -
loop well containing additives such as R-22, ethanol, or other antifireeze or corrosion inhibitors).
A. PROPERTY OWNER(S)IAPPLICANT(S)
List each Property Owner listed on property deed (if awned by a business or government agency, state name of
entity and a representative wlauthority for signature): Matthew Radack
(1) Mailing Address: 6910 Finian Drive
City: Wilmington State: NC Zip Code: 28409 County: New Hanover
Home/Office Tele No.: 910-793-9236 Cell No..
Email Address_ Website:
(2) Physical Address of Well Site (if different than above):
City: State: Zip Code: County:
Home/Office Tele No.: Cell No.:
IL AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAIL Address. -
Address:
City: State: Zip Code: County --
Office Tele No.: Cell No.:
Website Address of Company, if any: RECEIVED 10ENR J OAQ
*Tde Protecoort secli-orl
GPUIUIC 5QW Notification of Intent Farm (Revised 912008) NOV 16 2009 page.l

C. WELL DRILLER INFORMATION
Company Name: A pp lied Resource Management. P.C.
Well Driller Contractor's Name: """'H='-'. M=ic=h=a=el'""'S=ag=e ________________ _
NC Contractor Certification No.: -----=2-=-5=-3 =-1-""'A=----------------------
Contact Person~: ~J•=·m~C~o=rn=e~tt=e __________ =E=-MA=I=L~A~d=d=r~es=s~: -=J=im=....cA~RM=®=·=b=el=ls=o-=u=th=.n=e=t __
Address: P.O. Box 882
City: Hampstead Zip Code: 28443 County: ___ P~e=nd~e~r ________ _
Office Tele No.: 910-270-2919 Cell No.: 910-512-4890
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: ___ T~a-y_lo~r~s ~H~e=at=in=g ........ &~A~ir ____________________ _
Contact Person: Chris James EMAIL Address: --------------------------------
Address: ----=-P"'"'.O""'.-=B""'o=x"""'8=2=6'--------------------------
City: Carolina Beach Zip Code: 28428 County: ---=N~e~w~H=an=o-=-v~e=r ______ _
Office Tele No.: 910-458-5732
E. STATUS OF APPLICANT
Private: _X~
State:
Federal:
Municipal: __
Cell No.: -----------
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Closed loo p geothermal s stem. Water onl v. grouted alon g the loop 's entirety
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: _ _,cl~l-'/2=3"""'/2~0-=0.c..9 ____ Number of borings: __ 5 ___ _
Approximate depth of each boring (feet): 200'
(2) Type of tubing to be used (copper, PVC, etc): __ H_D_P_E ______ _
(3) Well casing. Is the well(s) cased? (check either (a.) Yes or (b.) No below)
(a) Yes ___ if yes, then provide casing information below
Type: _galvanized steel __ black steel_plastic __ other (specify)
Casing depth: From ____ to ___ feet (reference to land surface)
Casing extends to above ground ___ inches
(b) No X
(4) Grout Info (material surrounding well casing and/or piping):
(a)
(b)
(c)
Grout type: Neat Cement __ Bentonite Other (specify) _ __..c.T=he=rm=e=x __
Grout placement: Pumping__ Pressure ____x_ Other
Grout depth of tubing (reference to land surface): from O to 200 (feet)
If well has casing, indicate grout depth: from ___ to ____ (feet)
GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page2
H. INJECTION -RELATED EQi.1lPMEN'T
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
I. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(1) Include a Site Map (can be drawn) showing: buildings, property lines, surface water bodies, potential
sources of groundwater contamination and the orientation of and distances between the proposed well(s) and
any existing well(s) or waste disposal facilities such as septic tanks or drain fields Iocated within 200 feet of
the geothermal heat pump well system. Label all features clearly and include a north arrow,
(2) The Site Map must show the subject property in relation to the surrounding area by using at least two fixed
reference points such as roads, streams, and/or highway intersections.
CERTIFICATION
Note. This Permit Application must be signed by each person appearing on the
recorded legal property deed.
"1 hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and complete.
I am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with ft;e approved_ specif cati s a onditions of the Permit."
t 1
Signature of Property Owner/Applicant
Print or Type Full Name and title
Signature of Property Owner/Applicant
Print or Type Full Name and title
Signature of Authorized Agent, if any
Print or Type Full Name and title
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section-UIC Program RECEI'VE5 I DENR t YM
1636 Mail Service Center'}ife,rOfaclte�t ?e4lIOtT
Raleigh, NC 27699-1636 NOV 10 �Qd�
Telephone [phone]
GPU/IJIC 5QW Notification of Intent Form (Revised 8/2008) Page 3

i
4 _ Finian Drive
i -
> 20
2 von
4
i
k
N
Approximate Property Lines
Approximate Building Perimeter
Approximate Closed Loop Locations
Notes:
1. Subject property and surrounding area are serviced by public sewer and water services.
2. Well locations are approximate and will be a minimum of 20' ❑part and 25' from the building,
I Adapted from Google Earth and New Hanover County GIS Map, November 2009.
TITLE: SITE MAP FIGURE;
lied Resource Manaaement PC 6910 F I N IAN DRIVE
7kL(PO. Bax mpstead, 4 JGB: SCALE; DATE: DRAWN BY;
910) 270-2919 FAX [phone] Radack As Shown 1 1 /10/09 DNH

i
--,W.-r.-
Finian Drive
lejj ► F
4 P
• rr
iV
Approximate Property Lines
Approximate Building Perimeter
Approximate Closed Loop Locations
Notes:
1. Subject property and surrounding area are serviced by public sewer and water services.
2. Well locations are approximate and will be a minimum of 20' apart and 25' from the building.
3. Adapted from Google Earth and New Hanover County GIS Map, November 2009.
TITLE: SITE MAP FIGURE:
lied l2e5ource Mana ement PC; 6910 FINIAN DRIVE
ox ampstead, N 4 JOB: SCALE: DATE: DRAWN BY:
7kt910) 270-2919 FAX [phone] R❑dack As Shown 1 1 /1 0/09 DNH

L
691 0 Finion Drive ►
Sr
V
/ { M
1
11
-r t
a
� a
Property Location
N
Notes:
1. Subject property and surrounding area are serviced by public sewer and water services.
2. Well locations are approximate and will be a minimum of 20' apart and 25' from the building.
3. Adapted from Google Earth and New Hanover County GIS Map, November 2009.
TITLE, SITE VICINITY MAP FIGURE;
vIied rKecource Manaoement PC
Box W2, Hampstead, NC 28440JOB: SCALE: DATE: IDRAWN BY;
[phone] FAX [phone] Radack As Shown 1 1110109 DNH 2

Parameter Fecal Coliform
units CFU/100ml
NC MCL and/or EPA Standard NC MCL=<1
Influent Sample Results < 1
Effluent Sample Results < 1
Parameter Nitrate+ Nitrite
units mg/Las N
NC MCL and/or EPA Standard NC MCL = 11
EPAPDWS= 11
Influent Sample Results <0 .1
Effluent Sample Results <0.1
Parameter Chromium, Cr
units µg/L
NC MCL and/or EPA Standard NCMCL=10
EPA PDWS = 100
Influent Sample Results <10
Effluent Sample Results <10
Parameter Sodium, Na
units mg/L
NC MCL and/or EPA Standard NS
Influent Sample Results 12
Effluent Sample Results 12
NC DIVISION OF WATER RESOURCES
LABORATORY ANALYTICAL RESULTS
GEOTHERMAL UNDERGROUND INJECTION CONTROL (UIC) WELL
PERMIT NO .: Wl0700176
PERMITTEE(S): Thomas and Lana Brunk
SAMPLE COLLECTION DATE: 3/25/2015
Total Coliform Total Dissolved Solids Chloride, Cl
CFU/100ml mg/L mg/L
NC MCL= 1 NC MCL= 500 NCMCL=250
EPA SOWS= 500 EPA SOWS= 250
< 1 310 9.6
< 1 316 9.8
Hardness as CaC03
Nitrite (by Calculation) * Aluminum, Al
mg/Las N mg/L as CaC03 µg/L
NC MCL = 1 NS NS
EPAPOWS = 1 EPA SOWS= 50 to 200
< 0.01 283 .3 <50
< 0 .01 283 .3 <50
Copper, Cu Iron, Fe Potassium, K
µg/L µg/L mg/L
NC MCL= 1000 NC MCL= 300 NS
EPA SOWS= 1000; POWS = 1300 EPA SOWS = 300
17 550 1.0
20 570 1.1
Nickel, Ni Lead, Pb Zinc, Zn
µg/L µg/L µg/L
NC MCL= 100 NC MCL = 15 NC MCL = 1000
EPAPDWS= 15 EPA SOWS::: 5000
<2.0 <2.0 17
2 .1 <2 .0 18
Fluoride, FL
mg/L
NC MCL=2
EPA POWS = 4.0
<0 .4
<0.4
Arsenic, As
µg/L
NC MCL= 10
EPA POWS= 10
<2 .0
<2.0
Magnesium, Mg
mg/L
NS
2 .1
2 .1
pH (field)
units
NC MCL = 6.5-8 .5
EPA SOWS= 6.5 to 8.5
6.0
6 .0
NC MCL = North Carol ina Ma ximum Contami nati on Li mits per 15A NCAC 2L .0200
EPA PDWS = Environmenta l Protection Agency Primary Drin ki ng Water Sta ndards
EPA SO WS= Environme ntal Protecti on Ag ency Secondary Drin king Water Standa rds
NS = No Standa rd
• Cal culation performed by WaRO
Sulfate, S04
mg/L
NC MCL = 250
EPA SOWS= 250
29
29
Calcium, Ca
mg/L
NS
110
110
Manganese, Mn
µg/L
NC MCL= 50
EPA SOWS =50
26
27
.5c (jo��
North Carolina
AQUIFER PROTECTION FIELDSHEET Department orEnvironmentand Natural Resources
DIVISION OF WATER RES0URCES�AQIJ707,PROTECT I0N SECTi0N
Location code S X07 O 0 176 _ SAMPLE TYPE SAMPLE PRIO}?TY 7 7County e A v & � Water M-Rw lne ! Lab Number AMR z
Quad No Serial No. ❑ soil ❑ Emergency h� Bate Received PU Atf Time: 3�
Lat. Long. ❑ Other Rec'd By: rn[ Fmm:Bus, Courier, F3and DeL,
El Chain of Custody Other- �� "
Report To: ARC, FRO, MRO, RRO, 459D, W iP O, Data Entry By- Ck'
WSRO, Kinston FO, Fed. Trust, Central Off., Other: Date Reported:_-__
Shipped by: Bus, !:�[and Del_ Other: Purpose_
Coll=o*):9a� D A 115 Time Biaseline, Complaint, r I' LUST, Pesticide Study, Federal Trust, Other:_
FIELD ANALYSES OwnerT4s_i+! �t+l
pH ao4 Spec. Cond.y4 at 250C Location or Site to 6 0 6 D e7 K E k- L - C
Temp.,� °C Odor A0M a Description of sampling $airtt
Appearance f EC Sampling Method Ls VRII Sample Interval A _`
Field AnalysisBy— K Remarks E►Ry'7kWWI;,�—
i.ABORATORY ANALY5F4 ("no bum, w>ww•. etc.)
HOD 310 mgli.
COD HiSIT 340 ME&
COD Low 335 mg/L
Caldorm: MF Fecal 31616 1100131
Coliform: MF Total 31504 Il00rtsl
TOC 680 MWL
Turbidity 76 NTU
114siduy Tntal Suspended 530' mglL
pH 403 uarita
Ailcaliniry to pH 4.5 410 mSIL
Alkalinity re PH 8:3 415 Mel -
Carbon - 5 mg/i.
D�40 mg/L
Cart7a wq*ide 4055 " meL
Chlorida94o mglL
Chro+niom.;ac 1032 ug/L
Color: True 80 CU
Cyanide 720 ntg1L
Lab Comments
Disc. Solids 70300 mg/L
Fluoride 951 mg/L
Hardness: Tawl 900 mg/1.
Hardness (noncarb) 902 mg/L
Phenols32730 ug/1
speeerlc Cond. 95 {tmhf sfm
Sulfatc 945 mg/L.
Sai5dc745 rngjL
Oil and Grease mg/l,
Mfi, as N 610 ntg/L
TKN as N 625 rng/i.
NOx+ NOr as N 630 mg/L
P: Total as P 665 mg/L.
Nitrate (NO,as N) 620 xr g
Nitrite (NO, w N) 615 mg1L,
GW-54 REV W013 For Vi5soived Analysis -submit lillered sample and writs' 01S" in biotic.
Ag-Si hoer 46%6
AI -Aluminum 46557 a
AyArwnic 46551 4LL
Da-Dariutn 46558 u
Ca -Calcium 46352 M
EL
Cd-Cadmium 46559 u LIL
Cr-Chromium 46559 UWL
Cu-Copper 46562 u L
Fe-lron 46563 u
H04%mvq 71900
K=Potassium 46555 m
Mg -Magnesium 46554 ra/L
Mn-Manganemc 46565gp
Na-Sodium 46556 to
M-Niclxl
Pb-Lead 46564 u
Sc-Salenium u n-
ZrrZirte 46567 a
Qr_ gam ^_chlorine Pcsticides
Orgaaapho�a-vs Pes[icidPes[icidas
TQitra�enPesticidw. _ —_ T
Acid Hubicides
PCIBS '
5emivolatle
TPH.Diesel'
TPFL-Gasoline Ringo J
LPH-BTEX Gm i -A Ranee jl
LAB USE ONLY
Temperature on arrival M!

AC17922 :NC (J)W<l( Water Sciences Section-Cfiemistry La6oratorv <Rgsu{ts
County: CRAVEN Sample ID: AC17922
River Basin )W ll • PO Number# 15G009B
Report To WARO ~~ Date Received: 03/26/2015
Collector: RSIPE
Time Received: 08:00
Region: ~ Division of Water Resources
Labworks LoginlD MSWIFT
Sample Matrix: GROUNDWATER
Final Report Date: 4/15/15
Loe. Type: WATER SUPPLY Final ReQort Report Print Date: 04/15/2015
Emergency Yes/No VisitlD
COC Yes/No
Loe. Descr.: THOMAS BRUNK ; 1002 COOPER COURT TRENT WOODS , NC
I Location ID: WI0700176 / Collect Date: 03/25/2015 ] Collect Time: 09:15 / Sample Depth I
If this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
CAS# Anal yt e Name PQL ResulV Units Method Analysis Validated by
Qualifier Reference Date
LAB
Sample temperature at receipt by lab 2.9 ·c 3/26/15 MSWIFT
MIC
Coliform, MF Fecal in liquid 1 1 B2, Q1 CFU/100ml APHA9222D-20th 3/26/15 ESTAFFORD1
Coliform, MF Total in liquid 1 1 B2, Q1 CFU/100ml APHA9222B-20th 3/26/15 ESTAFFORD1
WET
Ion Chromatography TITLE_ mg/L EPA 300.0 rev2 .1 4/2/15 CGREEN -
Fluoride 0.4 0.4U mg/L EPA 300.0 rev2 .1 4/2/15 CGREEN
Chloride 1.0 9.6 mg/L EPA 300.0 rev2 .1 4/2/15 CGREEN
Bromide 0.4 0.4U mg/L EPA 300.0 rev2 .1 4/2/15 CGREEN
Sulfate 2.0 29 mg/L EPA 300.0 rev2 .1 4/2/15 CGREEN
Total Dissolved Solids in liquid 12 310 mg/L SM 2540 C-1997 3/31/15 CGREEN
NUT
NO2+NO3 as N in liquid 0.02 0.10 U,P mg/Las N EPA 353.2 REV 2 3/27/15 CGREEN
Nitrate as N in liquid 0.02 0.10 U mg/Las N EPA 353.2 REV 2 3/30/15 CGREEN
Nitrite as N in liquid 0.01 0.01 U mg/Las N EPA 353 .2 REV 2 3/26/15 CGREEN
MET
7429-90-5 Al by ICP 50 50 U ug/L EPA 200.7 4/9/15 ESTAFFORD1
7440-38-2 As by ICPMS 2.0 2.0 U ug/L EPA200.8 4/9/15 ESTAFFORD1
7440-70-2 Ca by ICP 0 .10 110 mg/L EPA200 .7 4/8/15 ESTAFFORD1
7440-47-3 Cr by ICPMS 10 10 U ug/L EPA200.8 4/9/15 ESTAFFORD1
7440-50-8 Cu by ICPMS 2.0 17 ug/L EPA200.8 4/9/15 ESTAFFORD1
7439-89-6 Fe by ICP 50 550 ug/L EPA200.7 4/9/15 ESTAFFORD1
7440-09-7 K by ICP 0.10 1.0 mg/L EPA200.7 4/8/15 ESTAFFORD1
7439-95-4 Mg by ICP 0.10 2.1 mg/L EPA200.7 4/8/15 ESTAFFORD1
7439-96-5 Mn by ICP 10 26 ug/L EPA200.7 4/9/15 ESTAFFORD1
7440-23-5 Na by ICP 0.10 12 mg/L EPA200.7 4/8/15 ESTAFFORD1
7440-02-0 Ni by ICPMS 2.0 2.0 U ug/L EPA200.8 4/9/15 ESTAFFORD1
7439-92-1 Pb by ICPMS 2.0 2.0 U ug/L EPA200.8 4/9/15 ESTAFFORD1
7440-66-6 Zn by ICPMS 10 17 ug/L EPA200.8 4/9/15 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed description of the aualifier codes refer to <htto ://oortal.ncdenr.ondweb/wa/oos/methods-and-Dals>
Page 1 of 2
NC (J)W<J( La6oratory Section CR.§suJts
Location ID: WI0700176 Sample ID: AC17922 Collect Date: 03/25/2015 Collect Time:: 09 :15
MET
GAS# Anal yt e Name PQL Result!
Qualifier
Sample Comments
NUT: N03N02-P-used sample dilution due to matrix interference.
MET:Cu-J2, estimated-LFM recovery <°?0% due ti matrix interference.
Units Method
Reference
RECEIVED/DEN RID WR
APR 2 4 lC15
Water Qu,,,·r.
Operat;L;qf } l ~·
Analysis
Date
WSS Chemistry laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed descriotion of the oualifier codes refer to <htto://oortal.ncdenr.ore:/web/wa/ovs/methods-and-oals>
Page 2 of 2
Validated by
J�� CK2� � �
AQUIFER PROTECTION FIELDSHEET
Location code J7 0 7 00j—
County AVE
Quad No Serial No. _
Lat. Lang.
SAMPLE TYPE
[Water
0 Soil
❑ Other
❑ Chain of Custody
Report To: ARO, FRO, MRO, RRO, V 1>la 5')WiRO, IL—
WSRO, Kinston FO, Fed. Trust, Central Oft., Other -,--
Shipped by: Bus, Hand Del., Other:
Collectors}: i a E: Date
FIELD ANALYSES —
PH 400 6 Spec. Cond.94 at 256C
Temp.i0 —OC Odor_ _ A
Appearance _
Field Agalysis By:- jl ? _
LABORATORY ANALYSES
BOD 310 mgli
COD High 340 mg/L
COD Low 335 MUL
CofiFonn MF Fecal31616 /Mini
C0lira m: MY Total 31304 Moroi
TQC 680 mg/L.
Turbidity 76 NTTJ
Residue. Total Suspeaded 536- MR/L
pH 403 unify
Alkaiinrcy to pH 4.5 410 mSIL
Alkalinity to pH 8 3 415 w9fL
Carbonate 445 malt,
Bicarbonate 440 mg/i.
Carbon dioxtde405 rnj/L
_
chlonde 940 mg/L,
Chromitnrt: Hex 1032 ur/t.
Color Trite 90 CU
Cyanide 720 mSti
Lab Comments
Pu
TimeS `
0,1
Owner i
Location or 5il
D"cription of
Sampling Melt
Dim Solids 79300 mglf.
Fluoride 951 TWL
Hardness- Tmaf 900 mg1.
Hardness (non-rarb)902 mglL
Phenals 31,730 ugA
Spcciric Cond. 93 liNthoalk un
Sulfate 945 mal[..
Sulfide 745 f mg/L
Oil and Gnme -91L.
NH, as N 620 +ne1L
TXN as N 625 rogti
NGa + NOs as N 639 mall,
P: Total as P 665 tna/L
Nimte [NOS as N) 620 m g/L
Nitrite (NQx as>) 615 mg/L
GW-54 REV V2013 Fur Dissolved Ana' ysis-submil filtered satnple and write "DIS" to Wock.
SAMPLE PRIOFUTY
Routine
❑ Emergency
ine,
North Caralina
Department of Fnviromnent and natural Resources
DIVISION OF WATER RESOURCES -AQUIFER PROTECTION SECTION
Lab Number X C I � _
Date Received aJ3Trine.
Rec'd By. From:Bus, Courier; Hand Del.,
Other: J s
Data Entry By_ Ck
Date Reported:
LUST- Pesticide Study, Federal Trus4 Other. T
( one)
or.W e
A
Ag•SiNer 46566 0
Ai -Aluminum 46557 uwt-
As -Arsenic 46551 u, L
Ba-Barium 46559 u
01
Ca -Calcium 46552 m
Cd-Cadmium 46559 agiL
Cr-Civamium 46559 0
Qj-Co u 46562 u
Fe -Iron 46563 u
Ht-Mercury 71900 u
K-Potmiun+ 46555 m WL
Mg-Magncstum 44554 mgq,
Ma-Manganem 46565 OL
Na-Sodium 46556 m
M-Nicker u
Pb-[.cad 46564 u
Selenium u L
ZwZine46567 u L
Sample Interval __ _ t.� _
9 tlrne, air ramp.. aim
OrgzanOMMitn Pesticides
Orgaimphosphorrus Pesticides
Nips n Pestiades T
Acid Herbicides
PCBs
Temperature on arrival ('C;]:

AC17923 ,fie 0TOX �i�1later'Sciences Section-Chemist
La6oratvey �esuCis
County:
CRAVEN
sample ID:
AC17923
River Basin
PO Number 9
15GO099
Report To
WARD
Date Received:
DWR
03/2612015
Time Received:
00:00
Collector:
R 5lPE
Labworks LoginlD
MSWIFT
Region:
WARD
Divlston of Water Resources
Report Date:
4115115
Sample Matrix'
GROUNDWATER
Report
Final Repo1't Report Print Date:
0411512Q15
Loc. Type:
WATER SUPPLY
Emergency YeslNo
Visitlo
COG YeslNo
Lac, Descr.: THOMAS BRUNT{ 1002 COOPER COURT TRENT WOODS. NC
Location ID:
W10700176
Collect Date: 0312512015 Collect Time: D9:30
Sample Depth
If this report is labeled preliminary report, the results have not been validated Do not use for Regulatory purposes.
Result) Method Analysis Vlidated b�
CAS # Anals to Name POL Qualifier Units Reference Date
LAB
Sample temperature at receipt by lab 2.9 °C 3128115 MSWIFT
LlLo
Coliform, MF Fecal in liquid
1
1132, Q1
CFUI140rn1
APHA9222D-20th
3126/15
ESTAFFORDI
Coliform. MF Total in liquid
1
1 B2, Q1
CFU1100m1
APHA9222B-20th
3/26115
ESTAFFORD1
WET
Ion Chromatography
_TITLE_
Mwl-
EPA 300,0 rev2.1
412115
CGREEN
Fluoride
0A
0A U
mg/L
EPA 300.0 rev2.1
412i15
CGREEN
Chloride
1.0
9.8
mg1L
EPA 300.0 rev21
412115
CGREEN
Bromide
0A
0.4 U
mglL
EPA 300.0 rev2.1
412M5
CGREEN
Sulfate
2.0
29
r69/L
EPA 300.0 rev2.1
412115
CGREEN
Total Dissolved Solids in liquid
12
316
mg/L
SM 2540 C-1997
3131115
CGREEN
NUT
NO2+NO3 as N in liquid 0.02 0.10 U,P mg/L as N EPA 353.2 REV 2 3127M5 CGREEN
Nitrate as N in liquid 0.02 0.10 U mg/L as N EPA 353.2 REV 2 3130115 CGREEN
Nitrite as N in liquid 0.01 0,01 Ll mg/L as N EPA 353.2 REV 2 3/26115 CGREEN
MET
7429-90-5
Al by ICP
50
50 U
ug/L
EPA 200.7
4NI15
ESTAFFORDI
7440-38-2
As by ICPMS
2.0
2.0 U
ug1L
EPA 200.8
419115
ESTAFFOR01
7440-70-2
Ca by ICP
0.10
410
mg/L
EPA200.7
418115
ESTAFFORDI
7440-47-3
Cr by ICPMS
10
10 u
ug1L
EPA 200.E
419115
ESTAFFORD1
7440-50-B
Cu by ICPMS
2.0
20
ug1L
EPA 200.8
V9115
ESTAFFORDI
7439-69•6
Fe by ICP
50
570
uglL
EPA 200.7
419115
ESTAFFORDI
744M9-7
K by ICP
0.10
1.1
mg/L
EPA 200.7
41U1-5
ESTAFFORD1
7439-95-4
Mg by ICP
0.10
2.1
mglL
EPA 200.7
418115
ESTAFFORDI
7439-96-5
Mn by ICP
10
27
ug/L
EPA 200.7
419115
ESTAFFORD1
7440-23-5
Na by ICP
0.10
12
mglL
EPA 200.7
418115
ESTAFFORDI
7440-02-0
Ni by ICPMS
2.0
2.1
ug1L
EPA200.8
419115
ESTAFFORDI
7439-92-1
Pb by ICPMS
2.0
2.0 U
u91L
EPA 200.8
419715
ESTAFFORDI
7440-66-6
Zn by ICPMS
10
18
ug1L
EPA 200.8
419115
ESTAFFORD1
W$5 Chemistry Laboratory>> 1623 Mail Service Center, Raleigh, NC 27599-1623 (919) 733.390E
Fo r a 0 ataidod des rij*of)of the Qualifiermd.sTarstd<htt D://i)ortal.nedenr.org/weblwo/o-os/methods-and-t)als>
Page 1 of 2

:NC <D'vf,,\1( La6oratory Section (J?gsu[ts
Location ID: WI0700176 Sample ID: AC17923 Collect Date : 03/25/2015 Collect Time:: 09:30
MET
CAS# Anal yte Name PQL Result/
Qualifier Units Method
Reference
Analysis
Date
Sample Comments
NUT: N03N02-P-used sample dilution due to matrix interference.
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed description of the oualifier codes referto <http:/ /oortal.ncdenr.org/web/wa/ oos/methods-and-oa ls>
Page 2 of 2
Validated by
, S y mbol
A
B
BB
C
G
J
Definition
Value reported is the mean (average) of two or more determinations. This code is to be used if the results of two or more discrete
and separate samples are averaged. These samples shall have been processed and analyzed independently (e.g., field duplicates,
different dilutions of the same sample). This code is not required for BOD or colifmm reporting since averaging multiple
dilutions for these parameters is fundamental to those methods.
Results based upon colony counts outside the acceptable range and should be used with caution. This code applies to
microbiological tests and specifically to membrane filter (MF) colony counts. It is to be used if less than I 00% sample was
analyzed and the colony count is generated from a plate in which the number of colonies exceeds the ideal ranges indicated by
the method. These ideal ranges are defined in the method as:
Fecal coliform or Enterococcus bacteria: 20-60 colonies Total coliform bacteria: 20-80 colonies
I. Countable membranes with less than 20 colonies. Reported value is estimated or is a total of the counts on all filters
reported per I 00 ml.
2. Counts from all filters were zero. The value reported is based on the number of colonies per JOO ml that would have
been reported if there had been one colony on the filter representing the largest filtration volume (reported as a less
than"<" value).
3. Countable membranes with more than 60 or 80 colonies. The value repo1ted is calculated using the count from the
smallest volume filtered and reported as a greater than ">" value.
4. 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 per JOO ml.
5. Too many colonies were present; too numerous to count (1NTC). TNTC is generally defined as > 150 colonies. The
numeric value represents the maximum number of counts typically accepted on a filter membrane (60 for fecal or
enterococcus and 80 for total), multiplied by JOO and then divided by the smallest filtration volume analyzed. This
number is reported as a greater than value.
6. Estimated Value. Blank contamination evident.
7. Many non-coliform or non-enterococcus colonies or interfering non-coliform or non-enterococcus growth present. In
this competitive situation, the reported value may under-represent actual density.
Note: A "B" value shall be accompanied by justification for its use denoted by the numbers listed above (e.g., Bl, B2, etc.).
Note: A "J2" should be used for spikin g failures.
This code applies to most probable number (MPN) microbiological tests.
1. No weJJs or tubes gave a positive reaction. Value based upon the appropriate MPN Index and reported as a Jess than
"<'' value.
2. AU wells or tubes gave positive reactions. Value based upon the MPN Index and reported as a greater than ">" value.
Note: A "BB" value shall be accom panied by justification for its use denoted by the numbers listed above (e.g., BBi, BB2, etc.).
Total residual chlorine was present in sample upon receipt in the laboratory; value is estimated. Generally applies to cyanide,
phenol, NH3, TKN, colifonn, and organics.
A single quality control failure occurred during biochemical oxygen demand (BOD) analysis. The sample results should be used
with caution.
I. The dissolved oxygen (DO) depletion of the dilution water blank exceeded 0.2 mg/L.
2. 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 least 1.0 mg/L.
3. 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.
4. Evidence of toxicity was present. This is generally characterized by a significant increase in the BOD value as the
sample concentration decreases. The reported value is calculated from the highest dilution representing the maximum
loading potential and should be considered an estimated value.
5. The glucose/ glutamic acid standard exceeded the range of 198 ± 30.5 mg/L.
6. The calculated seed correction exceeded the range of0.6 to 1.0 mg/L.
7. Less than 1 mg/L DO remained for all dilutions set. The reported value is an estimated greater than value and is
calculated for the dilution using the least amount of sample.
8. Oxygen usage is less than 2 mg/L for all dilutions set. The reported value is an estimated Jess than value and is
calculated for the dilution using the most amount of sample.
9. The DO depletion of the dilution water blank produced a negative value.
Note: A "G" value shall be accom panied by j ustification for its use denoted b y the numbers listed above (e.g.., GI, G2, etc.).
Estimated value; value may not be accurate. This code is to be used in the following instances:
I. Surrogate recovery limits have been exceeded.
2. The reported value failed to meet the established quality control criteria for either precision or accuracy.
3. The sample matrix interfered with the ability to make any accurate dete1mination.
4. The data is questionable because of improper laboratory or field protocols (e.g., composite sample was collected
instead of grab, plastic instead of glass container, etc.) .
. 5. Temperature limits exceeded (samples frozen or >6°C) during transport or not verifiable (e.g., no temperature blank
orovided ): non-re portable for NPDES com pliance monitoring.
J 6. The laboratory analysis was from an unpreserved or improperly chemically preserved sample. The data may not be \
accurate. "' ·
7. This qualifier is used to identify analyte concentration exceeding the upper calibration range of the analytical
instrument/method . The rep01ted value should be considered estimated .
8 . Temperature limits exceeded (samples frozen or >6°C) during storage, the data may not be accurate.
9 . The reported value is determined by a one-point estimation rather than against a regression equation. The estimated
concentration is less than the laboratory practical quantitation limit and greater than the laboratory method detection
limit.
10. Unidentified peak; estimated value.
11. The rep01ted value is determined by a one-point estimation rather than against a regression equation. The estimated
concentration is less than the laboratory practical quantitation limit and greater than the instrument noise level. This
c ode is used when an MDL has not been established for the analyte in question.
12. The calibration verification did not meet the calibration acceptance criterion for field parameters .
Note: A "J" value shall be accompanied by justification for its use denoted by the numbers listed above (e .g., JI, J2, etc.). A "J"
value shall not be used if another code a pp lies (e.g., N, V M ).
M Sample and duplicate results are "out of control". The sample is non-homogenous (e.g., VOA soil). The reported value is the
lower value of du p licate anal yses of a sample.
N Presumptive evidence of presence of material; estimated value. This code is to be used if:
I. The component has been tentatively identified based on mass spectral library search .
2. There is an indication that the analyte is present, but quality control requirements for confirmation were not met (i.e.,
presence ofanalyte was not confinned by alternate procedures).
3. This code shall be used if the level is too low to permit accurate quantification, but the estimated concentration is less
than the laboratory practical quantitation limit and greater than the laboratory method detection limit. This code is not
routinely used/or most analyses.
4. This code shall be used if the level is too low to pennit accurate quantification, but the estimated concentration is less
than the laboratory practical quantitation limit and greater than the instrument noise level. This code is used when an
MDL has not been established for the analyte in question.
5. The component has been tentatively identified based on a retention time standard.
Q Holding time exceeded . These codes shall be used if the value is derived from a sample that was received, prepared and /or
analyzed after the approved holding time restrictions for sample preparation and analysis . The value does not meet NPDES
requirements.
l. Holding time exceeded prior to receipt by lab .
2. Holding time exceeded following receipt by lab.
p Elevated PQL* due to matrix interference and/or sample dilution .
s Not enough sample provided to prepare and/or analyze a method-required matrix spike (MS) and /or matrix spike duplicate
(MSD).
u Indicates that the analyte was analyzed for but not detected above the reported practical quantitation limit*. The number value
re ported with the "U" qualifier is equal to the laboratory 's practical quantitation limit*.
X Sample not analyzed for this constituent. This code is to be used if:
1. Sample not screened for this compound.
2. Sampled, but analysis lost or not perfonned-field error.
3. Sampled, but analysis lost or not perfonned-lab error.
Note: an "X" value shall . be accomoanied bv iustification for its use b v the numbers listed.
V Indicates the analyte was detected in both the sample and the associated method blank. Note : The value in the blank shall not be
subtracted from the associated samples.
y Elevated PQL * due to insufficient sample size.
z The sample analysis/results are not reported due to:
I. Inability to analyze the sample.
2. Questions concerning data reliability.
The presence or absence of the anal yte cannot be verified .
*PQL The Practica_l Quantitation Limit (PQL) is defined and proposed as "the lowest level achievable among laboratories within
specified limits during routine laboratory operation". The PQL is about three to five times the calculated Method Detection Limit
(MDL) and represents a practical and routinely achievable detection limit with a relatively good ce1tainty that any repo1ied value
is reliable"
3/10/2011
Permit Number WI0700176
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SWRule
Permitted Flow
Facility
Facility ll!ame
Thomas· and· Lana Brunk SFR
Location Address
1002 Coopers Ct
Trent Woods
Owner
Owner Name
Thomas F
Dates/Events
NC
Orig Issue
6/3/2010
App Received
2/20/2015
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
28562
Brunk
Draft Initiated
Scheduled
Issuance
Central Files: APS SWP
4/2/2015
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
Thomas F. Brunk
Owner
1002 Coopers Ct
Trent Woods
Region
Washington
County
Craven
NC 28562
Public Notice Issue Effective Expiration
Requested /Received Events
RO staff report requested
RO staff report received
Streamlndex Number Current Class
3/2/15
4/1/15
Subbasin
AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Thomas and Lana Brunk
1002 Coopers Ct.
Trent Woods, NC 28562
Re: Issuance of Injection Well Permit
Permit No. WI0700176
April 8, 2015
Geothermal Heating/Cooling Water Return Well
Craven County
Dear Mr. and Mrs. Brunk:
Donald R. van der Vaart
Secretary
In accordance with your permit renewal application request received February 20, 2015, I am
forwarding Permit No. WI0700176 for the continued operation of geothermal heating/cooling water
return well( s) located at the above referenced address. Please note that this renewed permit shall
become effective on June· 1, 2015, (i.e., the day after the expiration date of the existing permit), which
may differ from the date of this letter. This permit shall be effective from June 1, 2015, until May 31,
2020, and shall be subject to the conditions and limitations stated therein.
Please Note: The Washington Regional Office collected samples from your geothermal well
system on March 25, 2015. Laboratory analytical results will be forwarded to you when it
becomes available.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit 120 days prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water Resources. Jfyou have any questions regarding your permit or the Underground
Injection Control Program please call me at [phone].
Best Regards,
~~~
Michael Rogers, P.~. ~-& FL)
Hydrogeologist
Division of Water Resources, NCDENR
Water Quality Regional Operations Section
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: [phone] \ Internet: http://www.ncwater.org
An Equal Opportunity I Affirmative Action Employer -Made in part by recycled paper
Thomas and Lana Brunk
cc: David May and Robert Tankard, Washington Regional Office
Central Office File, WI0700176
Craven 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 IS HEREBY GRANTED TO
Thomas and Lana Brunk
FOR THE OPERATION ON ONE (1) GEOTHERMAL HEATINGICOOLING WATER RETURN WELL(S),
defined in Title: 15A North Carolina Administrative Code 02C .0224(a), which will be used for the injection of
heat pump effluent. The injection well(s) located at 1002 Coopers Court, Trent Woods, Craven County, NC
28562 will be operated in accordance with the application submitted February 20, 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 operation of an injection well skull be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
constriction and use.
This permit shall be effective, unless revoked, from June 1, 2015, (i.e., the day after the expiration date of the
existing permit) until May 31, 2020, and shall be subject to the specified conditions and limitations set forth in
this peanut.
Permit issued this the 8th day of April 2015
S. Jay Zimmerman, Director
Division of Water Resources
By Authority of the Environmental Management Commission.
Permit #WI0700176 WOW Page 1 of 5
ver. 01/15/2015

PART I -PERMIT GENERAL CONDITIONS
1. The Permittee shall comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94
2. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [15A NCAC 02C .021 l(a)].
3. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data [15A NCAC 02C .0211(1)].
4. This permit is not transferable without prior notice and approval. In the event there is a desire for the
facility to change ownership, or there is a name change of the Permittee, a formal permit amendment
request must be submitted, including any supporting materials as may be appropriate, at least 30 days
prior to the date of the change [15A NCAC 02C .021 l(q)].
5. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not irriply 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.
2. If a separate injection well is used then it shall also be constructed in accordance with the requirements of
Rule .0107 of this Subchapter except that the entire length of the casing shall be grouted from the top of
the gravel pack to the land surface 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 [15A NCAC
02C .0224(d)(2)].
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. For open-end wells, the casing shall be grouted from the bottom of the casing to the land surface 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 [15A NCAC 02C .0224(d)(3)].
5. 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)].
6. 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).
Permit #WI0700176 UIC/5A7
ver. 01/15/2015
Page 2 of5
7. Each well shall have permanently affixed an identification plate [15A NCAC .01070)(2)].
8. A completed Well Construction Record (Form GW-1) shall be submitted as described in Part VI.5 of this
permit.
PART III-OPERATION AND USE CONDITIONS
1. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity [15A NCAC 02C .021 l(j)].
2. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface
water or groundwater resulting from the operation of this facility [15A NCAC 02C .0206].
3. The injection facility shall be properly maintained and operated at all times to achieve compliance with
the conditions of this permit and the rules of 15A NCAC 02C .0200, even if compliance requires a
reduction or elimination of the permitted activity [15A NCAC 02C .021 l(j)].
4 . In the event ~at 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 [I SA NCAC 02C .0206].
PART IV-INSPECTIONS [15A NCAC 02C .0211(k)]
1. Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable time for the purpose of determining compliance with this permit, may
inspect or copy any records that must be maintained under the terms and conditions of this permit, and
may obtain samples of groundwater, surface water, or injection fluids.
2. DWR representatives shall have reasonable access for purposes of inspection, observation, and sampling
associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary samples of the injection facility's activities.
PART V -MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction, repair, or abandonment shall·be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on-site and available for inspection [I SA NCAC
02C .0224(t)(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 [ISA NCAC 02C
.0224(t)(l )] .
3. The Permittee shall report any monitoring or other information that indicates noncompliance with a
specific permit condition, that a contaminant may cause a violation of applicable groundwater quality
Pennit #WI0700176 UIC/5A7
ver. 01/15/2015
Page 3 of5
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 .02ll(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 Washington Regional Office Staff at telephone number 252-946-6481.
(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 . Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee [15A NCAC 02C
.021 l(b)].
5. All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff
Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Water Quality Regional Operations Section
DWR Raleigh Regional Office
943 Washington Square Mall
Washington, NC 27889
PART VI-PERMIT RENEWAL [15A NCAC 02C .0224(c)]
As required by rule an application for permit renewal shall be made at least 120 days prior to the
expiration date of the permit. This permit condition does not apply if the Permittee chooses to
discontinue operation of the well for injection of effluent from the geothermal heating and cooling system
associated with this permit.
PART VII-CHANGE OF WELL STATUS [15ANCAC 02C .0240]
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the .discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(l), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures·specified in 15A NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will · not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
Pennit #WI0700176 UIC/5A7
ver. 01/15/2015
Page 4 of5
. ,.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner-that will prevent the movement of
fluids into or between underground sources ofdrinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
ISA NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part VII (1) a:nd (2) (G) shall be submitted to the addresses
specified in Part VIl.5 above.
Permit #WI0700176 UIC/5A7
ver. 01/15/2015
Page 5 of5
AQUIFER PROTECTION SECTION -GROUNDWATER PROTECTION UNIT
REG1ONALSTAFFREPORT
Date: 3/25/15 Permittee(s): Thomas & Laura Brunk
Permit No.: WI0700176
To: APS Central Office County: Craven
Central Office Reviewer: Michael Ro gersProject Name: Geothermal Heatin g/Coolin g Return Well
Regional Login No: __ _
L GENERAL INFORMATION
1. This application is (check all that apply): D SFR Waste Irrigation System IZ! UIC Well(s)
D New IZI Renewal
D Minor Modification D Major Modification
D Surface Irrigation D Reuse D Recycle D High Rate Infiltration D Evaporation/Infiltration Lagoon
D Land Application of Residuals D Attachment B included D 503 regulated D 503 exempt
D Distribution of Residuals D Surface Disposal
D Closed-loop Groundwater Remediation 1Z! Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? IZ! Yes or D No.
a. Date of site visit: 3/25/15
b. Person contacted and contact information: Thomas Brunk (252 ) 714-0159
c. Site visit conducted by: R. Si pe & A. Clark
RECEIVED/DENR/OWR
t1PR O 1 201:i
d. Inspection Report Attached: IZ! Yes or D No. Water Q,l'ality Regional
Jperatlons Section
2. Is the following information entered into the BIMS record for this application correct?
IZ! Yes or D No. If no, please complete the following or indicate that it is correct on the current application.
For SFR Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude: __ Method Used (GPS, Google™, etc.); __
e. Regulated Activities/ Type of Wastes (e.g., subdivision, food processing, municipal wastewater): __
For UIC Injection Sites:
(If multi ple sites either indicate which sites the information a pp lies to . co py and paste a new section into the
document for each site . or attach additional pa ges for each site )
a. Location(s): 1002 Coo pers Court. Trent Woods . NC 28562
b. Driving Directions: No change since permit issuance
c. USGS Quadrangle Map name and number: __
d. Latitude: 35.0875N Longitude: 77.094444W Method Used (GPS, Google™, etc.); Unk.
APS-GPU Regional Staff Report (Sept 09) Page 1 of 4 Pages
AQUIFER PROTECTION SECTION -GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description of Well(s) and Facilities -New, Renewal, and Modification
1. Type of injection system:
IZ! Heating/cooling water return flow (5A 7)
D Closed-loop heat pump system (5QM/5QW)
□In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5L/"Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? D Yes 1Z! No
3. Are there any potential pollution sources that may affect injection? D Yes IZ! No
What is/are the pollution source(s)? . What is the distance of the in jection well (s ) from the pollution
source(s )? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? 20 ft.
5. Quality of drainage at site: D Good IZI Adequate D Poor
6. Flooding potential of site: IZ! 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. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: NA
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? IZ! Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
Injection Well Permit Renewal and Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes IZI No. If yes , ex plain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes D No. If es , ex plain: NA
3. For renewal or modification of g roundwater remediation permits ( of an v L vp e ). will
continued/additional/modified in jections have an adverse im pact on mi gration of the plume or management of
the contamination incident? D Yes D No. If yes , explain: NA
APS-GPU Regional Staff Report (Sept 09) Page 2 of 4 Pages
AQUIFER PROTECTION SECTION -GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
4. Drilling Contractor: Name: John Taylor
Address: 2030 Taylor Rd
Chocowin it \'. NC 27817
NC Certification number: 2435-A
5. Complete and attach NEW Injection Facility Inspection Report, if applicable
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the Application: No issues observed with in j. and
su pp ly wells. Recommend that permit be renewed.
2. Attach new Injection Facility Inspection Form, if applicable
3. Do you foresee any problems with issuance/renewal of this permit? D Yes ~ No. If yes, please explain
briefly. __ ..
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
APS-GPU Regional Staff Report (Sept 09) Page 3 of 4 Pages
AQUIFER PROTECTION SECTION -GROUNDWATER PROTECTION UNIT
REGiONALSTAFFREPORT
7. Recommendation: D Hold, pending receipt and review of additional information by regional office; D Hold,
pending review of draft permit by regional office; D Issue upon receipt of needed additional information; ~
Issue; D Deny. If deny, please state reasons: __
8. s;gnature ofreport Preparer(,): 0 d'~ J;;_e.--
Signature of APS regional supervisor: ~~--~---------------
Date: 3 /25-// .5'-
VL ADDITIONAL INFORMATION AND SITE MAP (Sketch o f site showing house and waste irrigation
s vstem, spra 1• or dri p field, location o f well{s), and/or other relevant in(ormation-SHOW NORTH ARROW)
APS-GPU Regional Staff Report (Sept 09) Page 4 of 4 Pages
� 1Qrl)C4
-�r4q rl�"
C\ �6cK a�
1
20
CA--
DRAW SKETCH OF SrM ABOVE (Show property boundaries, buildings; other welI,s, septic tanksldrain fields, other
potential pollution sources, roads, approximate scale, and NORTH arrow)
Draw Schematic of well above showing TD, casing depth, grout, ete.
Inicotion Facility Insp, Report (R.ev. Sept 2009) Page 2 of 3 Pages

North Carolina Department of Environment and Natural Resources
Divis~on of Water Quality -Aquifer Protection Section
INJECTION FACILITY INSPECTION REPORT
PERMIT NO. WI0700176
DA TE OF INSPECTION: 3/25/15
INSPECTOR: R. Sipe w/WQROS WaRO
NAME OF PERMITTEE(S) Thomas and Laura Brunk
MAILING ADDRESS OF PERMITTEE 1002 Coopers Court, Trent Woods, NC 28562
PHYSICAL ADDRESS OF SITE (if different than above) ________________ _
PERSON MET WITH ON-SITE Thomas Brunk; TELE NO.[phone]
WELL(S) STATUS:
X Existing and operating Class V Well
__ Existing well proposed to be converted to Class V well
__ Proposed/not constructed
LAT/LONG OF WELL(S) 35.0875N, 77.094444W
Appx. distance of well to property boundaries: 20 feet
Appx. distance of well from foundation of house/structure: 4 7 feet
Appx. distance of well from septic tank/field (if present): NA, Residence served by public water & sewer
Appx. distance of well to other well(s) (if present): inj. well approx. 25 feet from supply well.
Appx. distance to other sources of pollution: ___________________ _
Flooding Potential of Site: _high __ moderate _x_low
Comments: Both inj . and supply wells appear to be in good condition and operating
adequately ------------------------------
Injection Facility Insp. Report (Rev. Sept 2009) Page I of 3 Pages
1002
C '� Ca m '
4
t
a
it ,
41
I00-JZ
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)
lq-4'1,�CI46i 6-W-/
Draw. Schematie of well above showing TD, casing ,depth, grout, etc.
Injection Facility Insp. Report (Rev. Sept 2009) Page 2 of Pages

Well Construction Information
Date Constructed: 6/4/10
Well Contracting Company: Taylor Well Systems
Well Driller Name: John Taylor
NC Well Cert. No.: 2435.a.A
Address:2030 Taylor Rd., Chocowinity, NC 27817
Telephone No.: [phone]; Cell No.: ----------
Email Address: -----------
Proposed Depth of Well(s): 100 feet
Total Depth: 70 feet Total Depth of Source Well, if present: 70 feet
Casing:
Depth: 0 to 50 feet; Diameter: 2 inches; Type (gav . steel, PVC, etc.): Sch. 40 PVC; Stick Up: 1ft
Grout:
Depth: 0 to 20+ feet; Type (cement, bentonite, etc.):bentonite; Placement (pumping, press. etc.):pumped
Well ID Plate Present (Y or N): _Y._; Heat Pump ID plate present (Y or N): Y
Influent spigot (Y or N): ----y Effluent spigot (Y or N): __ Y __ _
Well Sampled? (Y orN): __ Ye..__; If Yes, Lab Sample ID numbers: Influent (supply well) & Effluent (inj. well)
Static Water Level: 11 feet
Injection Information (if applicable):
Injection Rate: _______ GPM
Injection Pressure: PSI
Injection Volume: GPD
Temperature-Summer: P0
Temperature-Winter: P 0
Comments/Notes -----------------------------------
injection Facili ty ln sp . Report (Rev. Sept 2009) Page 3 of3 P ages
�.d�Ry gyp'
ORD
ONRESIDEN77AL WELL CONSTRUCTION REC
y
t 4 North Caroling Department of En-vironment and Natural Resources- Division of Water Quality
u � WELL CONTRACTOR CERTIFICATION #
1. WELL COINTRACTOR-
r7 aI� i zza& _
Well Contractor Individual) Name
Well Contractor Com any Name
�Strwt Address
City or Town $tale Zip Code
Z)-%�, .
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# A,,. ' O WJ 7 6
OTHER ASSOCIATED PERMrrWf eppticeble)
SITE WELL 10 1kii apoicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Indusbia!ICornmercial D Aarcultural 0 Recovery Injection'
irrigation❑ Other ❑ (list use)
DATE DRILLED `
Lr-
4. WELL LOCATION:
.L� _foaP ,C4 CT � e��-
[Street Nsme, Numbers, Cornmunny, Subdivision, Lot No., Pere}, Zp Code)
CITY: 7— 7' 1AVO 7S C0LJNTY C U
TOPOGRAPHIC 1 LAND SETTING: (check- appropriate box)
D Slope EiValley 5e4at Q R' a (DDther
LATITUDE . "PS' / a " DMS OR 3r(.)ODXX)0(7fJ[ DE)
LONGITUDE !`_ 7 'AS_'jp, I_" DMS OR 7LM x=X oc DD
L.atitudeflongitude source: PS CITopographlc map
[location of Well must be stfown on a USGS tops map andaffached to
this form rf not using GPSj
5. FACILITY (Name ,of the business where the well is located.)
d. TOP OF CASING IS FT. Above Land Surface`
'Top of casing terminated atlor below land surface may require
a Variance in accordance with 15A NCAC 2C .011S.
a. YIELD (gpm): METHOIx OF TEST.j61,9 xk-'l"
f. DISINFECTION: Type �//lt��M�� -- - Arnourd
: g. WATER ZONES (depth):
Top Bottom_ Top Z _ B thnml?�--
Top Bottom Top Bottom
Top Bottom Top Bottom
.
"�hickreessJ
T. CASING:
Depth Diameter Welghl
mat'enal
Top_
Bottom Ft-_
: Top
Bottom Ft.
Top
Bottom Ft.
: 8- GROUT
Depth Material
Method
Tcp
Bottom Ft. PfL L- i5( d0egfe
Top
Bottom Ft ^��etJ
Top
Bottom FI.
: 9. SCREEN, Depth Dia"ieter SIM Size
material
: Topes
Bottom� Ft, S_ in. adin,
If t I' --
Top
Bottom Ft._!A. in.
Top
Bottom Ft, in. in.
10. SANDIGRAVEL PACK:
Depth size
: Top�BOttorn-2-2— Ft -
Top Bottom Ft.
Top Bottom Ft
11. DRILLING LOG
Top Bottom
Facility Plante
Facility ID# (K applicable) 1 �
1
Street Address
1
City or Town
state Zip Code
Contact Narne
!
t r
Mailing Address
City or Town
u
State Zip ode "a Ulu
P. REMARKS:
matarle
i�d—
Forrnation Description
51-9N6
r,+rti
' i t
- - � s - r•- � ti
f GJ
Irltorrrr�laRra �Pt�c:s�.., _ , ,-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Yarrtii
- SSA NCAC EC, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THI6
- RECORD HAS BEE .D\nDED To THE WELL OWNER. _. .. -�..••
b. DOES WELL REPLACE EXISTING WELL? YES Cl NO K : SIOWTURE OF CEPTIF11156 WELL CON7RAC�DR � DATE
c. WATER LEVEL Below Top of Casln : � ,�•I FT -
(Lisa "+" if Above Top of Casing) : PRINTED NAME PERSON CONSTRUCTING THE WELL
Form GW-1b
5#bM t;' Wthh 30. OV.s of: i>n�.�e4Fm� tie_t]t js s ff �4�st ti ii j::}. riiF rrvladoh P,r:�.eess rig; Rau. z�a9
a�,��-s�, oa _- - -
Area code
Phone number
S.IWELL DETAILS:
a. TOTAL DEPTH: 70

Pay
r
1. WELL CONTRACTOR -
NON RESIDENTML we > . caNsyRuCTaON R-CO416 S U t
North Carolina Department ofEavlmnment and Natural Resources- DNision'of Water Quality
WELL CONTRACTOR CERTIFICAT30N # Z �
Weil Contractor (;ndiuldual) Name
4 g
Well tontractor Company Name
Street Addrest, z
City or Town �^ State Zip Code
Area code Phone number
2. WELL INFORMATION -
WELL CONSTRUCTION PERMIT4 Y�
d. TOP OF CASIAG M z FT- Above Land SDrface'
"Top of rasing terminated aVor below;and surface may require
a variance in accordance with 15A NCAC 2G .0118.
s. YIELD jgpm): 3D PkETHOD OF TEST ,6i� L,1�
f. 01SIN F'ECTtON-, Typeed1—V�i1�� Amouni C�-�•
g. WATER ZONES (depth):
Top _ Bolt., Top -- Topes Bottom-Z2_
Top Bottom Top Bottom
Top Bottom Top Bottom
Thltknessl
P. CASING: Depth Di .I Weight matertal
Top Bottom X� Ft
OTHER ASSOCIATED PERMIT#{it appiicaMe} � : Top Bottom Ft.
SITE WELL ID *(it appficabe) r : Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring El MuniclpaltPublie p S. GROUT Depth Material Method
IndustriallCommerciel ❑ Agrioullurat ❑ Recovery a Injection ❑ : Top —a —Bottom _ Ft- 0r.►i�.
lrrigatloni ] ❑user [list use} & Zi L Top 3 sattnml'L Ft. m+� ix
DATE DRILi.Eti �'� �� dd� :Top $OttAm Ft.
4. WELL LOCA'nON:
. joI5.3 rf d 0
($tree+. Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: COUNTY
sTOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley� rA Flat Ll Ridge ❑ other
LATITUDE °�Je7 °o.5 •Z,� 7 - DMS OR 3x.)MX=rxxx DID
LONGITUDE WJ "l0.S '� DMS OR7X. Xlfx MM DD
Latitudeflongilude source: BPS Qiopographsc map
(location of well mustbe shown on a USGS tops reap andattached to
(his form if not using GPS)
S. FACIL r (Name of the business where the Weil is located-)
Facility Name Facility I0# (it applicable)
Street Address
Clty or Town State Zip Code
Contact Name
Mading Address
City or Town
Area code Phone number
S. WELL DETAILS -
a. TOTAL DEPTH: %d
S. SCREENDep& Diameter
Top Bottom Ft. , ln.
Top Bottom Ft. in.
Top Bottom Ft, in.
10. SAMDtGRAVEL PACK.
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
Slat Size Materiel
in.
in.
in-
Reterial
11- DRILLING LOG
Top Bottom Formation Description
r �•�Ir &.
-ti
State Zip Codi?,
IR $$7q r `"
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOW
c. WATER, LEVEL Below Top of Casing FT-
iUse "+" If AL ove Top of Casing)
I DOHEREBY CERTIFY THAT THIS WELL WAS CONSTRLICTEO IN ACCORDANCE WITH
ISA NCAC 2C. WELL CONSTRUCTION STANDAR.D5. AND THAT A COPY OF 7WS
RECORD HAS BEEN OVIDED TO THEW LL OWNER.
SIGNAYU RE OF CER {7 FI WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
7. Form G)N-1It
11�2Y4EE X, thin, 30 day5 [t? z0ftiold i011 kO_ btO - ;OIi. 6fOat�b•.Qq➢,2lfity - i�l4vern�.'fld.4n ?rpeessjng. Rev, V09
R.8 I7:I 1aiG 5er k,c Gel�4�r, 14z fel lfi;:ib x7699=`9 B i;'Pi�riale , .:79j $tt7='fi Ql}

Com pliance Ins pection Re port
Permit: WI0700176
soc:
Effective: 06/03/10
Effective:
Expiration: 05/31/15 Owner: Thomas F Brunk
Expiration: Facility: Thomas and Lana Brunk SFR
1002 Coopers Ct County: Craven
Region : Washington
Contact Person: Thomas F Brunk
Directions to Facility:
Trent Woods NC 28562
Title : Phone : [phone]
From downtown New Bern, NC go West on Martin Luther King Blvd./NC55 approximately 3 miles. Left on McCarthy Blvd., and go
approximately 1 mile (road name changes to Chelsea Road). Left on Country Club Dr. then left on Coopers Court. House is on
left.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 03/25/2015 Entry Time: 09:00AM Exit Time: 09:45AM
Primary Inspector: Dwight R Sipe Phone:
Secondary lnspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Heating/Cooling Water Return Well
Facility Status: ■ Compliant D Not Compliant
Question Areas:
■
(See attachment summary)
Page : 1
Pennit: WI07001 76
Inspection Date: 03 /25 /2015
Inspection Summary:
Owner -Facility: Thomas F Brunk
Inspection Type : Compliance Eva luation Reason for Visit; Routine
On 3/25/15 a site visit was conducted by R. Sipe and A. Clark w/ WaRO WQROS as part of the permit renewal application
review process for the existing 5A7 injection well. No problems were observed with either the injection well or supply well.
Also, there were no potential pollution sources observed. The site is considered in compliance with permit# WI0700176.
Samples were collected for lab analyses from both the injection and supply wells .
Page: 2
Permit: WI0700176
Inspection Date: 03/25/2015
Owner -Facility: Thomas F Brunk
Inspection Type : Compliance Evaluation Reason for Visit: Routine
Page: 3
WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW RE QUEST FORM
Date: March 2, 2015
To: WaRO-WQROS: David May/ Robert Tankard
From: Michael Rogers, WQROS -Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
A. Permit Number: WI0700176
B. Applicant: Thomas and Lana Brunk
C. Facilitv Name:
D. Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal
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 QROS 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-WOROSReviewer: __________________ Date: _____ _
COMMENTS:
NOTES:
FORM: WQROS-ARR ver. 092614 Page I of 1
~A
CDE
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Thomas and Lana Brunk
1002 Coopers Ct.
Trent Woods, NC _28562
March 2, 2015
RE: Acknowledgement of Application No. WI0700176
Geothennal Heating/Cooling Water Return Well
Craven County
Dear Mr. and Mrs. Brunk:
Donald R. van der Vaart
Secretary
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit application and supporting documentation received on February 20, 2015. Your
application package has been assigned the number listed above, and the primary reviewer is
Michael Rogers.
Central and Washington Regional Office staff will perform a detailed review of the
provided application, and may contact you with a request for additional information. To-ensure
maximum efficiency in processing permit applications, the Water Quality Regional Operations
Section (WQROS) requests your assistance in providing a timely and complete response to any
additional information requests.
Please note that processing standard review permit applications may take as long as 60 to
90 days after receipt of a complete application. If you have any questions, please contact
Michael Rogers at [phone] or [e-mail].
cc: Washington Regional Office, WQROS
Permtt FileWI0700176
~~/>e ___ _
() 0 V Debra J. Watts, Supervisor
Animal Feeding Operations & Groundwater
Protection Branch
Division of Water Resources
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: [phone] \ Internet: http://www.ncwater.org
An Equal Opportunity I Affirmafive Ac!fon l:mp!6yei;:~ae in part by recycled paper
NORTH CAROLINA DEPARTMENT OF ENVIRONWNT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of l 5A NCAC 02C ,Q224
GEOTHERMAL NEATMGICOOLING WATER RETURN WELI►S)
These well(s) inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
CHECK ONE OF THE FOLLOWING:
New Application Renewal* Modification Permit Rescission Request*
*For Permit Renewals or Rescission Request, complete Pages l and 4 (signature page) only
Print or Type Irrformatian and Mail to the 14ddress on the Last Page- 111eg16Ie Applications Will Be Returned As Iitcomplete
DATE:
A.
S.
C.
PERMIT NO. W j D 70o 17 d (leave blank if New Application)
CURRENT WELL USE AND OWNERSHIP STATUS (leave blank if New Application)
1. Current Use of Well
a. Continue to use as t"' 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).
❑ Yes, I wish to rescind the permit
Z. Current Ownership Status
Has there been a change of ownership since permit last issued? ❑ YES
If yes, indicate new owner's contact information:
Names) - - .x `.: A- -4 ,L' -- —
Mailing Address: _/ 0 ` ` s _� _- , - r T
City: `! �. t �- ' ►r _State: 4 Zip Code: County:
Day Tele No.: Email Address.:
RECEIVEDIDEWDWR
STATUS OF APPLICANT (choose one)
Non -Government: Individual Residence
►r Business/Organization FEB 2 0 2015
Government: State Municipal County Fede ter Quality Regional
tions Sec on
WELL OWNER(S)IPERMIT 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:
/
Mailing Address: 1 ■o 2. Cpo PeAS C-7—
City: rD—kfgT w 0&4 s sty: A zip Code: 2- Fr4 2. county: c A► v t d
Day Tele No.. Cell No_: Zr2" 71 y - v15-9
EMA.II A J-0At,4Ids,,AAe^f e-t Al IL , NE ►- Fax No_:
Geothermal Water Return Well Permit Application (Revised Ian 2015) Page i

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:8: "Z.o..3 ~ I .. oo 1.. County: c f{Jl-vE,J
(2) Physical Address (if different than mailing address): _______________ _
City: _______________ State: NC Zip Code: ________ _
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name: T IJ Ylt1 & w c l.L s '/.$MM S'
NC Well Drilling Contractor Certification No.: -=-<...:Jc.:r=----...... 11..:....... _______________ _
CompanyName: 7/t {lP P,. lv,;tL S YS1"1:MS
Contact Person: .:r OH Al 7:11 Y ltJ l, EMAIL Address: W ~LLMtl,i/ l8~ii, A&ll1t1IJ ,A/11..T
Address: 2 12 J o 7 If Yi-o /J.. flt)
City: C.lf:t?co1c,,1A1 tl'I Zip Code: 2711 2 State:~County: 8/J,tvfo/l"f
Office Tele No.: -2.S-1 -9y J-r/'12. CeUNo.: ________ Fa;x:No .:. _______ _
G. HV AC CONTRACTOR INFORMATION (if different than driller)
HVACContractor'sName: Cl',.t:£ /{ HfA:l'/AI& ~t,1/L
NC HVAC Contractor License No.: _______________________ _
Company Name: ______________________________ _
Contact Person: ~' 1,J S"v~ IJ EMAIL Address:8/1.. ~(; AV/I€ 1;,,,,IJ ~Afi,.,,tllL ,~oltl
Address: f")t ) M. t>fl.t OAI J.J>
City: ,NI= w B ~ p..,./ Zip Code: 2 rs-, .Z. State:~ c County : -=C.=/1..:_-~":_v_e:.......c......AI ____ _
Office Tele No.: ~fl· 25'9 · 7'1/ I Cell No .: _________ Fax No.:. ______ _
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The mjection operation? YES ____ NO ~
(2) Personal consumption? YES ____ NO V"'"
I. WELL CONSTRUCTION REQUIREMENTS-As specified in ISA NCAC 02C .0224(d):
{I)
(2)
The water supply well shall be constructed in accordance with the water supply-well requirements of
15ANCAG02C .'0107. .
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 ]SA NCAC 02C ;0107, except tpat:
Geothermal Water Return Well Permit Application (Revised Jan 20 l 5) 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:
Z. *EXISTJNG 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 iajection 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 c!early 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(j)(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. OPERATJNG DATA
(1)
(2)
(3)
(4)
Injection Rate:
Injection Volume:
Injection Pressure:
Injection Temperature:
Average (daily) / 3. gallons per minute (gpm).
Average (daily)J,ooo gallons per day (gpd).
Average (daily)Zo-JD pounds/square inch (psi);
Average(January) 6'/ °F,Average(July) 6'1 °F.
L. -SITEMAP-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 cOBtamination listed in 15A NCAC 02C .0107( a )(2 ) located within 250
feet of the proposed irtjection well(s).
(3) -Property boundaries located within 250 feet_ofthe parcel on which the proposed injection well(s) are
to be located.
(4) Au-arrow orienting the site to one of the cardinal directions (north, south, west, or east)
Geothermal Water Return Well Permit Application (Revised Jan 2015) Page3
NOTE. fir 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 properly can be searched by
owner name or address The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, eta can then be drawn in by hand Also, a `layer' can be selected showing topographic contours or
elevation data
Nt CERTIFICATION (to be signed as required below or by that person's authorized agent)
l SA NCAC 02C .02- 11 (e) requires that all permit applications shall be signed as follows:
I . for a corporation: by a responsible corporate officer,
2. for a partnership or sale 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 ali the person(s) listed.on the property deed_
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"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, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of
the Permit."
Signature of Property licant
-T/i►a. A-S 1'r 13�y�r K- —
Print or Type Full Name
Siga�ofP�operv-� �wmdApplic:ant
L,94l4 L.. ,l AunlK
Print or Type Full Name
Signature of Authorized Agent, if any
pri'at or Type l+ulI Name
Submit two copies of the completed application package to:
Division of Water Resources
Water (duality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Reium Weil Permit Application (Revised Ian 2015) Page 4

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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 maiipiece,
or on the front if space permits.
1. Article Addressed to:
IHOWPS grid 4ar� rural
f �2 er"5 Care
A. Signature //
❑ Agent
© Addressee
B. lieoeived by (Printed Name) C. Date of Deli
D. Is delivery address different from item 17 ❑ Yes
If YES, enter delivery address below: ❑ No
3. Aer#ce Type
rtifieded Ma0 ©Priority Maii Express'"
❑ Registered ❑ Return Recelpt for Merchandise
❑ insured Mail 0 Cotlect on Delivery
4. Restricted Delivery? (Extra Fee) Cl Yes
2. Article Number 7014 1200 0001 3432 8374
[Transfer irom service lahef%
P5 Form 3811, July 2013 Domestic Retum Receipt

AVA
MCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
February 6, 2015
CERTIFIED MAIL# 7014 1200 000134328374
RETURN RECEIPT REQUESTED
Thomas and Lana Brunk
1002 Coopers Court
Trent Woods, NC 28562
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No. WI0700176
Craven County
Dear Mr. and Mrs. Brunk:
Donald R. van der Vaart
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation qf 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 located at the above referenced address
was issued to you on June 3, 2010, and expires on May 31, 2015. Per permit conditions and
requirements per 15A NCAC 2C .0224(c), the renewal application must be submitted at least 120
calendar days prior to expiration of your permit if you wish to continue operating the injection well.
According to our records, your permit renewal application is now past due. Please submit your
application (attached) as soon as possible if you wish to continue using the well for injection.
If Your Geothermal Water Return Well is Still Currently 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 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
· according to the regwlatory _requirements listed under NCAC Title 15A, Subchapter 2C, Section
.0240. _WheBUie well is...plu~ged and abandoned, a well abandonment record (Form GW-30) must
be submitted to our office to certify that the abandonment was properly conducted.
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Plll::le: 919-807-6464\ tnternet: www.ncdenr.gov
Arr Eqmtl Oppl,rtunily I Affirmative Acfion Empbyer :--Made ln part eyrefyeled paper
. . . . .
Thomas and Lana Brunk Page2
If There has been a Chan ge of Ownership of the Prope rtv :
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 (919)
807-6406 or by email at Michael.Ro gers @ncdenr.gov.
Regards,
~-GZ
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Sedion
Enclosures
cc: Washington Regional Office -WQROS w/o enclosures
Central Fiies -Permit No. WI0700176 w/o enclosures
L-
No NRESIDENT'ML WELL CONSTRUCTION RUCTION REC0RD ``----
North Carolina Deparanent of Environment and Natural Rcsoarccs- Division of Water Quality
WELL CONTRACTOR C19 Rt'!,''IVICATION #
9. WELL CONTRACTOR:
lt2 y� �.
Wag Contractor Individual) Name
-::OYLd l,.J,6'1- L 5,,TZ** �S
Well Contractor Company Name
Street Address _
Cf dCDPlAJf 7k _zti_ ' ei 7ki I
City or Town State Zip Code
Area Code Phone number
a. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#��J
OTHER ASSOCIATED PERMIT#(if apphcaHe)
SITE WELL ID #fh appficahlej
a, WELL USE (Check One Box) Monitoring ❑ Municipal/Public p
lndustrial/Commeresal ❑ Agricultural ❑ Recovery❑ Injection W
"gationp Other 0 (list use)
DATE DRILLED, 6, `
6. WELL LOCATION'
ZO-fl2 foyAcl5 CT z?��7-
(Street Name, Numbers, Community, Subdimsion, Lot No., Parr* Zip Code) � p
CITY: T��,UY�i�-
-aQ T COUNTY V fl C
TOPOGRAPHIC 1 LAND SETTING: (check eppropriate bex)
❑ Slope ❑ Valley at O Ride ❑ Other
LATITUDE °�'�' DIAS OR 3x.mO(M)O vc DID
LONGITUDE �77 °d�'f0i,_" DMS OR 7x.xxxxxxxxx f7D
Latitude4ongitude source: ASPS QTopographiC map
(location of Well most be stbwn on a USGS topo map andatfachod to
this form if no( using CPS)
S. FACILITY [Flame of the business where the well is located-}
d. TOP OF CASING IS _ L FT. Above Lanni Surface"
`Top of rasing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .014&.
e. YIELD (9pm): 20 METHOD Or- TEST �
f. t]ISINFECTIDFI: T3roeI /Z644 r , Amount � jt1Cs
g, WATER ZONES (depth). Topes Bottom_ Top f t1
2 — Snttatn �
Top_ Bottom Top Bottom
Top Bottom Top Bottom
Thickness.l
7, CASING: Depth Diameter Weight Material
Top Bottom 'L? Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUTDepth Material Method
Top(2 Bottom 3 Ft. Pb �L- f 7 �4
Top 3 Boltam Ft. FA) 0*0Y--'
Top Bottom Ft.
9. SCREEW Depth Dis"Wter Slot Size materfef
Top � Bottom W _ FL-` - im e dZ40 in. - jor e -
Top Bottom Ft. in. in.
Top Bottom Ft, in. in.
- 10. SANDIGRAVEL PACs[
Depth Size RM,aterls
= Top `A Bottom Ft. _f ,3 N
Top eattorrt Ft,
_ Tap Bottom FL
11. DRILLING LOG
Tap Bottom
o / !W
Facility Na e
w Facility ID# (if applicable) l n
1
Street Address
I
r
City or Town
State Zip Code
!
Contact Name
r
""KZ F-j
Mailing Address
--- t 1
, -2
City or Town
Stale ZIp Co
.12. EMARKS-
Area code
Phone number
6. WELL DETAILS:
a" TQTAL DEPTH: 70
Formation Description
5r'.11/ f)--I- 5rL
100 HEREBY CERTIFY THAT THIS WELLWAS CONSTRUCTED IN ACCOROANCE *TN
- t5A NCAC 2C, WELL CONS7RUCTION STANDARAS, AND THAT A COPY OF THIS
RECORD KAS BEE .OVIDED TO THE WELL OWNER.
b. DOES WELL REPLACE EXISTING WELL? YES EI NO
yt : SIGNATURE OF CIEFZTJF166 WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 11 �—FT_
(Use "*' if Above Top of Casing) = PRINTED NAME OF PERSON CONSTRUCTING THE WELL
. .. ,. .- . Form GW-ib
5u rr)jt' itl ire 30: ays:of cotz?�71eY6o Yci .. i i5t�l f i113a4yap f i E j.;�. lai)"hitioe�i?racess�rig; Rey. 2109
r9fii7 �Ilail'�ger>viCe'.C�trt►+er, �ale.l.�'f►,{iiC �ISSB;'Ifs,�, 3?>norie.: ��9��}#;ff�-y63'aD„

NONRE'.SIDENT'� WELL CONSTRUCTION RECORD
North Carolina Deparitnent of Environment and Natural Resourt:es- Division of Water Quality
WELL COI�[TRACTGR C-EIB'I MICATION # � y
- d. TOP OF CASING 15 �� FT.
(,? f 72-) -OZ �� •
Area code Phone number
2. WELL I14FOf7MATION,
WELL CONSTRUCTION PERMIT*
OTHER ASSOCIATED PERMIT#[li applicade)
SITE WELL ID *(if appi mwe)
3. WELL USE (Check One Box) Monitoring ❑ MunicipallPublio ❑
industriaUCommarcial ❑ Agricultural ❑ Recovery G Injection O
IrrigaWn❑ Other {fist use) !] �� -_
DATE DRILLED A • .3 1a �O *Ace
{. WELL LOCATION:
/Dl.a l a o ecu C7�
(Stroet Name, Numbers, Commvmy, Subd osion, Lai No., Parcd, %p CWe)
CITY_ rhkZ: �VO� .S cauraTr G � J
+TOPOGRAPHIC 1 LAND SETTING: [erre(* appropriate box)
❑ Slope []Valley y�j)9 Flat ❑ Ridge ❑ Other
LATITUDE 7P.]7 °J2S 'N 7_ _" DMS OR 3X-XXXXX1 CX OD
LONGITUDE *10 °c75' O, / DMS OR 7N.XX 7 XMXx DD
La0ludellongft2esource: 5OPS Uopopraphic map
{lvcafion of weh must be st6wn on a USGS tope map ande tached to
this form if not using GAS)
5. FACILITY (Name of the business where the well is located.)
Facility Name Facility "DO (it applicable)
Street Address
City or Town state Zip Code
Contaci Name
Mailing Address
City or Town State 2
�J
Area Code Phone number
6. WELL DETAILS:
e�. TOTAL DEPTH: 70
b. DOES WELL REPLACE EXISTIWG WELL? YES q NO p}
c. WATER LEVEL Below Top of Casing: �� -- FT
(Use `+^ if Above Top of Casing)
_ a.
Above Land Surface`
'Top of casing terminated aUor below land surface may require
a variance in accordance with 15A NCAC 2C .011&
YIELD (9wn): 3& MET140D OF TE54'_�4 j L
DISINFECTION: Typed'�AVAW-16_ _ Amount L.?-"�
g+ WATER ZONES {depth}:
Top _ Bottom,- Top Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Thickness/
7. CASING;
Depth
cis elegy
Weight Material
Top
Bottom r I
�I +
ko �U�
Top
Bottom Ft,
Top
Bottom F1.
8. GRdUT Depth Material Method
Top J_ Bottom FS. !7
Top 3 Bottom 244 Ft.�
Top Bottom F1. _-
9. SCREEN: Depth Diameter Slat Saxe Material
Top Bottom Ft. , in- in.
Top Bottom Ft, in. in.
Top Bottom Ft. in. in,
10- SANDIGRAVEL PACK -
Depth Size Material
Top Bottom Ft.
Top Bonorn Ft.
Top Bottom FL. _
11. DRILLING LOG
Top Bottom Formation Descriptidi
= 1 s' 1,
I
1
1
I ITC HEREBY CERTtFYTHAT TENS WELL WAS CONSTRUCTS IN ACCpRDANCE WITH
15A W-AC 7C, WELL OONSTR.IJUPON STANDARDS, AND THAT A COPY OF THIS
RECORD A5 BEEN ❑MUED TO THE LL OWNER.
!r 7TP ' It]
SI[31si OF CER 1lFl WELL CONTRA DATE
�oW0J 7 ,e
PRINTED NAME OF PERSON CON UCTING THE WELL
Form GW-tb
Si�i rftit;k% Min.n if . s`C#4 , anlp9e icon isi Q$vision >f VNatei Quality.- �rr,f�"Oi� h Prcrcessi�fq Rev. z�o9
-, : .
9i7 l:Seeyce EeitBe�'i�aieih;:NC7g9�i.67; Iyhvne �•��F4j RIFT=60@
I

� ou
w-
z 41
N nz
DRAW SKETCH OF SITE ABOVE (Show property boundaries, buildings, other wells, septic tanks1drain fields, other
aotential pollution sources, roads, approximate scale., and NORTH arrow)
50
1N
)raw Schematic of well above shoring TD, casing depth, grout, etc.
zjection Facility Insp. Report (Rev- Sept 2009) Page 2 of 3 Pages

e. .o --4;i
Lj< mDENTIAL WELL
CONSTRUCTION RECORD '`�'`"`" �^� 4.
North Carolina Department of Environment and Natural Rcsources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # NCWC-3538-A
1. WELL CONTRACTOR:
g. WATER ZONES (depth):
OWARD E. CMER
Top NA Bottom NA Top Bottom
_
Well Contractor (Individual) Name
Top Bottom Top Bottom
PINK$T�C N—PUMP AND WELL COMPANY
Top Bottom Top Bottom
Well Contractor Company Name
Thicknesst
PQBOX 15482
T. CASING: Depth Diameter Weight Material
Street Address
Top NA Bottom NA Ft.
CHESAPEAKE VA 23328
Top Bottom Ft.
City or Town State Zip Code
Top Bottom Ft.
7[ -- 57- a 4 S-2036
Area code Phone number
8. GROUT: Depth Material Method
2. WELL INFORMATION:
Top U' Bottom 20 Ft. BENTONITE TREMI
WELL CONSTRUCTION PERMIT#
Top Bottom Ft.
OTHER ASSOCIATED PERMIT#{ir applicable) WICI
Top Bottom Ft.
SITE WELL ID #{rf applicable}
9. SCREEN: Depth Diameter Slot Size Material
3. WELL USE (Check Applicable Box): Residential Water Supply M
Tap NA Bottom NA Ft. in. in.
DATE DRILLED O1M--d1I20I11
Top Bottom Ft. in. in.
TIME COMPLETED 3:30 AM 0 FMTop
Bottom Ft, in in.
4. WELL LOCATION:
10. SANDIGRAVEL PACK:
Depth Size Material
CITY SALVO COUNTY DARE _ _
Top NA Bottom NA Ft.
26182 N_ SAND DOLLAR DRIVE
Top Bottom Ft.
[Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code]
Top Bottom Ft,
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
p Slape ❑Valley G(Flat D Ridge 0 Other
11. DRILLING LOG
Top Bottom Formation Description
LATITUDE 35 ° ss > 14,2000 " DMS OR 3x.xxxxxxxxx DID
NA 1 NA NO SAMPLES TAKEN!
LONGITUDE 75 ° za 10.700o A DMS OR 7x-xxxxxxxxx DO
1 THIS IS A SET OF SEVEN
Latitude/longitude source: &�3PS Lfropographic map
1 GEOTHERMAL CLOSED
(location of well must tie shown on a USGS topo map andaflached to =
1 LOOPS INSTALLED TO 200'.
this form if not using GPS)
1
THIS IS 5QM CIRCULATION
5. WELL OWNER
1
DEENIE PURINAI =
1 NOTICE: THIS 1S NOT A
Owner Name
1 WATER WELL
26182 N._SAND DOLLAR DRIVE
!
Street Address
SALVO NC 27972
1
City or Town State Zip Code
Area code Phone number
=
12. REMARKS:
s. WELL DI=TAILS:
THESE_7 HOLES ARE GEOTHERMAL CLOSED LOOP
a. TOTAL DEPTH: 7 () 200'
50M LOOPSINSTALLED TO 2W AND GROUTED FROM
6. DOES WELL REPLACE EXISTING WELL? YES p NO P(
U TO 20 PLUS' WITH SENTONITE GROUT THRU TRiMi
100 HEREBY CERTIFY THAT THIS WELLWAS CONSTRUCTED IN
c. WATER LEVEL Below Top of Casing. NA FT,
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
_ _
(Use "+" if Above Top of Casing)
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS NA FT. Above Land Surface'
"Top of casing terminated at/or below land surface may require
Y r� . "...: ; 01/22/2011
a variance in accordance with 15A NCAC 2C .fl118.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD (gpm): NA METHOD OF TEST NA
HOWARD E. CUTTER
f. DISINFECTION: Type NA Amount NA
_
PRINTED NAME OF PERSON CONSTRUCTING THE WELL

Permit Number WI0700176
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael .rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Thomas and Lana Brunk SFR
Location Address
1002 Coopers Ct
Trent Woods
Owner
Owner Name
Thomas
Dates/Events
NC
F
28562
Brunk
Orig Issue
06/03/10
App Received Draft Initiated
05/17/10
Scheduled
Issuance
• Central Files: APS_ SWP_
06/10/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Thomas F. Brunk
Owner
1002 Coopers Ct
Trent Woods NC
Major/Minor
Minor
Region
Washington
County
Craven
Facility Contact Affiliation
Owner Type
Individual
Owner Afflllatlon
Thomas F. Brunk
Owner
1002 Coopers Ct
Trent Woods NC
28562
28562
Public Notice Issue
06/03/10
Effective
06/03/10
Expiration
05/31/15
'--'R"'"e.,..g--=-u'--'la;....;t.:..e....;d--=-A--=-c;;..;t;.;.iv....;i..c.ti--=-e.:..s ________________ .:...;R=e=gi.::u=e=s=te=d=/_,_R=e=c=e=iv=-=e=d=-=E=v=e.:.:n=ts=-------------
Heat Pump Injection RO staff report requested
Outfall NU!..L
Waterbody Name
Additional information requested
Additional information received
RO staff report received
Stream Index Number Current Class
05/20/10
05/20/10
05/20/10
05/21/10
Subbasin
Permit Number WI0700176
Program Category
Ground Water
Permit Type
Injection hleatinglCaoling Water Return Well (5A7)
Primary Reviewer
michael.rogers
Coastal SVV Rule
Permitted Flow
Facility Name
Thomas and Lana Brunk SFR
Location Address
1002 Coopers Ct
Trent Woods NC
28562
Central Files? AP5 SWP
05127/10
Permit Tracking Slip
Status Project Type
In review New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Thomas F. Brunk
Owner
1002 Coopers Ct
Trent Woods NC 28562
MajorlMinor Region
Minor Washington
County
Craven
Facility Contact Affiliation
Owner Name
Owner Type
Individual
Thomas F Brunk
Owner Affiliation
Thomas F. Brunk
Owner
1002 Coopers Ct
Trent Woods NC
28562
Scheduled
Orig Issue App Received Draft Initiated Issuance
Public Notice issue Effective
Expi n
05/17/10
UN 10
�! �1 6
I
Re-iulated Activities
ReC.uestedlReceived Events
Heat Pump Injection
Additional information requested
05/20/10
Additional information received
05/20110
RO staff report requested
05/20/10
RO staff report received
0512111 ❑
Outfall ` JL L
Waterbody Name Stream index Number Current Class Subbasin

AWA --~ NCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Thomas and Lana Brunk
1 002 Coopers Court
Trent Woods, NC 28562
Re: Issuance of Injection Well Permit
Permit No. WI0700176
Issued to Thomas and Lana Brunk
Craven County
Dear Mr. and Mrs. Brunk:
Coleen H. Sull ins
Director
June 3 , 2010
Dee Freema n
Secretary
In accordance with your application received May 17, 2010, and additional information received May 20 , 2010,
I am forwarding Permit No. WI0700176 for the construction and operation of a SA 7 geothermal underground
injection control (UIC) well heat pump system located at the above referenced address. This permit shall be
effective from the date of issuance until May 31, 2015, and shall be subject to the conditions and limitations
stated therein.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an application
to renew the permit four months prior to its expiration date. As indicated in the permit, this permit is not
. transferable to any person without prior notice to, and approval by, the Director of the Division of Water
Quality. If you have any questions regarding your permit or the Underground Injection Control Program please
call me at [phone].-
Best Regards,
-~~
Michael Rogers, P.O. (NC & FL)
Environmental Specialist
cc: David May-Washington Regional Office
Central Office File-WI0700176
Craven County Environmental' Health Dept.
AQUIFE R PROTECT ION SECT ION
1636 Mail Service Cen ter, Raleigh, North Carolina 27699-1636
Location : 2728 Capital Boulevard , Raleigh, North Carolina 27604
Phone: [phone] I FAX 1: 919-715-0588; FAX 2: 919-715-6048 I Custorner Service: 1-877-623-6748
Internet: www.ncwaterguality.org
An Equ al Opportunity \ Affi rmati ve Ac tion Em pl oyer
N~ith Carolina
/Vaturatlu
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION.
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Thomas and Lana Brunk
FOR THE CONSTR:UC'.I'ION AND OPERATION OF A TYPE SA 7 INJECTION WELL, defined in Title 1 SA
North Carolina Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat pump
effluent. This injection well is located at 1002 Coopers Court, Trent Woods, Craven County, North Carolina
28562, and will be constructed and operated in accordance with the application May 4, 2010, and conformity
with the specifications and supporting data received May 20, 2010, all of which are filed with the Department of
Environment and Natural Resources and are considered a part of this permit.
This permit is for Construction and Operation of an injection well shall be in compliance with Title 15A North
Carolina Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertainii;ig to
well construction and use.
This permit shall be effective, unless revoked, from the date ofits issuance until May 31, 2015, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
~
Permit issued this the ~ "1 day of_~~--------' 2010
~ JLJJ~
1r} Coleen H. Sullins, Direct~r 0 Division of Water Quality
By Authority of the Environmental Management Commission.
WI0700176 1
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be permanently labeled with a warning that it is for injection purposes and the entrance to each well
must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.0213(g).
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to :
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Washington Regional Office
943 Washington Square Mall
Washington. NC 27889
[phone]
GW-1 s must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight ( 48) hours prior to constructing each injection well, the Permittee shall notify the
Aquifer Protection Section-Underground Injection Control (UIC), Central Office staff, telephone number
[phone] and the Washington Regional Office Aquifer Protection Section (APS) Staff, telephone
number [phone].
2. Within 30 days of injection well completion, Permittee must contact the Vv. ashington Regional Office
APS Staff in order to have samples collected at the source well and injection well.
WI0700176 2
..
3. Continued operation of the injection system will be contingent upon the effluent not impacting
groundwater quality. The water quality of the effluent cannot be that of a lower quality than the influent,
which results in a degrading of water quality of the aquifer.
4. The injection well system must be constructed with sampling ports so that system influent and effluent
may be sampled.
5. The injection well must be constructed to a depth such that it is injecting water into the same aquifer that
the source well is drawing from.
PART III-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is.not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
PART IV-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater which will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times .
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
WI0700176 3
3. At least forty-eight (48) hours prior to the initiation of the operation of the facility for injection, the
Pennittee must notify by telephone the Aquifer Protection Section-Underground Injection Control (UIC),
Central Office staff, telephone number [phone] Notification is required so that Division staff can
inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials , enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface ' and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours ·of the occurrence or first knowledge of the
occurrence, to the Washington Regional Office, telephone number [phone], any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3 . Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VIII -PERMIT RENEW AL
The Permittee shall, at least 120 day s prior to the expiration of this permit, request an extension.
WI0700176 4
PART IX-CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to ISA NCAC 2C .0213(h)(l), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 1 SA NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an undergruund source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of . gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources or drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
WI0700176
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
5
AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
Date: 0511812010
To: APS Central Office
Central Office Reviewer:
Regional Login No:
Permittee(s): Thomas Brunk
Permit No.: Approval
County: Craven
Project Name: Brunk
1. GENERAL INFORMATION
1. This application is (check all that apply): ❑ SFR Waste Irrigation System ®UIC Well(s)
® New ❑ Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporationlinfiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Remediation ® Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No
a. Date of site visit: 05/18/2010
b. Verson contacted and contact information, Thomas Brunk 1002 C000ers Court, Trent Woods NC 28562
c. Site visit conducted by: Allen Clark- DWQ/APS Washington Regional Office
d. Inspection Report Attached: ® Yes or ❑ No.
2. Is the following information entered into the RIMS record for this application correct?
® Yes or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For UIC Injection Sites:
cif multiUle sites either indicate which sites the information aoolies to. coov and haste a new section into the
document for each site, or attach additional races for each site l
a. Location(s): 1002 Coopers Court. Trent Woods. Craven County. NC
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude 35 05 15 N Longitude -77 05 40 W Method Used; Google Earth
If. NEW AND MAJOR MODIFICATION APPLICATIONS this section not needed for renewals or minor
modifications skip to next section Description of Waste System and Facilities: NA
ill. RENEWAL AND MODIFICA TION APPLICA TIONS (use previous section for new or major modification
s stems : NA
W. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed -loop groundwater remediation effluent injection wells, in situ remediation injection wells, and
heat pump injection wells.)
Description of Well(s) and Facilities — New, Renewal, and Modification
1. Type of injection system:
Heating/cooling water return flow (5A7)
❑ Closed -loop heat pump system (5QMl5QW)
RLCEiVED 1 DEi'NR (I)WQ
AOLIIF-fir? 11Pw;r ink qR.-T MN
MAY 21 lh PO
APS-GPU Regional Staff Report (Sept 09) Page 1 of 3 Pages

AQUIFER PROTECTION SECTION -GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
□ In situ remediation (51)
D Closed-loop groundwater remediation effluent injection (5U"Non-Discharge")
D Other (Specify: ___j
2. Does system use same well for water source and injection? D Yes [8J No
3. Are there any potential pollution sources that may affect injection? D Yes [8J No
What is/are the pollution source(s)? . What is the distance of the in jection well (s ) from the pollution
source(s )? ft.
4. What is the minimum distance of proposed injection wells from the property boundary?~
5. Quality of drainage at site : [8J Good D Adequate D Poor
6. Flooding potential of site: [8J 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. Attach map
of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? [8J Yes or D No . If
no or no map, please attach a sketch of the site . Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
Injection Well Permit Renewal and Modification Only: NA
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g . turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes D No. If yes , ex plain :
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit
issuance or last inspection? D Yes D No. If yes, explain:
3. For renewal or modification of groundwater remediation permits (of an y typ e), will
continued/additional/modified in jections have an adverse im pact on mi gration of the plume or management of
the contamination incident? D Yes D No. If yes , ex plain:
4. Drilling Contractor: Name: John Tay lor, Taylor Well Systems
Address: 2030 Taylor Road , Chocowinity , NC 27817
NC Certification number: 2435-A
5. Complete and attach NEW Injection Facility Inspection Report, if applicable
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the Application:
2. Attach new Injection Facility Inspection Form, if applicable
3 . Do you foresee any problems with issuance/renewal of this permit? D Yes [8J No . If yes, please explain
briefly. __ .
APS-GPU Regional Staff Report (Sept 09) Page 2 of 3 Pages
AQUIFER PROTECTION SECTION — GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
4. List any items that you would like APS Central Office to obtain through an additional information request. Make
sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
F-Condition
Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Reason
7 Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information;
® Issue; ❑ Deny. if deny, please state reason 1
8. Signature of report Pre arer s : t l)
Signature of APS regional supervisor: I j
Dater
VI. ADDITIONAL INFORMATION AND SITE MAP [Sketch of site showing house and waste irrigation system,
spray or drip field, location of welits), andlor other relevant information- SHOW NORTH ARROW] ^�
Met on -site with homeowner Thomas Brunk on May 18, 2010, to conducted site visit as part of theapplication
review process to install Type 5A7 infection well. No problems were observed, Purposed location measured 47 feet
from home. The residence is on public water and sewer. There were no potential pollution sources observed.
*See Attached Site Map.
APS-GPU Regional Staff Report (Sept 09) Page 3 of 3 Pages

JCL
Ham
DRAW SKETCH OF SITE ABOVE (Show property boundaries, buildings, other welds, septic tanksldrain fields, other
potential pollution sources, roads, approximate scale, and NORTH arrow)
lid
M
S
ilwf C)
Draw Schematic of well above showing TD, casing depth, grout, etc.
Injection Facility Insp. Report (Rev. Sept 2009) Page 2 of 3 Pages

WASHINGTON REGIONAL OFFICE - APS SECTION - PHOTOGRAPHIC RECORD
Site Name: Thomas Brunk residence Permit Numbe Pending Approval
Site Location 1002 Coopers Court, Trent Woods, NC 28562 City 1 County: Trent Woods 1 Craven County
Photographer:
rF
Photographer:
A. Clark
1
A. Clark
-
A
Date*
Date:
5/18/2010
5/18/2010
Photo Location:
-
Photo Location:
Front Yard
- _
Backyard
Photo Direction:)
Photo Direction:
South
NNE
Comments:
=�-
Com ments:
Ground is level -
camera was not
level.
Photographer:
, g
Photographer:
A. Clark
ry
A. Clark
Date:
Date:
5/18/2010
5118f2010
Photo Location:
Photo Location:
Backyard
Backyard
Photo Direction:
Photo Direction:
SSW
West
-F-
Comments:
Comments:
Purposed well
Purposed well
site identified by
_
site identified by
measuring tape.
measuring tape.

North Carolina Department of Environment and Natural Resources
Division of Water Quality -Aquifer Protection Section
INJECTION FACILITY INSPECTION REPORT
PERMIT NO. WI07000?? Pending
DATE OF INSPECTION: May 18, 2010
INSPECTOR: Allen Clark; WaRO
NAME OF PERMITfEE(S) Thomas Brunk
MAILING ADDRESS OF PERMITTEE: 1002 Coopers Court, Trent Woods, NC 28562
PHYSICAL ADDRESS OF SITE (if different than above) ________________ _
PERSON MET WITH ON-SITE: Thomas Brunk; TELE NO . [phone]
WELL(S) STATUS:
__ Existing and operating Class V Well
__ Existing well proposed to be converted to Class V well
__ Proposed/not constructed
Purposed Injection Well Location: Latitude: 35 De g., 05 Min., 15 Sec: Longitude: -77 De g .• 05 Min .• 40 Sec.
Appx. distance of well to property boundaries: 20 feet (both wells )
Appx. distance of well from foundation of house/structure: 47 feet (both wells )
Appx. distance of well from septic tank/field (if present): N/A: Facilit y Connected to Public Water and Sewer
Appx. distance of well to other well(s) (if present): The purposed Injection Well and purposed Supply Well will
be approximately 25 feet away from each other.
Appx. distance to other sources of pollution: ___________________ _
Flooding Potential of Site: _high __ moderate X.Jow
Comments: There were no potential problems observed during the site visit.
Injection Facility Insp. Report (Rev . Sept 2009) Page I of 3 Pages
k A
r An Y0
le4 Iv,
r 20
'zG
DRAW SKETCH OF SITE ABOVE (Show property boundaries, buildings, other wells, septic tanksldrain fields, other
potential pollution sources, roads, approximate scale, and NORTH arrow)
. y.. 1�
G
Draw Schematic of well above showing TD, casing depth, grout, etc.
Injection Facility Insp. Report (Rev. Sept 2009) Page 2 of 3 Pagcs

Well Construction· Information
,
Date Constructed: Not yet constructed ,
Well Contracting Company: Taylor Well Systems
Well Driller Name: John Tay lor
NC Well Cert. No.: 2435-A
Address: 2030 Taylor Road, Chocowinity. NC 27817
Telephone No.: __________ ; Cell No.: (252 )943-5842
Email Address: -----------
Proposed Depth of Well(s): 100 feet
Total Depth: TBD
Casing:
Total Depth of Source Well, if present: Not yet constructed
Depth: TBD Diameter: 2 inch; Type (gav. steel, PVC, etc.): PVC;
Grout:
Depth: Type (cement, bentonite, etc.): Placement (pump, press. etc.):
Well ID Plate Present (Y or N): ; Heat Pump ID plate present (Y or N):
Influent spigot (Y or N): (sample taken from pipe leading into heating unit); Effluent spigot (Y or N):
Well Sampled? (Y or N):
If Yes, Lab Sample ID numbers: _______________ _
Static Water Level: 1.
Injection Information (if applicable):
Injection Rate:? _____ GPM
Injection Pressure:? _____ PSI
Injection Volume: ? _____ GPD
Temperature-Summer: ? ____ P 0
Temperature-Winter: ? ____ P 0
Comments/Notes: Met on-site with home owner Thomas Brunk on May 18 . 2010. to conducted site visit as part
of the a pplication review process to install Type 5A7 injection well. No problems were observed. P urp osed
location 47 feet from home. Residence on City water and sewer. No potential p ollution sources were observed.
Injection Facility Insp . Report (Rev. Sept 2009) Page 3 of3 Pages
Rogers, Michael
From:
Sent:
To:
May, David
Friday, May 21, 2010 10: 13 AM
Rogers, Michael
Cc: Clark, Allen; [e-mail]
Subject: UIC Permit -Thomas Brunk Residence -Craven County
Michael,
The Washington Regional Office has conducted an inspection of Mr. Brunk's residence. We're OK with the design and
set-up and recommend issuance of the permit; The staff report from our office has been forwarded along. Please let us
know if you have any questions.
Thanks
David
David May, Regional Aquifer Protection Supervisor
Washington Regional Office
Division of Water Quality
Aquifer Protection Section
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
E-mail: david.ma yC@.ncdenr.gov
E-mail con-espondence to and from this address may be subject to the Nmih Carolina Public Records Law and may be
disclosed to third parties.
1
Ro g ers, Michael
From:
Sent:
To:
Cc:
Subject:
Rogers, Michael
Friday, May 21, 2010 9:57 AM
May, David
Clark, Allen
FW: ljection well Brunk
Correction-the name should be Brunk, not Grubbs.
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to n_,y attn on cover letter)
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
From: Rogers, Michael
Sent: Friday, May 21, 2010 9:50 AM
To: May, David
Cc: Clark, Allen
Subject: FW: Ijection well Grubbs
David-
I talked to Mr. Grubbs in regards to his 5A7 geothermal well application. He said he sent you a copy
also. Do you recommend permit issuance? If so, I'll use this e-mail as the staff report in order to
expedite.
Thanks
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
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
From: tbrunk [mailto:[e-mail]]
Sent: Thursday, May 20, 2010 4:55 PM
To: Rogers, Michael
Subject: Ijection well
Mike
I talked to the well driller and that should have been zero to 20+ feet.
1
Ro gers, Michael
From:
Sent:
To:
tbrunk [[e-mail]]
Friday, May 28, 2010 6:44 AM
Rogers, Michael
Subject: RE: pemit forejection well Brunk WI0700176
Michael
Same as Ejection well
From: Rogers, Michael [mailto:[e-mail]]
Sent: Thursday, May 27, 2010 3:54 PM
To: tbrunk
Subject: RE: pemit forejection well Brunk WI0700176
Mr. Brunk.
Do you have the construction information for the proposed source well? Or is it the same as the injection
well?
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section {APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
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
From: tbrunk [mailto:[e-mail]]
Sent: Wednesday, May 26, 2010 12:44 PM
To: Rogers, Michael
Subject: pemit forejection well
Michael
We talked last week, and I understood you that my permit could possibly be issued sometime this week. I haven't heard
anything and am just checking to see when I can get the permit and let the well man get started. Thanks for your help.
Again my name is Tom Brunk in New Bern. My phone number is 252-714-0159
1
Ro gers, Michael
From:
Sent:
To:
Subject:
Mike
tbrunk [[e-mail]]
Thursday, May 20, 2010 4 :55 PM
Rogers, Michael
ljection well
I talked to the well driller and that should have been zero to 20+ feet.
1
TXVJ
HCDENR
North Carolina department of Environment and Natural Resources
DMsion of Water Quality
Beverly Eaves Perdue Coleerl H. Sullins
Governor Director
May 20, 2010
Thomas F Brunk
Lana L Brunk
1002 Coopers Ct.
Trent Woods, NC 28562
Subject: Acknowledgement of Application No. WI0700176
Thomas F Brunk SFR
Injection Heating./Cooling Water Return Well (5A7)
Craven
Dear Mr. and Mrs. Brunk:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on May 17, 2010. This application package has been assigned the number listed above and will be reviewed 5y
Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
tnaximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the. Division's Regional office, copied below, must provide recominendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days after receipt of a complete
application,
If you have any questions, please contact Michael Rogers at 9I9-715-6166, or via e-mail at [e-mail]. If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to htir,:llh2e.enr.state.nc.usidocummtsidwu orQchart.ndf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAILING INQUMMS Old THIS PROJECT
Sinc y,
far Det3 raa . W tts
Supervisor
cc: Washington Regional Office, Aquifer Protection Section.
John Taylor (Taylor Well Systems, 2030 Taylor Rd., Chocowinity, NC 27817)
Edin Suko (Green Heating and A/C, Inc., 5313 Morton Rd., New Bem, NC 28562)
Permit Application File W10700176
AQUIFER PROTECTION SECTION
1636 Mail Service Genter, Raleigh, North Carona 27699-1636
Locatiom 2728 Capital Boulevard. Raleigh, North Cardne 27604
Phone: [phone] FAX [phone]; FAX 2; 919-715-60481 Customer Service: 1-877-i23-a748
intemet: www.nouaterouality.ory
One
North Carolina.
An Equal Opoorirsmry � A Armative Action Employer

\,JI01CXJl 1 i
NORTll CAROLINA
DEPARTMENT OF EN-VTRONMENT AND NATURAL RESOURCES
RECEi\lfu t DENR I DWQ,
AQUJFF=R 'PROTFr.Tl()N S~C.TIOW
MAY 1 7 l010J
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR INJECTION
Wlffi A GEOmERMAL HEAT PUMP SYSTEM
TYPE 5A 7 "OPEN LOOP" INJECTION WELL(S)
(check one) _X_New Permit Application Renewal Modification ------
DATE: ___ 5/_1_3 _ 2010
PERMIT NO.: _WI _____ _ (leave blank if NEW pem1it application)
A. PROPERTY OWNER/PERMIT APPLICANT
Name of each owner listed on property deed. For a business or government agency, state name of entity and
name of person delegated authority to sign application on behalf of the business/agency: Thomas F. Brunk.
LanaL Bnmk'-----------------------------------
(1) Mailing Address: ----'1"""00"""2=--"C'""oo=ne=rs~C=t~---------
City: Trent Woods State: _NC_ Zip Code: __ ~28=5~6=2'----
Home/Office Tele No.: 252-714-0159 Cell No.:
Fax No. Email Address: tbrunk(@ suddenlink.net ------------
County: Craven
Same
(2) Physical Address of Well Site (if different than above}=~---------------
City: ________ _ State: __ Zip Code: ______ Counr1: _____ _
Home/Office Tele No.: _____________ C~e1_1 _N_o~·=------------
Fax No. Email Address: -----------
B. PROPERTY OWNERSHIP DOCUMENTATION
Provide iegai documentation of properly ownership, such as a contract, deed, article of inco, r'Dmion, etc. and
a PLAT map showing the property. This information may be obtained from county Register of Deeds or GIS
website.
C. AUTHORIZED AGENT, IF ANY
If the property ov..ner/permit applicant wants to authorize someone else to sign the permit on their behalf, then
attach a ~ letter from the propcrt".f ovmcr/pcrmit applicant spc-df.ting and authorizing their agent (well
driHer, heat pump contractor, or other type of contractor/agent) to sign this application on their behalf
Company Name: _____________ _
Contact Person: Email Address:
Address: _____________________ _
City: State: Zip Code: ______ County:
Office Tele No.: Fax No. Cell No~·=--------
Website Address of Company, if any: _________________ _
T)Jx: 5A 7 InJ.:cii.m Wdl P .. Tmil Appli1.-diiun (Rev. August 2009) Page I of4
D. W ELLL DRILLIM INFORMATION
Company Name: Taylor Well Svstems
Well Drilling Contractor's Name: John Taylor
NC Contractor Certification No.: 2435-A Contact Person: John Taylor
Company Website: WW W. Email Address: wellmagf _ harr xet
Address: 2030 Taylor Road
City: Chocowinity State: NC —Zip Code: 27817 County: 13eaufort
Office Tele No.. 252-943-5842 Fax No.: Celt No.: 252-943-5842
E. HEAT PUMP CONTRACTOR INFORMATION Gill diiilerent than Driger)
Company Name: Green Heatint., and A/C. Inc- Contact Person: Edin Suko
Company Website: WWW. Email Address: breuavari)gn bargmail.com
Address: 5313 Morton Road
City: New Bern State: NC_ Zip Code: 28562 County: Craven
Office Tele No.: 252 259-7961 Fax No. Cell No- 252-259-7961
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Drop t;im from adiacent well
G. WELL USE Will the injection well(s) also be used as the supply well(s) #arthe follo►xring?
(1) The injection operation? {ES NO x
(2) Persona.{ consumption? YES NO x
M WELL CONSTRUCTION DATA
x PROPOSED Wells) to be constructed for use as an injection well- Provide the dda in (1) through
(7) below as PROPOSED construction specifications. Submit Form G1I A after construction_
EXISTING Wells) being proposed for use as an injection well. Provide the data in (1) through (7)
below to the best of your knowledge. Attach a copy of the Well Construction Record (Form
G W-1) if available.
(1) Well Construction D*.-, May 2010 Number ofborings: i
Depth of each: boring {feet}- E MY
(2) Well casing. 1s the well(s) eased?
(a) YES __-_x If yes, then provide the casing information below.
Type: Galvanized steel Black steel Plastic x Other (specify)
Casing thickness: -sch4Q diameter (inches): _ Z" _- depth: from 8& �to� f _ feet {-relative
to land surface)
Gassing extends above ground
(b) NO
(?) Grout material surrounding well casing:
(a) Grout type: Cement Bentonite* —x Other (specify)
*fly selecting bentonhe gr=a ti-,Uiance is herby requestr4 to I5A W AC 2C .OZ I:r(d)(I)(A). which requires it ceinent glee gtnui
Tyree 5A7 Fnjw6an ►W01 Permit Appliaafion (Rev. August 2009) Fa6e 2 a'.'u

(b) Depth of grout around well casing (relative to land surface): from _20' to _ 20'+ feet
(4) Well Screen or Open Borehole depth (relative to land surface): from—approx 80'_ to _100' feet
(5) N.C. State Regulations (Title 1 SA NCAC 2C .0200) require the Permittee to make provisions for
monitoring wellhead processes. A faucet on both Influent (groundwater entering heat pump) and Effluent
(water being injected back into the well) lines is required. Will there be a faucet on:
(a) Influent line? Yes x No (b) Effluent line? Yes_x No
(b) Source Weil Construction Informatior+. If the water source well is a different well than the injection
well, attach a copy of the well construction record (Form GW-1). If Form GW-1 is not available, provide
the following data:
From what depth, formation, and type of rock/sediment units will the groundwater be withdrawn? (e.g.
granite, limestone, sand, etc.)
Depth: 90' to 120'� Formation: Limestone Rock/sediment
unit:
NOTE: THE WELL DRILLING OR 11 AT PUMP CONTRACTOR CAN HELP SUPPLY THE DATA IF TFIIS
INFORMATION IS OTHERWISE URAVAM ABLE..
1. OPERATING DATA
J.
K.
(1)
Injection Rate:
(2)
Injection Volume:
(3)
Injection Pressure:
(4)
Injection Temperature:
INJECTION -RELATED EQUIPMENT
Average (daily) f12 gallons per minute (gprn).
Average (daily) _3,00(] gat tons per day (gpd).
Average (daily) 20-30 pounds/square inch (psi).
Average (January) _b4_a F, Average (July) 64
U F.
Attach a schematic diagram or cross-section of the well construction that shows the total depth, length of casing,
extent of grout, stickup, location of influent/effluent sampling ports, etc. If this is a modification, show the
engineering layout or proposed modification of the injection equipment and exterior piping/tubing associated with
the injection operation. The manufacturer's brochure may provide supplementary information if needed -
LOCATION OF WELL(S)
(1) Attach a site reap (Can be drawn) showing: houses and other structures, property lines, surface water bodies,
potential sources of groundwater contamination, and the orientation of and distances between the proposed
injection wc1l(s) and any other existing well(s) or waste disposal facilities such as septic tan"-s or drain fields
located within 1000 feet of the geothermal heal pump well system. Label all features clearly and include a
north arrow_
(2) Attach a scaled topographic map of the area extending; 114 mile from the property boundary that indicates
the facility's location, a north arrow, and die map name.
NOTE. In west cases, an aerial photograph of the property ,parcel showing properly lines and structures can be
obtained and downloaded from the applicable county CIS website. Typically, the property can be searched by owner
►ware or addrm The location of the wells in relation to property boundarim, koascs, septic tanks, other wells, etc.
ran then be drawn in 1z, hand Also, a'layer' con be selected showing topographic contours or elevation data
Type 5A7 lnjeclion Well Permit Application (Rev. August 2009) Page 3 of 4

RECEIVED 1 DENR r DVVQ
AQUIPR P 6TFPTInN qF, i ION
MAY 17 A 10
L. CERTIFICATION (to be signed as required below or by that person's authorized agent)
NCAC 15A 2C .0211(b) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner.
If an authorized agent is signing on behalf of the applicant, then submit a letter signed by the
applicant that names and authorim their agent as specified in Part C of this permit application.
"1 hereby certify, under penalty of law, that I have personally examined and am familiar with the information submitted in
this document and all attachments thereto and that, based on my inquiry of those individuals immediately responsible for
obtaining said information, I believe that the information is true, accurate and complete. I am aware that there are sipfficant
penalties, including the possibility of fines and imprisonment, for submitting false information. I agree to construct, operate,
maintain, repair, and if applicable, abandon the injection well and all related appurtenances in accordance with the approved
specifications and conditions of the Permit."
Signature of Property Owner/Applicant
Thomas F. Brunk
Print or Type Full Name
Si re of Property �/Aplicant
Lana L. Brunk
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit TWO signed copies of the completed application package and all attachments to:
U1C Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Type 5A7 injection Well Permit Application (Rev. August 2009) Page 4 of 4

s
; PREPARED BYBOUX 12 3 5 PAGE j
•
STATE OF NORTH CAROL INA WARD AHp eMlrH, r,&
ATTORM(ya AT "W
'COUNTY OF CRAVEN L001 vnzLear Cfli1RT
NEW arRN, ry, Zq
20500
THIS DEED, made and entered into this the J:!—day of
ch/a�, 19 �L, by and between Spectrum Builders, Inc., party
of the first party and Thomas F. Brunk and wife, Lana L. Brunk,
whose address i8 _ .�� P r1'�4�16r, ��--W I� Li ` ��e.F- ,
parties of the second party
W I T N E S 5 E T H=
That the party of the.first part in consideration of
the sum of Ten Dollars ($10.00) and other good and valuable
considerations to said party paid by the parties of the. second
part, the receipt of which is hereby acknowledged, has -bargained
and sold and by these presents does bargain, sell and convey
unto the parties of the second part, said parties' heirs and
assigns, the following dejcribed property, to witi
All those certain tracts or parcels of land
lying and being situate in Number Eight
Township, Craven County, North Carolina, and
being more particularly described as follows:
Being all of. Lots Nos. 2 and 2A as same are
'shown and delineated on a map of Bel l of ern
Section 10, said map being recorded in Plat
Cabinet E, Slides 249 and 249 in the office of
the Register of Deeds of Craven County,
reference to said map being hereby made for a
more perfect description of said Lots Nos, 2
and 2A.
This conveyance is made subject to those
i

SDUK I
r.:
�ME
to convey the same in fee simpler that the same is free from
encumbrances except any encumbrances or restrictions mentioned
above and that said party will warrant and defend the title to
the same against the lawful claim of all persons whomsoever.
IN TESTIMONY WHEREOF, the party of the first part has
caused this instrument to he executed in its corporate name by
its, President, attested by its Secretary# and its
corporate 'seal to be affixed hereto, all by order of its Board
of Directors duly given, this day and year first above written.
Spectrum Builders, Inc.
By=
3
Presider
VZWa&
i
G.
it
t.
Y

�F
9
STATE OF NORTH CAROLINA
COUNTY OF CRAVEN ,,,11 BOOK 12
.����O PAGE 121
11 -- --- -c Ai�.riU_ w • �aIl'i IA - a Notary
Public i and for said County and Starr j do hereby certify that
on the d of 19 � , before me personally
appeared _ ��41. Yaeax- , with whom I am
personally acquainted,, who, 15eing by me duly sworn, says that he
is President and that :erl / • ip{. L
is Secretary of Spe rtim Builders, Inc,. the
corporation described in and which executed the foregoing
instrument; that he knows the common seal of said corporation;
that the 'seal affixed to the foregoing instrument is said common
seal; that the name of the corporation was subscribed thereto by
the said President= that the said President and
Secretary subscribed their names thereto and the said
common seal was affixed, all by order of the Board of Directors
of said corporation; and that the said instrument is the act and
deed of said corporation.
7
�WITNESS my hand and notarial seal, this the � day
C�
of ,- , 19 S .
••'" Xy,eaaamission expi-es:
/0 •.C�
'y 'rt
Notary Public
;jj ATE OF FORTH CAROLINA
11,00tOUNTY OF CRAVEN '
The foregoing certificate ZE
Publ is of ,J
Cr
, a Nota �nC �ouny,
North Carolina, is certified to be correct. This instrument was
presented for registration this day and hour and dray recorded
in the office of the lj , inter of Reeds of Crave aunty, North
Carolina, in Book /
r This d of -
/19 at

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