WI0700402_GEO THERMAL_20150908

AT!: Aci>ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mary L. Critz
106 Nixonton Loop
Donald R. van der Vaart
Secretary
September 2, 2015
Elizabeth City, North Carolina 27909
W~ f,Znat .n
SUBJECT:
Dear Ms. Critz:
Groundwater Sampling Results
UIC Permit No. WI0700402
Issued to Mary L. Critz
New Bern, Craven County, North Carolina
RECEIVED/OENR/DWR
SEP -

8

2015
Water Quality Regional
Operations Section
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 on
July 22, 2015. 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 three constituents were detected above state groundwater standards in both samples from your
system:
Parameter Units NC Groundwater Results
Standard
Iron ug/L 300 3500 (supply well-influent)
3500 (in jection well-effluent)
Manganese ug/L 50 280 (supply well-influent)
280 (in jection well-effluent)
Total Coliform Colonies/100ml 1 6 (supply well-influent)
4 (in iection well-effluent)
These exceedances should not affect the use of the wells for your geothermal heat pump system;
however, it is recommended before using the water from these wells for personal consumption that you
consult with the Albemarle Regional Health Services. If you have any questions regarding the sampling
results or your permit, please feel free to contact me at [phone].
Attachme~
&~~~
Dwight Randy Sipe, P.G ., Hydrogeologist
Water Quality Regional Operations Section
Division of Water Resources, NCDENR
cc: /4uchael Rogers ...: DWR Groundwater Protection Unit, Central Office
Albemarle Regional Health Services
WaRO
Division of Water Resources ~ Water Quality Regional Operations Section -Washington Regional Office
943 Washington Square Mall, Washington, NC 27889 .
Phone: [phone] \ Fax : [phone]\ Internet: www.ricdenr.gov
An Equal Opportunity I Affirmative Action Employer -Made in part by recycled paper
Parameter
units
NC MCL and/or EPA Standard
Influent Sample Results
Effluent Sample Results
Parameter
units
NC MCL and/or EPA Standard
Influent Sample Results
Effluent Sample Results
Parameter
units
NC MCL and/or EPA Standard
Influent Sample Results
Effluent Sample Results
Parameter
units
NC MCL and/or EPA Standard
Influent Sample Results
Effluent Sample Results
{ECElVEO/DENR/DWR NC DIVISION OF WATER RESOURCES
LABORATORY ANALYTICAL RESULTS
SE p _ 8 20\5 GEOTHERMAL UNDERGROUND INJECTION CONTROL (UIC) WELL
PERMIT NO.: W l 0700402
Water Quality Regional
Operations Section
Fecal Coliform Total Coliform
CFU/100ml CFU/100ml
NCGWS =< 1 NC GWS = 1
<1 6
<1 4
Nitrate Nitrite
mg/Las N mg/Las N
NCGWS= 10 NC GWS = 1
EPA PDWS = 10 EPA PDWS = 1
<0.2 <0.01
<0.2 <0.01
Chromium, Cr Copper, Cu
µg/L µg/L
NC GWS = 10 NC GWS = 1000
PERMITTEE(S) Mary Critz
SAMPLE COLLECTION DATE: 7/2212 0 15
Total Dissolved Solids Chloride, Cl
mg/L . mg/L
NC GWS= 500 NC GWS=250
EPA SOWS = 500 EPA SOWS = 250
320 34
29
Hardness as CaC03
(by Calculation)* Aluminum, Al
mg/L as CaC03 µg/L
NS NS
EPA SOWS = 50 to 200
200 <50
186 <50
Iron, Fe Potassium, K
µg/L mg/L
NC GWS = 300 NS
EPA PDWS = 100 EPA SOWS= 1000; PDWS = 1300 EPA SOWS= 300
<10 14 3500 3.4
<10 13 3500 3.4
Sodium, Na Nickel, Ni Lead, Pb Zinc,Zn
mg/L µg/L µg/L µg/L
NS NC GWS = 100 NC GWS= 15 NC GWS = 1000
EPA PDWS = 15 EPA SOWS= 5000
32 <2.0 <2.0 16
32 <2.0 <2.0 13
Fluoride, FL
mg/L
NC GWS =2
EPA PDWS = 4.0
<0.4
<0.4
Arsenic, As
µg/L
NC GWS = 10
EPA PDWS = 10
<2.0
<2.0
Magnesium, Mg
mg/L
NS
10
10
pH (field)
units
NC GWS = 6.5-8.5
EPA SOWS = 6.5 to 8.5
7.0
7.0
NC GWS. = North Carolina Groundwater Standard per 15A NCAC 2L .0200 * Calculation performed by WaRO
EPA PDWS = Environmental Protection Agency Primary Drinking Water Standards
EPA SOWS = Environmental Protection Agency Secondary Drinking Water Standards
NS = No Standard
Sulfate, S04
mg/L
NCGWS=250
EPA SOWS = 250
3.9
3.7
Calcium, Ca
mg/L
NS
64
58
Manganese, Mn
µg/L
NC GWS =50
EPASDWS =50
280
280
'tt:~EIVED/DENR/DWR \ 5 u.)LH:,> \
SEP -8 2015
North Carolina Division of W a ter Resources Mr~,!i-~--• . Visit ID: J:BTh-e I _________ Lab Use Only: ________ -i/t,jl Submittal Form Central Laboratory (Water Sciences Section) IDef'. IOllS -:;;. ,IILl!I (optional} Laboratory A ~ -~ k.J
Location Description: CI\ ·,-f Z , / 0 6 / 1 ii L b 1 ,z:"' b t--r '> Location Cade: (JJT O 7 {)0 'f-Od< Sample Number: I4~-i ,~1Cf '' "-:io "' DI\ 001 C..t+Y, l\l C 7/z;.3/15 P tl5 'f ~of ft rJ<.I --~~ Sf pe Date Received:
County: Collector: Priority: Water Matrix. Location Type:
W1r-~O
I DWROffice: GJ~ r o ORiver/Stream OLake
Time Received : ~~oO DWRRegion: I OAmbient
(based an county/ I (or agency name} Osurface OEstuary Ocanal • I ~ P A5 q u..t5>T t\ ~ !
7 /2-2 /1 _) ORoutine Ostormwater
Received By:
River Basin: ! Date:
! ~ompliance ~Ground OMonitoring Well Owater Supply LJState Courier
i TTme : t~A ~ Delivery Method: OHand Delivery Notes: ' Ococ Owaste OEffluent O1nfluent Oother: !
'11
D Chlorinated Ooe,chlorinated in Field
i Sampling ~Grab LJ composite
OEmergency O01ank □Field Blank □
Method: Tnp Blank
O ther:
Ofilterc;:~o+~ ti< wj. Temperature t•q
0 Filtered in Field Dissolved analysis : Enter "DIS"; N 1\-□QA Osolution
on Arrival : I· '7-
in check-boxes for parametp rs I
Sample Depth : gjoth~-"0(<1 l,.J£' l /
,,-· ({ E c, T e-4 --( V( ~ ~ () ~"')0-t 11+ h ouse (; VJ fj -f Jlli'N'I s 'l.-4.t/ly (.)J(;--l Collector's Comments: L;) OV\. 0 0~
Microbiology P;3rameters: I MBAS (surfactants) mg/L Metals Parameters: Tin (Sn) r µg/L
Ac idity. as CaC03, to pH 4.5/8.3 mg/~ Oil and Gr ease , HEM , Total Recoverable mg/L I"><. Aluminum (Al) µg/L Titanium (Ti) µg/L
Alkalinity,.as CaC03, to pH 4.5/8 .3 mg/t Phenols, Total Re coverable µg/L Antimony (Sb) µg/L Vanadium (V) µg/L
BOD: Sio ch~mical OKVcen Demand. 5-day mg/i. Residue : Total (Tola/ Solids) mg/L !X Arsenic (As) µg/L X Zinc (Zn) µg/L
cBO0: Carbonaceous BOO, 5-day mg/i. Residue : Volatile/Fixed . Total mg/L Barium (Ba) µg/L
~ Col i form : Fecal MF /lOOml Residue : Su spended (Suspen.ded Solids) mg/L Berylli um (Be) µg/L Boron (B). Total µg/L
IX Coliform: Total MF /lOOml Residue : Volatile/Fixed , Suspended mg/L Cadmium(Cd) µg/L Mercury 1631, low-level ng/L
Coliform: Tube Fecal /lOOml '"X T0S -Total Dissolved Solids mg/L l'x' Calcium {Ca) mg/L
Coliform : Tube Total /100ml S1l 1c:, mg/L P< Chromium (Cr). Total µg/l Organics Parameters:
Specific Conductance, at 25 °C \Jmhos/.cm Sulfide mg/L Cobalt (Co) µg/L Ac id He rb,c,des
TOC -Total Organic Carbon mgJL Tannin & L1gnln mg/L V Copper {Cu) µg/L Organochlorin e Pesticides
Turb idity NTU X Iron (Fe) µg/L Organonitrogen Pesticides
Other Paramf?i:ers: >< Lead (Pb) µg/L Organophosphorus Pes t icides
Wet Chemistry Parameters: pH s.u. Lithium (Li) µg/L PCBs (polychlorinated b1p henyls)
Bromide mg/~ Hardnes s, Tota I as CaC03 -by t1trat1on mg/L X Magnesium (Mg) mg/L x Chloride mg/~ .x... Manganese (Mn) µg/L Semi -Volatile Org anics {BNA sJ
Fluonde mg/~ Mercury (Hg) µg/L TPH Diesel Range
Sulfate mg/~ Nutrients Parameters: Molybdenum (Mo} µg/L
Chlorophyll a µg/~ Ammonia as N (NH3 -N) mg/L X Nickel (Ni) µg/L Volatile Orga nics (VOA)
Color:A0M I c.u .! L>< N1trate-N1 t rite as N (N03+N02-N) mg/L X Potassium (Kl mg/L
Color: Platinum Cobalt c.u .' Totai KJeldahl Nitrogen as N (TKN) mg/L Selenium (Se) µg/L TPH Gasoline Range
COO : Chemical Oxvgen Demand mg/~ Tota ! Phosphorus as P (TP) mg/L Si lver (Ag) µg/L
Cyanide, Total mg/( IV .Nitrite as N (N02-N) mg/L X Sodi um (Na) mg/L Biological :
Formaldehyde mg/L Nitrate as N (N03-N calculated) mg/L Strontium (Sr) µg/L Phytoplankton/ Algae
Hexava lent Chromium (Cr6+) mg/t Orthophosphat e as P (P04) mg/L Thallium (Tl) µg/L
LAB COMMENTS:
field Parameters(optiono/J : Water Temp (0 C): pH (s.u .): 7.D Dissolved Oxygen (ppm): Conductivity (µmhos/cm): Salinity {ppt):
Revision. 2/06/201S
AC21211 NC <DW1?_, Water Sciences Section-Cliemistrv La6oratorv <R.§su[ts
County :
River Bas in
Report To
PAS QUOTANK
WARO
Collector: R SIPE
Region: WARO
Sample Matrix: SURFACEWATER
Loe. Type : Water Supply
Emergency Yes /No
COC Yes/No
J Location ID : WI0700402
DWR
Division of Water Resources
Final Re port
VisitlD
Loe. Descr.: CRITZ 106 NIXTON LOOP
J Collect Date : 07/22/2015
Sample ID:· AC21211
PO Number# 15W4631
Date Received : 07/23/2015
Time Received : 08:20
Labworks LoginlD MSWIFT
Final Report Date : 8/21/15
Report Prin t Date : 08/21/2015
I Collect Time : 09:45 I Sample Depth I
If this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes .
CAS# Anal yte Name PQL ResulV
Units
Method Analysis Validated by
Qualifier Reference Date
LAB
Sample temperature at receipt by lab 1.2 ·c 7/23/15 MSWIFT
MIC
Coliform, fy1FFecal in liquid 1 1 B201 CFU/100ml APHA9222D -20th 7/23/15 ESTAFFORD1
Coliform, MF Total in liquid 6 01 CFU/100ml APHA9222B-20th 7/23/15 ESTAFFORD1
WET
Ion Chromatography _TITLE mg/L EPA 300.0 re v2.1 8/3/15 CGREEN -
Fluoride 0.4 0.4 U mg/L EPA 300.0 rev2.1 8/3/15 CGREEN
Chloride 1.0 34 mg/L EPA 300.0 rev2 .1 8/3/15 CGREEN
Bromide 0.4 0.4 U mg/L EPA 300.0 rev2.1 8/3/15 CGREEN
Sulfate 2 .0 3.9 mg/L EPA 300.0 rev2 .1 8/3/15 CGREEN
Total Dissolved Solids in liquid 12 320 mg/L SM 2540 C-1997 7/25/15 CGREEN
NUT
N02+N03 as N in liquid 0.02 0.20 U,P mg/Las N EPA 353.2 REV 2 7/28/1 5 CGREEN
N itrate as N in liquid 0.02 0:20 U,P mg/Las N EPA 35 3.2 REV 2 8/5/15 CGREEN
Nitrite as N in liquid 0.01 0.01 U mg/Las N EPA 353 .2 REV 2 7/23/15 CGREEN
MET
742 9-90-5 Al by ICP 50 50 U ug/L EPA200 .7 8/10/15 ESTAFFORD1
7440-38-2 As by ICPMS 2 .0 2.0 U ug/L EPA200.8 8/7/15 ESTAFFORD1
7440 -70-2 Ca by ICP 0.10 64 mg/L EPA200 .7 8/10/15 ESTAFFORD1
7440-47-3 Cr by ICPMS 10 10 U ug/L EPA200.8 8/7/15 ESTAFFORD1
------7-440-0 50-s--ea-by-lCP MS-----·--------------------···-··----··· 2-.0 ---------14 ----ugll · · ·-EPA-200,8 · ---8/7/15 ---ES'FAFF8REl-1 --·-
7439-89-6 Fe by ICP 50 3500 ug/L EPA200.7 8/10/15 ESTAFFORD1
7440-09-7 K by ICP 0.10 3.4 mg/L EPA200.7 8/1011 5 ESTAFFORD1
7439-95-4 Mg by ICP 0.10 10 mg/L EPA200.7 8/10115 ESTAFFORD1
7439-96-5 Mn by ICP 10 280 ug/L EPA200 .7 8/10115 ESTAFFORD1
7440c23-5 Na by ICP 0 .10 32 mg/L EPA200.7 8/10/1.5 ES TAFFORD1
7440-02-0 Ni by ICPMS 2.0 2.0 U ug/L EPA200.8 8/7/15 ESTAFFORD1
7439-92-1 Pb by ICPMS 2.0 2.0 U ugll EPA200.8 8/7/15 ESTAFFORD1
7440-66-6 Zn by ICPMS 10 16 ug/L EPA200.8 8/7/15 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
Fora detailed descriotion of the oualifiercodes refer to <htto://oortal.ncdenr.orn/web/wa/oos/methods-and-uals>
Page 1 of 2
'JfC <D~ La6oratory Section <Rgsults
Location ID: WI0700402 Sample ID: AC21211 Collect Date: 07122/2015 Collect Time:: 09:45
MET
CAS# Anal yt e Name PQL Result/
Qualifier Units Method
Reference
Analysis
Date
Sample Comments
NUT:N03N02-P-adjusted PQL; sample dilution used due to matrix interference.
WSS Chemistry Laboratory>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed description cf t~e oualifier codas refer to <htto ://oortal.ncdenr.orn:/web/wa/oos/methods-and-oals>
Page 2 of 2
Validated by
15 Uo qG 3z
North Carolina Division of Water Resources
Laboratory [WI teT'SCtenCe55eEd1311) Water 5atnplc ColleOtion &StsiJtnithd[ Farm
r E- i( E
Location I7e5cr1ptian_ � �—}, , f r1 J�J tywg4r\ 1,4� IU G Location Cade:
t�C lG { iJ r T
Visit ID: Tog
(apt+orw�1 ��
—
---------------- -----------
Lab Use Only:Central
Ln6euarary
Sarrrple lL'vmber: ��� i
ncrc Received:
County. ' -A
Collector- (
prlor(ty:
❑Ambient
❑ Routine
Nk mpttanoe
❑Coc
❑Emergenry
❑OA
Watertwatrix,
❑Surface
VhGrourkd
❑Waste
❑Blank
❑solvbon
!oration Type:
❑River/Stream []Lake.
0>:stuary ❑Canal
❑ S[ormwa ter
❑Monitoring Well ❑Warersupply
❑Effluent ❑Influent
❑Field Blank
Trip BlankMethod,
❑Filter Blank�j ��/j
&�C O r� r
IgGther.
'� bt-z,
rim r Re cetued:
Refe[vedBy. �V
U
State catmer
Mtvery Merhod: ❑Hand Celivery
❑avmr:
Temperature ('Cl ) }
an An -Awl: 1 4
DWI? Region.,
l6asedorrrnunryl V
V WR 0�7ce: (�
lwasa+rY++anK1
River$4sln:
�
�
y
Date:
Mores,
Time: �1
V
❑ Chlorinated ❑pt;-cYtlor+Hated in Field
Sumpling IIGrab �_ +Compoailo
� Qthef:
OISSaIV@d analysis* Emer "t115!
❑ Filtered in Flail in check -boxes for pararreefore
sample Depth:
Collvsrtdr's Canrrnerrra v �G -
[ (� VA v—
l k
W
Microbiology Parameters:
MBAS (surfactants)
mg/L
Metals Parameters:
Tin On) pgjL
ACidiey, as CaCO3, to pH 4.5/8.3 mg/i
Oft and Grease, HEM, Total Recoverable
mg/L
Aturninum (All
Pg/L
Tl[anium (Til pg/L
Alkarrnfty, as C-r03, to pH 4.S/8.3 mg/L
Phenols, Total Recoverable
pg/L
Antimony (Sb)
pgll
Vanadium (V) trg/L
SOD: aimhemiQi oxygen oemartd, sa.y mg/L
Residue: Tara (Tmol Solids }
mg/L
Arsenic (AS)
pg/L
Zinc (Znl pgfl
680D: Carbonareous 90D, $•day mg/1-
Residue: Valadk/Fixed, Tani
rng/L
Barium IBa)
pg/L
Celiform: fecal MF /100ml
Residue: Suspended (Suspended soWs )
mg/L
Beryllium (Bel
pg/L
1
Boram (B), Total leg/L
Celifarm- Total MF /200m1
I Aesidue: VotatlleWFixe4. Suspended
mg)1
Cadmium ICd}
pglL
Mercury 1631, low-level ng/L
Colifurm:Tube Fecal /1001h!
TDS -Total Dissolved Sof+ds
mjg 1.
Calcium (Cal
mglL
Cattform; Tube Total /100mi
Silica
mg/L
Chromium (Cr), Total Pg/L
Organe[s Parameters;
speetfic Conductance, in 25 "C umhuslem
sueRde
mg/L
cobalt (Co)
pg/L
Arid Herbicides
TOC -Total Organic Carhon mg/L
Tannin & Lignin
mg/L
Copper (cu)
pg/L
0rganochlorine Pesticides
Turbidity NTL
_
iron {Fel
Pg/L
Organonirrogeri Pesticides
OthirrPanamere.x:
teed (Ph)
VS/L
OrganophospherusPesdcldes
Wet C_heme5try Parameters:
pH
s.u.
Lithium (Lll
pg/L
PCBs (polychlorinated tsiphenyk)
Bromide mg/L
Hardness,Total as CaCO3 - by tamtion
mg/L
Magneslum (Mg] rnglL
[hlndde mg/L
Manganese (Mnl pg/L
Semi -Volatile Organics (BNAs)
Fluoride mg/L
Mercury (tlg)
pglL
TPH Diesel Range
Sulfate mg/L
Novienrts Parameters-
Molybdenum (Ma) irg/L
Chtorophyl't a Pg/L
Ammonia as N INH3•N]
mg/L
Nickel (Ni)
pg/L
Volatile Organks (VOA)
Color: ADM[ cu,.
Nrcrale-Nitrite as N (N034402-N}
mg/L
Potassium (Kj
mq&
Color: Platinum Cobalt e.u.
Total Kleldahl Hitrogenas N (TKN)
mg/L
Selenium {Se}
pg/L
TPH Gasoline Range
COD: ChenctalGkMen demand mg/L
Total Phosphorus as P (TP]
mg/L
Silver (Ag)
}fg/L
Cyanide, Total mall,
Nitriten N (NO2-N)
mg/L
Sadtum (Na)
mgIL
awlagical;
'Formaldehyde mg1L
Nitrate as N (NO3-N calculaled)
mg/L
Stronilum (Sr)
pg/L
Phytopiankton / Algae
Hexayslent Chromium (CiF6+l mg1L
Orthophosphate as P (PO4)
mg/L
Thallium (TII
pg/L
LAB COMMENTS :
IField ParameteWvpdv. rj:I waterTemp (°Cl: I PH (,.): 7- 0 1 Dissolved Oxygen (ppm): I Conductivity ipmhos/cml: I Salinity (ppt):

AC21213 :NC <D'W<J( 'Water Sciences Section-Cfiemistry La6oratory <l{(!su[ts
County:
River Basin
Report To
Collector:
PAS Q UOTANK
PAS50
WARO
R SIPE
Region: WARO
Sample Matrix : SURFACEWATER
Loe. Type: Effluent
Emergency Yes/No
COC Yes/No
I Location ID: WI0700402
DWR
Division of Water R~sources
Final Re port
VisitlD
Loe. Descr.: CRITZ 106 NIXTON LOOP
I Collect Date: 07/22/2015
Sample ID:
PO Number#
Date Received :
Time Received :
Labworks LoginlD
Final Report Date :
Report Print Date:
I Collect Time: 10:00
AC21213
15W4632
07/23/2015
08:20
MSWIFT
8/21/15
08/21/2015
I Sample Depth I
If this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
CAS#
LAB
MIC
WET
NUT
MET
Anal yte Name
Sample temperature at receipt by lab
Coliform, MF Fecal in liquid
Coliform, MF Total in liquid
Ion Chromatography
Fluoride
Chloride
Bromide
Sulfate
Total Dissolved Solids in liquid
N02+N03 as N in liquid
Nitrate as N in liquid
Nitrite as N in liquid
7429-90-5 Al by ICP
7440-38-2 As by ICPMS
7440-70-2 Ca by ICP
7440-47-3 Cr by ICPMS
744 0-50-8 C u by IC PMS
7439-89-6 Fe by ICP
7440-09-7 K by ICP
7439-95-4 Mg by ICP
7439-96-5 Mn by JCP
7440-23-5 Na by ICP
7440-02-0 Ni by ICPMS
7439-92-1 Pb by ICPMS
7440-66-6 ?n by ICPMS
PQL
0.4
1.0
0.4
2.0
12
0.02
0.02
0.01
50
2.0
0.10
10
2.0
50
0.10
0.10
10
0.10
2.0
2.0
10
Result/
Qualifier
1.2
Units
·c
Method
Reference
Analysis Validated by
Date
7/23/15 MSWIFT
1 82Q1 CFU/100ml APHA9222D-20th 7/23/15 ESTAFFORD1
4 Q1 CFU/100ml APHA9222B-20th 7/23/15 ESTAFFORD1
_TITLE_ mg/L EPA 300.0 rev2.1 8/3/15 CGREEN
0.4 U mg/L EPA 300.0 rev2.1 8/3/15 CGREEN
29 mg/L EPA 300.0 rev2.1 8/3/15 CGREEN
0.4U mg/L EPA 300.0 rev2 .1 8/3/15 CGREEN
3.7 mg/L EPA 300.0 rev2.1 8/3/15 CGREEN
316 mg/L SM 2540 C-1997 7/25/15 CGREEN
0.20 U,P mg/Las N EPA 353 .2 REV 2 7/28/15 CGREEN
0.20 U,P mg/Las N EPA 353.2 REV 2 8/5/15 CGREEN
0.01 U mg/Las N EPA353.2 REV 2 7/23/15 CGREEN
50 U ug/L EPA200.7 8/10/15 ESTAFFORD1
2.0 U ug/L EPA200.8 8/7/15 ESTAFFORD1
58 mg/L EPA200.7 8/10/15 ESTAFFORD1
10 U ug /L EPA200.8 8/7/15 ESTAFFORD1
13 Ug/L EPA200 .8 ----------8/7-/-15 -----~S:rAFF-GRIJ-1-·
3500 ug/L EPA200.7 8/10/15 ESTAFFORD1
3.4 mg/L EPA200.7 8/10/15 ESTAFFORD1
10 mg/L EPA200.7 8/10/15 ESTAFFORD1
280 ug/L EPA 200.7 8/10/15 ESTAFFORD1
32 mg /L EPA200.7 8/10/15 ESTAFFORD1
2.0 U ug/L EPA200.8 8/7/15 ESTAFFORD1
2.0 U ug/L EPA200.8 8/7/15 ESTAFFORD1
13 ug/L EPA200.8 8/7/15 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed descriotion of the aualifier codes refer lo <http:/ /oortal.ncdenr.orn:/web/wq/oos/rnethods-and-pals>
Page 1 of 2
:NC aY~ La6oratory Section <Rgsufts
Location ID: WI0700402 Sample ID: AC21213 Collect Dale: 07/22/2015 Collect Time:: 10:00
MET
CAS # Anal yte Name PQL Result/
Qualifier Units Method
Reference
Analysis
Date
Sample Comments
NUT:N03N02-P-adjusted PQL; sample dilution used due to matrix interference.
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed descriotion of the qualifier codes refer to <htto:/ /oortal.ncdenr.orn:/web/wq/oos/methods:-and-oals>
Page 2 of 2
Validated by
Sy mbol
A
B
BB
C
G
J
Definition
Value reported is the mean (average) of two ol' 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, colifonn or acute/chronic metals
reporting since averaging multiple results for these parameters is fundamental to those methods or manner ofreporting.
1. The reported value is an average, where at least one result is qualified with a "U". The PQL is used for the qualified
result(s ) to calculate the average.
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 100% 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
1. Countable membranes with less than 20 colonies. Reported value is estimated or is a total of the counts on all filters
reported per 100 ml.
2. Counts from all filters were zero. The value reported is based on the number of colonies per 100 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 reported 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 100 ml.
5 . Too many colonies were present; too numerous to count (TNTC). 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 I 00 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 s pikin_g failures.
This code applies to most probable number (MPN) microbiological tests.
1. No wells or tubes gave a positive reaction . Value based upon the appropriate MPN Index and reported as a less than
"<"value.
2 . All 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 accompanied by justification for its use denoted by the numbers listed above (e.g., BB l, BB2,
etc.).
Total residual chlorine was present in sample upon rece ipt in the laboratory; value is estimated. Generally applies to cyanide,
phenol, NH3, TKN, coliform, and organics.
A single quality control failure occuJTed during biochemical oxygen demand (BOD) analysis. The sample results should be
used with caution.
1.
2.
3. --
4 .
5.
6.
7.
8.
9.
The dlssolved oxygen (DO) depletion of the dilution water blank exceeded 0.2 mg/L.
The bacterial seed controls did not meet the requirement of a DO depletion of at least 2 .0 mg/L and/or a DO residual
of at least 1.0 mg/L. ·
No sample dilution. met the re4.uirement of a DO _depletion of at_least 2 .0 mg/L and/or a DO residual of at least 1.0 .
mg/L. .
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 caJ'culated from the highest dilution representing the maximum
loading potential and should be considered iJ.n estimated value.
The glucose/ glutamic acid standard exceeded the range of 198 ± 30.5 mg/L.
The calculated seed correction exceeded the range of0.6 to 1.0 mg/L.
Less than l 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.
Oxygen usage is less than 2 mg/L fo r all dilutions set. The reported value is an estimated less than value and is
calculated for the dilution using the most amount of sample .
The DO depletion of the dilution water blank produced a negative value.
Note: A "G" value shall be accom panied b v justification for its use denoted by 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:
1. SmTogate 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 an v accurate determination.
4. The data is questionable because of improper laboratory or field protocols (e.g., composite sample was collected
instead of grab, ptastic instead of glass container, etc.).
5. Temperature limits exceeded (samples frozen or y5°C) during transport or not verifiable (e.g., no temperature blank
provided): non -reportable for NPDES compliance monitoring.
,]
6. Tina 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 reported value should be considered estimated.
8. Temperature limits exceeded {samples frozen ar>VC) during storage, the data may not be accurate.
R. 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 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 instrument noise level. This
code is zued when an MDL has not been established for the analyze in question.
12. The calibration verification did not meet the calibration acceptance criterion for tietd parameters.
Nate: A T' value shall be accompanied by justification for its use denoted by the numbers listed above (e.g.,11,12, etc.). A'7"
value shall not be used if another code a plies e.., 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 plicate onal,%ses of a s amp le.
Presumptive evidence of presence of material; estimated value. This cede is to be used if
N
1. 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 of analyte was not confirmed by alternate procedures).
3: This code shall be used if the level is too low to permit accurate quanti f cation, but the estimated concentration is
less than the laboratory practical quantitation limit and greater than the laboratory method detection limit. This cycle
isnoirowtingl used for most anar yses,
4. This code shall be used if the level is too Iow to permit accurate quantification, but the estimated concentration is
less than the laboratory prdctical quanlitation limit and greater than the instrument noise level. This code is used
when an MDL has nad been established for the analyze in question.
S, The component has been tentatively identified based on a retention time standard:
Holding time exceeded. These codes shall be used if the value is derived from a sample that was received, prepared and/or
Q
analyzed after the approved holding time restrictions for sample preparation and analysis, The value does not meet NPDES
requirements.
1, Holding tithe 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
S13.
Indicates that the analyts was analyzed for but oat detected above the reported practical quandtation limit*. The nurn her value
U
re ported with the "U" ; ualifier is equal to the Iaboretor+'s practical .luantitation limit O.
Indicates the analyte was detected in both the sample and the associated }clank. Note: The value in the blank shall not be
subtracted from the associated samples.
1. The analyte was detected in both the sample and the method blank.
2. The analyte was detected in both the sample and the Field blank
Samp a n'at aris�y for this consiitueiit.This cc is to be used if;' —
1, Sample not screened far this compound.
2. Sampled, but analysis lost or not performed -field error.
3. Samp tod, but analysis Iost or not performed -lab error.
Note: an " X" value shall be accompanied b y 'ustificatian for its use br the numbers listed.
Y
Elevated PQL* due to insufficient sample size.
Z
The sample anal ysis/resu Its are not reported due to:
1. Inability to analyze the sample.
2, Questions concerning data reliability.
The prescncc or absence of time analyte cannot be verified.

Supporting Definitions listed below
MDL A Method Detection Limit (MDL) is defined as the minimum concentration ofa substance that can be measured and reported
with 99 percent confidence that the true value is greater than zero and is detennined in accordance with 40 CFR Patt 136,
Appendix B.
ML Minimum Levels are used in some EPA methods. A Minimum Level (ML) is the lowest level at which the entire analytical
system must give a recognizable signal and acceptable calibration point for the analyte. It is equivalent to the concentration of
the lowest calibration standard, assuming that all method -specified sample weights, volumes, and cleanup procedures have
been employed. The ML is calculated by multiplying the MDL by 3.18 and rounding the result to the nearest factor of 10
multiple (i.e., I, 2, or 5). For example, MDL= 1.4 mg/L; ML= 1.4 mg/L x 3.18 = 4.45 rounded to the nearest factor of l 0
multiple (i.e ., 5) = 5 .0 mg/L
*PQL The Practical Quantitation Limit (PQL) is defined as the lowest concentration that can be reliably achieved within specified
limits of precision and accuracy during routine laboratory operating conditions. PQLs are subjectively set at some multiple of
typical MD Ls for reagent water (generally 3 to IO times the MDL depending upon the parameter or analyte and based on the
analyst's best professional judgement, the quality and age of the instrument and the nature of the samples) rather than explicitly
det.em1ined. PQLs may be nominally chosen within these guidelines to simplify data reporting and, where applicable, are
generally equal to the concentration of the lowest non-zero standard in the calibration curve. PQLs are adjusted for sample
size, dilution and % moisture. For parameters that are not amenable to MDL studies, the PQL may be defined by the sample
volume and buret graduations for titrations or by minimum measurement values set by the method for method-defined
parameters (e.g., BOD requires a minimum DO depletion of2.0 mg/L, fecal colifonn requires a minimum plate count of20
cfu, total suspended residue requires a minimum weight gain of2.5 mg, etc.). Additionally, some EPA methods prescribe
Minimum Levels (MLs) and the lab may set the PQL equal to thi s method-stated ML. Detem1ination of PQL is folly described
in the laboratory's analytical Standard Operating Procedure (SOP) document.
06/25/2015
Rogers, Michael
From:
Sent:
To:
Subject:
Attachments:
Michael,
Sipe, Randy
Thursday, July 23, 2015 3:21 PM
Rogers, Michael
Wl0700402 -Critz Geothermal Return Well
WI0700402 Injection Facility lnsp Report 7-22-15.docx; WI0700402 Critz Geotherm Retun
Well Photorecord 7-22-15.xlsx
We performed the initial sampling of the recently installed inj. and supply wells yesterday and prepared the updated
inspection report and photos.
Randy Sipe, P.G.
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Washington Regional Office
[phone] '
Note: All e-mail sent to and from this account are subject to the North Carolina Public Records Law and may be disclosed
to third parties
1
North Carolina Department of Environment and Natural Resources
Division of Water Quality -Aquifer Protection Section
INJECTION FACILITY INSPECTION REPORT
PERMIT NO. WI0700402
DATE OF INSPECTION: 7 /23/15
INSPECTOR: R. Sipe w/WQROS WaRO
NAME OF PERMITTEE(S) Mary Critz
MAILING ADDRESS OF PERMITTEE 106 Nixonton Loop, Elizabeth City, NC 27909
PHYSICAL ADDRESS OF SITE (if different than above) ________________ _
PERSON MET WITH ON-SITE Peggy (neighbor taking care of Ms. Critz); 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) 36.235278N, 76.1975W
Appx. distance of well to property boundaries: approx. 15 feet(both Inj. and Supply wells)
Appx. distance of well from foundation of house/structure: approx. 36 feet (Inj well), approx. 27 feet (Supply
well) .
Appx. distance of well from septic tank/field (if present): -50 feet
Appx. distance of well to other well(s) (if present): Inj. well approx. 12 feet from supply well.
Appx. distance to other sources of pollution: ___________________ _
Flooding Potential of Site: _high __ moderate ___lLlow
Comments: Both existing inj. and supply wells appear to be in good condition and operating adequately at time
of inspection. The wells are located at the approx. locations discussed with the driller during the site visit on
6/22/15.
Injection Facility lnsp. Report (Rev . Sept 2009) Page 1 of 4 Pages
DRAW SKETCH OF SITE ABOVE (Show property boundaries, buildings, other wells, septic tanks/drain fields, other
potential pollution sources, roads, approximate scale, and NORTH arrow)
See attached GW-1 forms for both inj. and supply wells.
Draw Schematic of well above showing TD, casing depth, grout, etc.
Injection Facility lnsp. Report (Rev. Sept 2009) Page 2 of 4 Pages
Well Construction Information
Date Constructed: 7 /1/15
Well Contracting Company: JP Enterprise
Well Driller Name: John Paul Simpson
NC Well Cert. No.: 2930-A
Address: 118 Leeward Dr., Grandy, NC 27939
(Supply Well)
Telephone No.: [phone]; Cell No.: ________ _
Email Address: -----------
Proposed Depth of Well(s): 60
Total Depth: 69 feet
Casing:
Total Depth of Source Well, if present: NA
Depth: + 1 to 59 feet; Diameter: 1.25 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.):gravity
Well ID Plate Present (Y or N): _I_; Heat Pump ID plate present (Y or N): _Y_
Influent spigot (Y or N): __ Y_ ; Effluent spigot (Y or N): Y __
Well Sampled? (Y or N): _Y __ ; If Yes, Lab Sample ID numbers: Inf (Supply Well)
Static Water Level: 10 feet
Injection Information (if applicable):
Injection Rate: GPM -------
Injection Pressure: PSI
Injection Volume: GPD
Temperature-Summer: P0
Temperature-Winter: P0
Comments/Notes: Supply well appeared to be in good condition and operating adequately at time of inspection.
Injection Facility Insp. Report (Rev. Sept 2009) Page 4 of 4 Pages
Date Constructed: 7/2/15
Well Construction Information
(Injection Well)
Well Contracting Company: JP Enterprise
Well Driller Name: John Paul Simpson
NC Well Cert. No.: 2930-A
Address: 118 Leeward Dr., Grandy, NC 27939
Telephone No.:[phone] ; Cell No.: ________ _
Email Address: -----------
Proposed Depth of Well(s): 60 feet
Total Depth: 69 feet Total Depth of Source Well, if present:69
Casing:
Depth: + 1 to 49 feet ; Diameter: 1.2 5 inches; Type (g av. steel, PVC , etc.): Sch . 40 PVC ; Stick Up: 1ft
Grout :
Depth: 0 to 48 feet ; Type (cement, bentonite, etc.):Cement; Placement (pumping , pre ss. etc .):gravity
Well ID Plate Present (Y or N): _Y _; Heat Pump ID plate present (Y or N): Y
Influent spigot (Y or N): __ N_A __ Effluent spigot (Y or N): _Y __
Well Sampled? (Y or N): _Y_; If Yes, Lab Sample ID numbers: Eff. (inj. well)
Static Water Level: 10 feet
Injection Information (if appJicable):
Injection Rate: _______ GPM
Inj ection Pressure: PSI
Inj ection Volume: GPD
Temperature-Summer: F°
Temperature-Winter : F0
Comments/Notes: Inj. well appeared to be in good condition and operating adequately at time of inspection.
Inject ion Facility Insp. Report (Rev. Sept 2009) Page 3 of 4 Pages
f)7/1.2/2@15 19:3e
2524534522
JP ENTERPRISE
PAGE 02/03
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07/ 12/ 2015 19: 38
2524534522
JP ENTERPRISE
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Permit Number Wl0700402
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SWRule
Permitted Flow
Facility
Facility Name
Mary L. Critz SFR
Location Address
106 Nixonton Loop
Elizabeth Cly
Owner
Owner Name
Mary
Dates/Events
NC
L
Orig Issue App Received
6/22/2015
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
27909
Critz
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
6/23/2015
Permit Tracking Slip
Status
In review
Version
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Mary L. Critz
106 Nixonton Loop
Elizabeth Cty
Region
Washington
County
Pasquotank
NC
Issue Effective
27909
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
M967A
NCDENR
North Carolina Department of Environment and Natural Resources
Rat McCrory
Governor
June 23, 2015
Mary L. Critz
106 Nixonton Loop
Elizabeth City, NC 27909
Re: Issuance of Injection Well Perndt
Permit No. W10700402
Geothermal heating/Cooling Water Return Well
Pasquotank County
Dear Ms. Crit2:
Donald R. van der Vaart
Secretary
In accordance with your permit application received June 22, 2015, I am forwarding Permit No.
WI0700402 for the Construction and operation of geothermal heating/cooling water return well(s)
located at the above referenced address. This permit shall be effective from June 23, 2015, until May
31, 2020, and shall be subject to the conditions and limitations stated therein.
Please Note:
• Per Permit Condition Part 11.7, a copy of the Well Construction Form(s) (GW-1),
which is completed and signed by the well contractor, roust be submitted to this
office and the Washington Regional Office within 30 days of completion of the
well(s). Copies of the GW-1 shall be retained on -site and available for inspection.
Per Permit Condition Part 111.2, within 30 days of injection well completion and
operation, Permittee must contact the Washington Regional Office APS Staff (252-
946-6481) to have influent and efRuent samples collected.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit 120 days prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water Resources. If you have any questions regarding your permit or the Underground
Injection Control Program please call me at [phone].
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: [phone]Internet h1tp:/1wavw.ncwater.org
An Equal OppWwnity 1 AMrrrdvo Aedon Employer - Made in part oy mycled paper

Mary L. C ritz
Best Regards,
.~~~
Michael Rogers, P.G. (NC & FL)
Hydro geologist
Division of Water Resources, NCDENR
Water Quality Regional Operations Section
cc: David May & Robert Tankard, Washington Regional Office
Central Office File, WI0700402
Pasquotank County Environmental Health Department
Page 2 of 2
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
Mary L. Critz
FOR THE CONSTRUCTION OF 1 (ONE) GEOTHERMAL HEATING/COOLING WATER RETURN
WELL(S), defined in Title 15A North Carolina Administrative Code 02C .0224(a), which will be used for the
injection of heat pump effluent. The injection well(s) located at 106 Nixonton Loop, Elizabeth City,
Pasquotank County, NC 27909 will be constructed in accordance with the application submitted June 22, 2015,
and conformity with the specifications and supporting data, all of which are filed with the Department of
Environment and Natural Resources and are considered a part of this permit
This permit is for construction of an injection well shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until May 31, 2020, and shall be
-subject to the specified conditions and limitations set forth in this permit.
Permit issued this the 23rd day of June 2015.
~-• ... S. Jay Zimmerman, P.G.·
\. Director, Division of Water Resources
By Authority of the Environmental Management Commission.
Permit #WI0700402 UIC/5A7
ver. 04/15 /2015
Page 1 of5
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 imply that all
regulatory requirements have been met [15A NCAC 02C .0203].
PART II -WELL CONSTRUCTION GENERAL CONDITIONS
1. The well supplying water for the geothermal heating and cooling system shall be constructed m
accordance with the requirements of rule 15A NCAC 02C .0107 except as required in Item #2 below.
2. Any injection well shall be constructed in accordance with the requirements of rule 15A NCAC 02C
.0107 except that the entire length of the casing shall be grouted in such a way that there is no
interconnection of aquifers or zones having differences in water quality that would result in degradation of
any aquifer or zone. For screened wells, grout shall be emplaced from the top of the gravel pack to the
land surface. For open-end wells, the casing shall be grouted from the bottom of the casing to the land
surface [15A NCAC 02C .0224(d)(2),(3)].
3. Bentonite grout shall not be used to seal any water~bearing zone with a chloride concentration equal to or
greater than 1,500 milligrams per liter. In areas where elevated chloride levels are known to exist or are
probable, such as coastal areas, chloride levels shall be verified in the field to determine existing
conditions. [15A NCAC .0225(g)(8)].
4. The injection well system shall be constructed such that a sampling tap or other collection equipment
approved by the Director provides a functional source of water when the system is operational. Such
equipment shall provide the means to collect a water sample immediately after emerging from the water
supply well and immediately prior to injection into the return well [15A NCAC 02C .0224(d)(4)].
5. Each well shall be secured to reasonably insure against unauthorized access and use and shall be sealed
with a watertight cap or well seal as defined in G. S. 87-85(16).
6. Each well shall have permanently affixed an identification plate [15A NCAC 02C .0107(j)(2)].
Permit #WI0700402 UIC/5A7
ver . 04/15/2015
Page 2 of5
7. A completed Well Construction Record (Form GW-1) shall be submitted as described in Part VI.5 of this
permit.
PART III-WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight (48) hours prior to constructing each injection well, the Permittee shall notify the
Underground Injection Control (UIC) Central Office staff, telephone number 919-807-6496 and the
Vlashington Regional Office Staff, telephone number 252-946-6481. [ISA NCAC 02C .021 l(k)].
2. Within 30 days of injection well completion the Permittee shall contact the Washington Regional Office
Staff in order to have samples col!ecte4 at the source well and injection well. [15A NCAr 02C .021 l(k)]
PART IV -OPERATION AND USE CONDITIONS
L The Pennittee shall comply with the conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and the rules of 1 SA NCAC 02C .0200,
even if compliance requires a reduction or elimination of the permitted activity [15A NCAC 02C
.021 l(j)].
2. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface
water or groundwater resulting from the operation of this facility. In the event that the facility fails to
perform satisfactorily, including the creation of nuisance conditions or failure of the injection zone to
adequately assimilate the injected fluid, the Permittee shall take immediate corrective actions that may be
required, such as the repair, modification, or abandonment of the injection facility [15A NCAC 02C
.0206].
PART V -INSPECTIONS [15A NCAC 02C .021 l(k)]
1. Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable time for the purpose of determining compliance with this permit, may
inspect or copy any records that-must be maintained under the terms and conditions of this permit, and
may obtain samples of groundwater, surface water, or injection fluids.
2. DWR representatives shall have reasonable access for purposes of inspection, observation, and sampling
associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary samples of the injection facility's activities.
PART VI -MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction, repair, or abandonment shall be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on-site and available for inspection [15A NCAC
02C .0224(t)(2), (4)].
Permit#W10700402 UIC/5A7
ver. 04/15/2015
Page 3 of5
2. Monitoring of any well may be required to ensure protection of the groundwater resources of the State
and compliance with the groundwater quality standards specified in 15A NCAC02L [15A NCAC 02C
.0224(f)(l )] .
3. The Permittee shall report any monitoring or other information that indicates noncompliance with a
specific permit condition, that a contaminant may cause a violation of applicable groundwater quality
standards, or that a malfunction of the injection system may cause the injected fluids to migrate outside
the approved injection zone or area. As specified in rule 15A NCAC 02C .0211 (r), noncompliance
notification shall be as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence, to the Washington Regional Office, 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. The Permittee shall record the number and location of the wells with the register of deeds in the county in
which the facility is located. [ 15A NCAC 02C .0224(f)(3)].
5. All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff
Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Water Quality Regional Operations Section
DWR Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
PART VII-PERMIT RENEW AL [15A NCAC 02C .0224(c)]
As required by rule an application for permit renewal shall be made at least 120 days prior to the
expiration date of the permit. This permit condition does not apply if the Permittee chooses to
discontinue operation of the well for injection of effluent from the geothermal heating and cooling system
associated with this permit.
PART VIII-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 take·n 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.
Permit #WI0700402 UIC/5A7
ver. 04/15/2015
Page4 of5
4. When injection operations have ceased at the facility and a well will no longer be used for any purpose,
the Permittee shall permanently abandon that injection well in accordance with the procedures specified in
15A NCAC 02C .0113(b), which include, but are not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected prior to sealing in accordance with rule 15A
NCAC 02C .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
operatiop.s, each well shall be abandoned in such a manner that will prevent the
movement of fluids into or between underground sources of drinking water.
(F) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0224(f)(4) within 30 days of completion of abandonment.
5. The written documentation required in Part VIII (4)(F) shall be submitted to the addresses specified in
Part VI.5 above.
Permit #WI0700402 ·illC/5A7
ver. 04/15/2015
Page 5 of5
Rogers, Michael
From:
Sent:
To:
Subject:
Attachments:
Michael,
Sipe, Randy
Tuesday, June 23, 2015 2:56 PM
Rogers, Michael
RE: Mary Critz Residence -Geothermal Return Well Permit Application -Pasquotank County
WI0700402
DOC062315-001.pdf; Critz Geotherm Ret. Well WI0700402 Photorecord 6-22-15.xlsx
Attached is a scanned copy of Jhe signed staff report and attachments. Hard copies are als9 being sent to you via
courier. The driller is supposed to get us a site map, which we will forward to you.
Randy Sipe, P.G.
Hyd rogeologist
Division of Water Resources
Water Quality Regional Operations Section
Washington Regional Office
[phone]
Note: All e-mail sent to and from this account are subject to the North Carolina Public Records La·w and may be disclosed
to third parties
From: Rogers, Michael
Sent: Tuesday, June 23, 2015 10:39 AM
To: May, David; Watts, Debra
Cc: Sipe, Randy; Tankard, Robert
Subject: RE: Mary Critz Residence -Geothermal Return _Well Permit Application -Pasquotank County WI0700402
I've entered Mary's info into BIMS and have a permit number-WI0700402. Include this in all future correspondence.
need some clarification on the proposed well construction, i.e., depth of casing, grout, screen, and sand pack. You can
include this in the staff report when done. Thanks.
From: May, David
Sent: Monday, June 22, 2015 5:00 PM
To: Watts, Debra
Cc: Sipe, Randy; Rogers, Michael; Tankard, Robert
Subject: Mary Critz Residence -Geothermal Return Well Permit Application -Pasquotank County
Debra,
Thanks for calling back. Please find the attached application for a geothermal water return injection well. Our office
received a call late this past Friday about Ms. Critz, who is 87 years old, being without air conditioning. The permit
application was mailed to our office and received today. Randy and I performed a site inspection today and met with
the well contractor at the site. We'll work on preparing our staff report to send up ASAP. I believe the driller is ready to
Po once-the permit is ready.
Ms. Critz would greatly appreciate any help with expediting the permit. She was sitting out under her carport today
while we were there.
Please let me and/or Randy know if there are any questions in the mean time.
1
Thanks
David May
Regional Supervisor
Division of Water Resources
Water Quality Regional Operations Section
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
E-mail: david.ma y@ ncdenr.qov
htt p://www.ncwater.org/
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.
2
AQUIFER PROTECTION SECTION -- GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
Date: 6/23I15 Permittee(s): Marr L. Critz
Permit No.: W10700402
To: APS Central Office County, Pasrauotank
Central Office Reviewer-, _Michael RogersProject Name: Geothermal Heating/Cooling, Return Well
Regional Login No: — - -
1 GENERAL INFORMATION
1. This application is (check e:i that apply): ❑ SFR Waste Irrigation System ® UIC Wells)
0 New ❑ Renewal
❑ Minor Modification ® Major Modification
Surface Irrigation
Reuse [] Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Ladd Application of Residuals ❑ Attachment 13 included ❑ 5D regulated 0 503 exempt
❑ DistTibution of Residuals ❑ Surface Disposal
[I 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: 6/22/15
b. Person contacted and contact information, JP Simpson t2521267-640
c. Site visit conducted by: R. Sipe & D. May
d. Inspection Report Attached: ® Yes or ❑ No.
2, Is the following information entered into the BIMS 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 SFR7 'Treatment Facilities:
a. Location`
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude: Method Used (GPS, GoogleT"c, etc.);
e. Regulated Activities 1 Type of Wastes (e.g., subdivision, food processing, municipal wastewater):
For UIC Injection Sites:
If multiple sites either indicate which sites the infon-natio�t applies to e= opv and paste a new section into the
document for each site. or attach additionallaages for each site]
a. Locations): 106 Nixonton Loop. Elizabeth City. NC 27909
b. Driving Directions: From Hw,y 17 take Halls Creek Rd south Vprox, 3.6 miles,. Turn right on Nixonton
Rd, Go approx,1.3 mites. Tura ri , at on Nixonton Loop Goa approx. ox. 0.2 mile to site on left.
c. USGS Quadrangle Map name and number:
d. Latitude; 36.199668N Longitude: 76.272170W
Earth.
Method Used (GPS, GoogleT�', etc.); Google
APS-GNU Regional Staff Report (Sept D9) Page 1 of Pages

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL, STAFF REPORT
IY. INTECTION WELL PERItIITAPPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed -loop groundwater remediation effluent injection wells, in situ rem ediation injection wells, and heat
pump injection weds.)
Description of Well(s) and Facilities — Now, Renewal, and Modification
1. Type of injection system:
Z Beating/cooling water return flow (5A7)
❑ Closed -loop heat pump system (5QM/5QW)
❑ In situ remediation (51)
❑ Closed loop groundwater remediation effluent injection (51,1"Non-Discharge")
❑ Other (Specify:
2, Does system use same well for water source and injection? ❑ Yes Z No
3, Are there any potential pollution sources that may affect irriection? ❑ Yes E No
What is/are the pollution souree(s)? �V.Lhgtis the distant -- of the in+ection well( si from the pollution
sou rcets )?
4. What is the vainimum distance of proposed injection wells from the property boundary? 15 ft.
5. Quality of drainage at site: ❑ Good ® Adequate ❑ Poor
6. Flooding potential of site: 22 Low ❑ Moderate ❑ High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc,) adequate? ❑ Yes ❑ No. Attach
Snap 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)? ❑ Yes or (] No. If
no or no reap, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow. Map ndi�_trtfo.from driller,
Trajection Well Permit Renewal and Modification Only:
1. For heat pump systems, art there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heatinglcooling)?
❑ Yes ❑ No. NA_ new S � stem.
Z. For closed -loop neat pump systems, has system lost pressure or requirod snake -up fluid since permit issuance
or last inspection? ❑ Yes ❑ No, If, ems, explain: NA
3, For renewal or modification of groundwater remediation permits �ofamr tvpe ill
continuedladdikionallmadified ini--ctiorss have an adverse irn,laact on rni ration of the plume or rn Wgm$nt_of
the contamination incident? ❑ Yes ❑ No. if yes. "plain; NA
APS-GPU Regional Staff Report (Sept 09) Page 2 of 4 Pages

AQUIFER PROTECTION SECTION -GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
4. DrilJing Contractor: Name: John Paul Sim pson
Address: 118 Leeward Dr.
Grandy. NC 27939
NC Certification number: 2930-A
5. Co_mplete 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 site
conditions or locations of proposed in j. and supp ly wells. Recommend that permit be issued.
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 pennit 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
REGIONAL STAFF REPORT
7. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional ogee, ❑ Issue upon receipt of needed additional information;
Issue; ❑ Deny. If deny, please state reasons:
S. Signature of report Preparers):
Signature of APS re ional supery
Date: p
V7 ADDITIONAL INFORMA TION AND SITE MAP gketch o(site Aawin g_house rtrrd waste irrigation
temisnray ardrip held.location of weli(s1. andlarotherrrelevantinlormation-SHOWNDRTHARRQ>�'�
Site map will be_pravided one final well locations are determined b, driller_
APS-GPU Regional Staff Report (Sept 09) Page 4 of 4 Pages

North Carolina Department of Environment and Natural Resources
Division of Water Quality-Aquifer Protection Section
INJECTION FACILITY INSPECTION REPORT
PERMIT NO. WI0700402
DATE OF INSPECTION: 6/22/15
INSPECTOR: R. Sipe and D. May w/WQROS WaRO
NA1\1E OF PERMITT.EE(S) Mary L Critz
MAILING ADDRESS OF PERMITfEE 106 Nixonton Loop., Elimbeth City, NC 27909
.PHYSICAL ADDRESS OF SITE (if different than above) _______________ _
PERSON MET Wl11ION-SITE JP Simpson; TELE NO.[phone]
,,
WELI..(S) STA11JS:
__ Existing and operating Class V Well
__ Existing well proposed to be converted to Class V well
_X_Proposed/not constructed
LAT/LONG OF WELL(S) 36.199668N, 76.272170W
Appx. distance of well to property boundaries: 15 feet(both proposed supply and inj. wells)
Appx. distance of well from foundation of house/structure: 25+feet (both proposed supply and inj. wells)
Appx. distance of well from septic tank/field (if present): 50+ feet (both proposed supply and inj. wells)
Appx. distance of well to other well(s) (if present): Proposed inj. well approx. 20 feet from proposed supply well.
Appx. distance to other sources of pollution:. __________________ _
Flooding Potential of Site: _high __ moderate ____x_ low
Comments: WaRO representatives discussed the proposed well locations with the driller, Mr Simpson, Final
locations will depend locations of septic systems on adjacent properties.
Injection Facility lnsp. Report (Rev. Sept 2009) Page I of3 Pages
Map to he forwarded upon receipt from Driller
DRAW SKETCH OF SITE ABOVE (Show properly boundaries, buildings, other wells, septic tanksldrain f gilds, other
potential pollulion sources, roads, approximate scale,,�p� d NORTH arrow)
�� juf05ec 1 ( i �Q�C
'A').bD (p5 CAPPfr
L 7�
f
to r
1)ra►v Sehcmatic of well above showing TD, cas'sng depth, grout, etc.
InJcctian Fad I ty In ftepotl (Rev. Sept 2009) Page 2 of 3 Pages

Well Construction I:nforma.tion
Date Constructed: TBD
Well Contracting Company: JP Enterprise
Well Driller Name: John Paul Simpson
NC Well Cert. No,: 2930-A
Address: 118 Leeward Dr., Grandy, NC 27939
Telephone No.:[phone] ; <:'ell No.: ~--------
Em a ii Address: ------------
Prop o s c d Depth of Well(s): 60 feet
Total Depth: TBD Total Depth of Source Well, if present: 60 feet (proposed)
Ca.sing (proposed)
Depth: 0 to 40 feet; Diameter: 2 inches; Type (gav. steel, PVC, etc.): Sch. 40 PVC; Stick Up: TBD, minimum
of 12 inches.
Grout: (proposed)
Depth: 0 to 40 feet; Type (cement, bentonite, etc.):Bentonite; Placement (pumping~ press. etc.):TBD
Well ID Plate Present (Y or N): _NA_; Heat Pump ID plate present (Y ~r N): _NA_
Influent spigot (Y or N): . N Effluent spigot (Y or N): ---=Y'--_
Well Sampl~d? (Y orN): _NA_; If Yes, Lab Sample ID numbers:
Static Water Level: TBD
Injection Information (if applicable):
Injection Rate: · GPM ------
Injection Pressure: PSI
Injection Volume: GPD
Temperature-Summer: P0
Temperature-Winter: P0
Comments/Notes: Both inj. well and supply well proposed have a TD of 60 feet, Supply well proposed to use 10
feet of 0.010 screen and inj. well proposed use 20 feet of 0.020 screen. Annular space in both wells proposed to
have bentonite grout. _________ _
lnjection Facility Insp. Report (Rev. Sept 2009) Page 3 of 3 Pages
Permit: Wl0700402
SOC:
County: Pasquotank
Region: Washington
Contact Person: Mary L Critz
Directions to Facility:
Effective:
Effective:
Com pliance Ins pection Re port
Expirntion:
Expiration:
Title:
Owner : Mary L Critz
Facility: Mary L. Critz SFR
106 Nlxonton Loop
Elizabeth Cty NC 27909
Phone:
From Hwy 17 take Halls Creek Rd. south approx. 3.6 miles. Turn right on Nixonton Rd. Go approx. 1.3 miles. Turn right on Nixonton
Loop. Go approx. 0.2 mile to site on left.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
O.n-Site Representative(s):
Related Permits:
Inspection Date: 06/22/2015 Entry Time: 10:30AM Exit Time: 11 :30AM
Primary Inspector: Dwight R Sipe Phone:
Secondary lnspector(s):
Reason for Inspection: Routine Inspection Type: Reconnaissance
Permit Inspection Type: Injection Heating/Cooling Water Return well
Faclllty Status: D Compliant D Not Compliant
Question Areas:
Other
{See attachment summary)
Page: 1
Permit: W10700402
Inspection Date: 0612212015
Owner. Faelll~: Mary L Critz
lnspeetlon Type ; Reconnaissance Reason for Visit: Routine
Inspection Summary:
On 6/22/15 R. Sipe and D. May w/ WaRO WQROS performed a site visit as part of the review for a application for a
geothermal return well in the subject property. We met with JP Simpson, the driller, and Chad Critz, the son of the
properrty owner. We reviewed site conditions and discussed proposed locations for the inj. and supply wells. It appeared
the proposed locations would meet the applicable setbacks. · Final locations will be dependant on the locations of the
septic systems on adjacent properties, w!"lich Mr. Simpson Is going identify and provide a site map to WaRO . Based on
the results of this site visit, this office had no objections to issuance of the proposed permit.
Page : 2
Permit: V\110700402
Inspection Date: 05/22/2015
Other
Comment:
owner • Faclllty: Mary L Critz
Inspection Type : Reconnaissance Reason for Visit: Routine
Yes No NA NE
Page: 3
WASHINGTON REGIONAL OFFICE - DWR WQRDS - PHOTOGRAPHIC RECORD
Site Name: Gritz Residence Incident/Permit Number: W10700402
Site Location: 106 Nixonton Loop Site Town/City: Elizabeth City, NC
Photographer:
; �' ` •� Photographer:
R. Sipe
�, :qA;:l. r R. Sipe
'
f - Date;
-
Date:
6/22/2015
6/22/2015
t.LAA�
Photo Location:
Photo Location:
Residence
Residence
Backyard
Backyard
Photo Direction:
vo
Photo Direction:-
r•r► Comments:
Comments:
}!
area of proposed
area of proposed
supply well
hp supply well
Photographer-
r" --ti t Photographer:
�
R. Sipe
R. Sipe
Date:"'
Date:
6/22/2015
_i _
fi/2212415
'r 1 Photo Location:
Residence
'
-
Photo Location:.
Residence
Backyard
`":' Backyard
.
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inj. well
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NORTEI CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMH TO CONSTRUCT OR OPERATE INJECTION
WELLS
In Accordance With the Provisions of I SA NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELLS
These wells inject groundwater directly into tine subsurface as part of a geothermal heating and coaling
system
(check one) New Application Renewal* Modification
* For renewals complete Parts A-D and 1, the signature page
�E�p�{yCQirNRi��
o 12 Z915
V+latar puality
F-e9t°nal
operatlollsgt naaOce
Waantngton
Print or Type Informadon and Mail to I/&- Address on the Last Page. Illegible Applications Well
Be RelunredAs Incomplete.
DATE: _ - 20
PERMIT NO. L-) 1_Jc_a 0q 4) f: (leave blank if New Application)
B. A., STATUS OF APPLICANT (choose one)
Nan -Government: Individual Residence Business/Organization
Government: State Municipal County Federal
B. WELL OWNERIPERMIT APPLICANT -- For individual residences, list owner(s) on
property deed. For all others, list name of entity and name of person delegated authority to
sign on behalf of the business or agency:. —
Mailing Address: �jrYlItA
r ! v
r •Zip Code
City: G tr �jl Stafe:: CSC coCou
c6d
1

Day Tele No.: c2>oe 716 Cell No.: -- -
EMAIL Address: fax No.:
C. WELL OPERATOR (if different from well owner) — For individual residences, list owner
(s) on prope;iy dead. For all others, list name of entity vLd name of person delegated
authority to sign on behalf of the business or agency.
Mailing Address:
City: _ State: Zip Cade: County:
Day 'fele No.: _ _ _ Cell No.:
EMAIL Address; Fax No.:
D. LOCATION OF WELL SITE -- Where the injection wells am physically located:
(1) Parcel Identification Number (PIN) of well site:R !-du S P lk&4 r County:
(2) Physical Address (if different than mailing address):
City:
State: NC Zip Code:
E. WELL DRILLER INFORMATION
We] I Drilling Contractor's Name:��
NC Well Drilling Contractor Certification No.: Z 7 3y ~ /'
Company Name:
2

{ �'
Contact Person: �i3 �-' ,` r 6►7tJti`f - .',1EMAH. Address:
Address:+�-
city.
Zip Code: Stated � County:
Office Tele No.: Z1' Z- Y373 V i 8 % Cell No.: '7--5 ?— Z- 10 Fax No.: ET Z- �3 764
C q&C,
M /Z-
F. HVAC CONTRACTOR. WFORMATION (if different tract driller)
{00AVACContractor'sName: f
NC HVAC Contractor License No.:
Company Name:
Contact Person: EMAIL Address:
Address-Y-
city: Al a Y c7 yam_ Zip Cade: C�Wf8 Stan• ounty:
Office Tele No.: pZLa - 23.1— 31 Cell No.: Fax No_:—
S.
C. G. WELL USE Will the in*tion weft(s) also be used as tite supply wells) for the
followi 7
o)
(1) The injection operation? YES NO
(2) Personal consumption? YES NO
H. WELL CONSTRUCTION REQU EWMS --As specified in f SA NCAC 02C:.0224
(l) The water supply well shall he constructed in accordance with the water supply well
3
rrrOV - 0. 10 5?4A-,

requirements of ISA NCAC 02C .0107.
(2) If a separc1te 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 .0107 , except that:
(a) For screen and gravel-packed wells; the entire length of casing shall be
grouted from the top of the gravel pack to land surface;
(b) For open-end wells without screen, the casing shall be grouted from the
bottom of the casing to land surface.
(3) A sampling tap or other approved collection equipment shall provide a functional
source of water during system operation for the collection of water samples
immediately after water emerges from, the supply well and immediately prior to
injection.
4
L WELL CONSTRUCTION SPECIFICATIONS
(l) Specify the ntmiber and type of wells to be used for the geothermal -heating/cooling
system:
----~*EXISTING .WELLS 1.,-.PROPOSEOWELLS
*For existing wells, please attach a copy of the Well Construction Record (Form
GW•l) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the
geothennal heating/cooling system. A single diagram can be used for
wel1s having the same construction specifications as long as the diagram
clearly identifies or distinguishes each well from one ano~.
Each diagram shall demonstrate compliance with the well construction requirements
specified in Part H above and shall .include, at a mimmwn, the following well
construction specifications:
(a) Depth of eaeh boring below latid surface
(b) Well casing and screen type, thic~s, and diameter
(c)
(d)
(e)
Casing depth beJow land surface
Casing height "stickup" above land surface
Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited/or sealing water-bearing
zones with 1500
.0107(1)(8)
mg/L chloride or greater per 15A N CAC 02C
(t) Length of well screen or Qpen borehole and depth below land
surface
(g) Length of sand or gravel packing around weU ~reen aml depth
below land surface
J. OPERATING DATA
( l) Injection Rate:
(2) Injection Volume:
(3) Injection Pressure:
(4) Injection Temperature:
Average (daily) [U gallons per minute (gpm).
'Average(daily) __ gallons perday(gpd).
Average (daily) __ pounds/square inch(psi).
Average (January) · ° F, Average (J1Jly) _ ° F.
K. SITE MAP-As specified in ISA NCAC 02C .0224(b)(4). attach a site-specific map that -is
scaled or otherwise accurately indicates distances and orientations of the specified features :from
the injection well(s). The site map shall include the following: ·
(1) All water supply wells, surface water bodies, and septic systems including drainfieJd,
waste application area, and repair area located within 250 feet of the
injection weJJ(s). .
(2) Any other potential sources of contamination listed in 15A NCA C 02C .0107(a)(2)
located within 250 feet of the proposed injection weJJ(s). · ·
(3) Property boundaries l<>Cated within 250 feet of the ~l on which the proposed
s
injection well(s) are to be located.
east)
( 4) An arrow orienting the site to one of the cardinal directions ( north, south, west, or
NOTE: In most coses an aerial photograph of the property parcel showing property
lines and structure:~ can be obtained and downloaded from the applicable county GIS
website. Typically, the property can be searched by owner name or address. The
location of the wells in relation to property boundarie.f, hous~ septic tanks, other
wells, etc. can t/1en be drawn in by hand. Also, a 'layer' can be selected showing
topographic contours or elevation data.
6
L. CFRTUPICATION (to be signed as required below or by that person's authorized
agent)
t SA_NCAC 02C .021 l(e) requires that all permit applications shall be signed as follows:
for a corporation: by a responsible corporate officer;
• for a partnership or sole proprietorship: by a general partner or the proprietor,
respectively;
+ for a municipality or a state, federal, or other public agency: by either a
principal executive officer or ranking publicly elected official;
• for all others: by the well owner (person(s) listed on the property deed).
If an authorized agent is signing on behalf of the applicant, then supply a letter
signed by the applicant that names and authorizes their agent to sign this
application on their behalf.
"I hereby certify, under penalty of law, that l have personally examined and am familiar with
the information submitted in this document grid all attachments thereto and that, based on my
inquiry of those individuals immediately responsible for obtaining said information, 1. believe
that the information is true, accurate and complete. l am aware that there are significant
penalties, including the possibility of fines and imprisonment; for submitting false
information, l agree to construct, operate, maintain, repair, acid if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications
and conditions of the Permit."
tignature f T, ropettyWwm/A p lican t
a Cr-jY7a.
Print or Type Full Name
Signature of Property flamer/Applicant
Print or Type Full Name
Signature of Authorized Agent, if any
Pfint or Type Full Name
7

Submit two copies of the completed application package to:
Underground Injection Control Program
NC Division of Water Re.,ources
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Open-Hole Well Design
Design
Proposed Existing
Injection; SuppJy;
Dual Purpose
Land Surface
k o <Ft-> +-·-
(Ft.)
Reeord Deplbs Below Land Swi'aee on l,ioes Provhkd
Reeord Depths Below Laud Surface oa Uoes Provided
Return or-Supply Line
Casing
Grout
WELL DETAILS
Casing Material: __ p_v_c__.· _____ _
Casing Diameter (in.): z__
Casing Thickness {in.): s· 0 (l. l ~ I
Grout Type: t'S t! ,..,-k i_, l ±:e-:
(cement, bentonite, or mix)
8
Screened Well
Proposed Existing
Injection; Supply; /
Dual Purpose
Screen Material: p
Screen Slot Size (in.): _ _r n t 0 a " i 0
Sand/Gravel Pack
Material:
Bedrock
Open Hale
(Ft.)
(F-)
(FQ
Screed . -
Bentonite Seal
rifPresent)
Sand/Gravel Pack
0

Govgle earth feet~1 :::::::-:_-:_-:_-:_-:_-:_-:_-:_-:_-:_-:_-:_-:_-:_-_-_-1000
rretersr-300
-----------
Pt
V-4 0
x
onton Ni
'Injection" ell 4w,
.106 N , -4
xcotoli L 60 P
c 'Zolfir-empi
NI
I

44
e. } 9r
AN
,'Supply Wells r' ,.:.;•.
IN
'� ; •,e `~a - f' ,' • ��.h Septic System 106 Nixonton Loop
PIT f-
IL
. _m A0 - _ . T - •��•

Pasquotank County Tax Query Results � V �D0y 0 2---
Page 1 of 2
PASQIIOTANK COUNTY RESIDENTIAL PROPERTY INFORMATION
Tax lnfo Mao, ales Election Info
Location: 00106 Acct: PIN: MAP: Deed:
NIXONTON 111538 890003427523 P12A- 917/583
LOOP 83
Ownor
CRITZ, MARY REV LIV
TRUST
106 N IXONTON LOOP
ELIZABETH CITY, NC
27909
Assessment
Prior
$30100.00 Current $2'1,'100.00
Land:
Land
Prior
$70,600.00 Current $78,200M
Bldg:
Bldg
Prior
T
Current
$100,700.00 $99,300.00
atal . Total
Taxed Acres: 0.316
'Estimated* 2013 County Tax: $634.41
*Estimated* 2014 County Tax: $754.68
NIxONTON
Click here to send PasQuotank County a
better/correct
picture. PJD: 0003306
Last Update: 2D130419
DATE
SALES TYPE SALE, PRICE
20060601
LAND+BLDG $ 0.00
LAND TYPE
SIZE
PRIMARY
13750.0 SO FT
01w
Deed Date:
20060601
SOURCE ASSESSMENT DEED BOOKIPAGE
100,700.0D 9171583
MKT Value
$ 21,120.00
DWELLING DATA (SEE DISCLAIMER)
COST DATA
STYLE
i BUNGALOW
BASE PRICE
$ 106,200.00
STORY HEIGHT
11.5
PLUMBING ADJ
$ 0.00
ATTIC
I NONE
HEATINGIAC ADJ
$ 3,910.00
BEDROOMS
13
EXTERIOR TRIM
$ 0.00
TOTAL ROOMS
16
FINISHED BASEMENT ADJ
$ 2
FULL BATHS
I 1
FIREPLACES
$ 4,090.00
HALF BATHS
10
ADDITIONS
$ 1D,OD0.00
YEAR BUILT
11950
SUBTOTAL
$ 130,090,00
YEAR REMODELED
10
GRAPE FACTOR
1.0
GROUND FLOOR AREA
11010.0
REPLACEMENT COST
$ 130,090.00
TOTAL LIVING AREA
11515
PERCENT GOOD
57°%
CONDITION
j AV
RCNLD
$ 74.200.00
DISCLAIMER: DWELLING DATA BASED ON OBSERVATION AND MAY NOr REFLECT ACTUAL VALUES. DWELLING DATA DOES NOT
htty://www.co,t)asQuotank-.nc.us/GIS/Tax/taxcard.cfm?PIN=890003427523 6/22/2015

Pasquotank County Tax Query Results
AFFECT THE VALUATION OF PROPERTY.
OUTBUILDING DATA
Type
RGI
32
Qty
12
Year Size Grade
1988 20Xl8.0 D
20
10 FOB
@)
20
34 14 ~f 280
20
23
1.5Fr
Ci§)
10
10
10 10 EFP 10
12 ~ 1
Con<!
F
10
14
Mode
Code
0000
o .. c,iotor/Area
A:1.5Fr
1010 gqft
8:FUB
200sqll
C:EFP
100sqlt
O:Carl!OII
280 sqft
MKT Adj RCN %GD Value
0 7859.339 51.0 $ 4010.0
htto://www.co.oasouotank.nc.us/GIS/Tax/taxcard.cfm?PIN=890003427523
Page 2 of2
6/22/2015
, AQUIFER PROTECTION SECTION -GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
Date: 6/23/15 Permittee(s): Ma ry L. Critz
Permit No.: WI0700402
To: APS Central Office County: Pas 9 uotank
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 ~ UIC Well(s)
~ New D Renewal
D Minor Modification~ 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 ~ Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ~ Yes or D No. -------------------=--....,Mrtta;-----'
RE.CENE.OIOENRIO'Nt\ a. Date of site visit: 6/22/15
b. Person contacted and contact information: JP Simpson (252 ) 267-6466
c. Site visit conducted by: R. Si pe & D. May
d. Inspection Report Attached:~ Yes or D No.
2. ls the following information entered into the BIMS record for this application correct?
j'J~ 2 5 7.G\5
. Reg\0110\
water a~a\\\)! section operat,ons
~ Yes or D No. Ifno, 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 VIC Injection Sites:
_ If multi Jle sites either indicate which sites the information a 11lies to . co pv and 12 aste a new section into the
document for each site . or attach additional pa.e.es for each site )
a. Location(s): 106 Nixonton Loo . Elizabeth Ci tv. NC 27909
b. Driving Directions: From Hwv 17 take Halls Creek Rd south a pp rox. 3.6 miles. Turn ri ght on Nixonton
Rd. Go a pp rox.1.3 miles. Turn ri i,,ht on Nixonton Loo p. Go a pp rox. 0.2 mile to site on left.
c. USGS Quadrangle Map name and number: __
d. Latitude: 36.199668N Longitude: 76.272170W
Earth.
APS-GPU Regional Staff Report (Sept 09)
Method Used (GPS, Google™, etc.); Google
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
I. Type of injection system:
C8J Heating/cooling water return flow (SA 7)
D Closed-loop heat pump system (SQM/SQW)
D In situ remediation (SI)
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 C8J No
3. Are there any potential pollution sources that may affect injection? D Yes C8J 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? 15 ft.
S. Qua! ity of drainage at site: D Good C8J Adequate D Poor
6. Flooding potential of site: C8J 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)? D Yes or D No. If
no or no map, please attach a sketch of the site. Show prope11y boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow. Ma o pendin g info from driller .
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 D No. N A, new S vstem.
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 ves . ex plain: NA
3. For renewal or modification of g roundwater remediation permits (of an v tvpe ). will
continued/additional/modified injections have an adverse im pact on mi gration of the plume or mana!l ement of
the contamination incident? D Yes D No. If es . ex Jlain: NA
APS-GPU Regional Staff Report (S ept 09) P age 2 of 4 Pages
AQUIFER PROTECTION SECTION -GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
4. Drilling Contractor: Name: John Paul Sim pson
Address: 118 Leeward Dr.
Grandy, NC 27939
NC Certification number: 2930-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 site
conditions or locations of pro posed in j. and su pp h wells. Recommend that permit be issued.
2. Attach new Injection Facility Inspection Form, if applicable
3. Do you foresee any problems with issuance/renewal of this permit? 0 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
AQUFER PROTECTION SECTION — GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
T Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information;
Issue; ❑ Deny. If deny, please state reasons:
S. Signature of report Preparer(s):
Signature of APS re '11iion21 supery
Date:
III. ADDITIONAL INFOR1iIATIONAND SITE MAP (Sketch o/ site showing; house and waste irrimation
sit syem xyrav or drip field. Location of weft, andlor other relevant information- SHOW NORTH ARROWi
Site anal, will be j-�rovided once final well locations are determined b� driller.
APS-GPU Regional Staff Report (Sept 09) Page 4 of 4 Pages

North Carolina Department of Environment and Natural Resources
Division of Water Quality-Aquifer Protection Section
INJECTION FACILITY INSPECTION REPORT
PERMIT NO. WI0700402
DA TE OF INSPECTION: 6/22/15
INSPECTOR: R. Sipe and D. May w/WQROS WaRO
NAME OF PERMITTEE(S) Mary L. Critz
MAILING ADDRESS OF PERMITTEE 106 Nixonton Loop., Elizabeth City, NC 27909
PHYSICAL ADDRESS OF SITE (if different than above) _________________ _
PERSON MET WITH ON-SITE JP Simpson; TELE NO.[phone]
WELL(S) STATUS:
__ Existing and operating Class V Well
__ Existing well proposed to be converted to Class V well
_X_Proposed/not constructed
LAT/LONG OF WELL(S) 36.199668N, 76.272170W
Appx. distance of well to property boundaries: 15 feet(both proposed supply and inj. wells)
Appx. distance of well from foundation of house/structure: 25+feet (both proposed supply and inj. wells)
Appx. distance of well from septic tank/field (if present): 50+ feet (both proposed supply and inj. wells)
Appx. distance of well to other well(s) (if present): Proposed inj. well approx. 20 feet from proposed supply well.
Ap px. distance to other sources of pollution: ___________________ _
Flooding Potential of Site: _high __ moderate __K_low
Comments: WaRO representatives discussed the proposed well locations with the driller, Mr Simpson, Final
locations will depend locations of septic systems on adjacent properties.
Injection Facility lnsp. Report (Rev. Sept 2009) Page I of 3 Pages
Map to be Forwarded upon, receipt from Driller
DRAW SKETCH OF SITE ABOVE (Show property boundaries, buildings, other wells, septic tanksldrai�Ids, 'eother
poieniial pollution sources, roads, approxiinate scale, d NORTH arrow}
X„ .[4eL�C pfa5e ( [jEtj C��.GpQs�
� P s �� r
V _.-W <t 0 C.
?W
c 7
to (
J
Draw Schematic of well above showing TD, casing depth, grout, etc.
Injection Facility In%p. Report {Rev. Scpl2004'} Page 2 of 3 Pages

Well Construction Information
Date Constructed: TBD
Well Contracting Company: JP Enterprise
Well Driller Name: John Paul Simpson
NC Well Cert. No.: 2930-A
Address: 118 Leeward Dr., Grandy, NC 27939
Telephone No.:[phone]; Cell No.: ________ _
Email Address: -----------
Proposed Depth of Well(s): 60 feet
Total Depth: TBD Total Depth of Source Well, if present: 60 feet (proposed)
Casing (proposed)
Depth: 0 to 40 feet; Diameter: 2 inches; Type (gav. steel, PVC, etc.): Sch. 40 PVC; Stick Up: TBD, minimum
of 12 inches.
Grout: (proposed)
Depth: 0 to 40 feet; Type (cement, bentonite, etc.):Bentonite; Placement (pumping, press. etc.):TBD
Well ID Plate Present (Y or N): _NA_; Heat Pump ID plate present (Y or N): _NA_
Influent spigot (Y or N): __ N __ Effluent spigot (Y or N): __ Y'--
Well Sampled? (Y orN): _NA_; IfYes, Lab Sample ID numbers:
Static Water Level: TBD
Injection Information (if applicable):
Injection Rate: _______ GPM
Injection Pressure: PSI
Injection Volume: GPD
Temperature-Summer: P0
Temperature-Winter: P0
Comments/Notes: Both inj. well and supply well proposed have a TD of 60 feet. Supply well proposed to use 10
feet of 0.010 screen and inj. well proposed use 20 feet of 0.020 screen. Annular space in both wells proposed to
have bentonite grout. __________ _
Injection Facility Insp. Report (Rev. Sept 2009) Page 3 of 3 Pages
Permit: WI0700402
SOC:
County: Pasquotank
Region: Washington
Contact Person: Mary L Critz
Directions to Facility:
Effective:
Effective:
Com p liance Ins pection Re port
Expiration:
Expiration:
Title:
Owner : Mary L Critz
Facility: Mary L. Critz SFR
106 Nixonton Loop
Elizabeth Cly NC 27909
Phone:
From Hwy 17 take Halls Creek Rd. south approx. 3.6 miles. Turn right on Nixonton Rd. Go approx. 1.3 miles. Turn right on Nixonton
Loop. Go approx. 0.2 mile to site on left.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 06/22/2015 Entry Time: 10:30AM Exit Time: 11 :30AM
Primary Inspector: Dwight R Sipe Phone:
Secondary lnspector(s):
Reason for Inspection: Routine Inspection Type: Reconnaissance
Permit Inspection Type: Injection Heating/Cooling Water Return Well
Facility Status: D Compliant D Not Compliant
Question Areas:
■ Other
(See attachment summary)
Page: 1
Permit: WI0700402
Inspection Date: 06/22/2015
Owner -Facility: Mary L Critz
Inspection Type: Reconnaissance Reason for Visit: Routine
Inspection Summary:
On 6/22/15 R. Sipe and D. May w/ WaRO WQROS performed a site visit as part of the review for a application for a
geothermal return well in the subject property. We met with JP Simpson, the driller, and Chad Critz, the son of the
properrty owner. We reviewed site conditions and discussed proposed locations for the inj. and supply wells. It appeared
the proposed locations would meet the applicable setbacks. Final locations will be dependant on the locations of the
septic systems on adjacent properties, which Mr. Simpson is going identify and provide a site map to WaRO. Based on
the results of this site visit, this office had no objections to issuance of the proposed permit.
Page: 2
Permit: WI0700402
Inspection Date: 06/22/2015
Other
Comment:
Owner -Facility: Mary L Critz
Inspection Type: Reconnaissance Reason for Visit: Routine
Yes No NA NE
Page: 3
WASHINGTON REGIONAL. OFFICE - ❑WR WOROS - PHOTOGRAPHIC RECORD
Site Name:
Critz Residence
1ncidentlPermit Number: W10700402
Site Location: 106 Nixonton Loop
Site Town/City:
Elizabeth Cit , NC
Photographer:.;
a
Photographer:
R. Sipe
R. Sipe
Date:
Date:
�
•e
6/2212015
6/2212045
Photo Location
Photo Location:
Residence
Residence
Backyard
Backyard
Photo Direction.
Photo Direction:
. y�
• '
r
Comments:
Comments:
'
r'
area of proposed
area of proposed
supply well
supply well
n
Photographer:
Photographer:
R. Sipe
R. Sipe
f
Date:
`
Date:
M
6122/2015
Photo Location:
612212015
Photo Location:
r
,
Residence
Backyard
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Residence
Backyard
Photo Direction:
Photo Direction:
NW
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SW
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Comments:
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Comments:
area of proposed
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area of proposed
nj. well
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inj. well
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