WI0800014_GEO THERMAL_20191114

ROY COOPER
Governor
MICHAELS. ~GAN
Secretary
LINDA CULPEPPER NORTH CAROLINA
Ennranmentul Quality Director
Graham & Maeomie Mosely
213 7 Auburn Lane
Wilmington, NC 28405
Subject: Permit Rescission
November 14, 2019
UIC Permit No. WI0800014
Geothermal Heating/Cooling Water Return Well
New Hanover County
Dear Mrs. and Mrs. Mosely:
Reference is made to your request for rescission of the subject Geothermal Heating/Cooling Water
Return Well Permit located at 2137 Auburn Lane, Wilmington, NC 28405. Staff from the
Wilmington Regional Office has agreed that a permit is no longer required. Therefore, in
accordance with your request, Underground Injection Control (UIC) Permit WI0800014 is
rescinded, effective immediately.
If in the future, you wish to operate a Geothermal Heating/Cooling Water Return Well injection
system, you must first apply for and receive a new permit. Operating a geothermal h~at pump
injection system without a valid permit may result in the assessment of civil penalties and/or the
use of other enforcement mechanisms available to the state.
If it would be helpful to discuss this matter further, please do not hesitate to call Shristi Shrestha
at [phone].
Attachment( s)
Sincere y,
or Linda Culpepper, Director
Division of Water Resources
cc: Wilmington Regional Office -WQROS
Central Files -Permit No. WI0800014
New Hanover County Environmental Health Dept.
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street I 1&36 Mall Service Center I Raleigh, North Carolina 27699-1636
919.707.9000
Department of Environmental Quality - Division of Water Resources
STATUS OF INJECTION WELL(S)IPERMIT RESCISSION REQUEST FORM
Permit Number:
G-na-�O-m MID
Permittee Name(s):
Mailing Address: ,/—Zl , / r�► LG 'La "fy-j� Q,�
Physical Address of Wells) (if different than mailing address):
city _Coiinty�da n D Vie �_ zip code, ga.5
Daytime Telephone No.: Cell No.:
Email Address: 222q ho a5P-1rf � �1� .. Y�. +� Q YA
Please check the selection which must closely describes the current status of your system;
1) ❑ WCII(s) still used for injection activities
2) ❑ Well(s) not used for injection but used for other purposes: a) Ll Water Supply
b) ❑ Recovery
c) ❑ Irrigation
d)Cl Monitoring
3) Er injection discontinued and: a) i=] Weil(s) temporarily abandoned
b) IEi'OVell(s) permanently abandoned
c) ❑ Well(s) not abandoned
4) ❑ Injection ►vell(s) never constructed ❑ NIA injection well(s) never proposed
Well(s) Abandonment/Comments:
If you checked (3)(a) or (h), attach a copy of the GW-30 (Weil Abandonment Record). If not applicable, then describe
the method used (or to be used) to abandon the we, ll(s), including a description of how the well were sealed and material
used. if the work below is proposed a GW-30 wilt need to be submitted to lie UIC Program 30 days after abandonment.
- W I tI0� �4A 0�+ /y7 fA 5 $—%E t) PF'7A52I-'iV f� rD f'w I A��1V
- - -- - vR ��� _ .�f •y• f cram. w �.0 — - c /. t.,*,*. 75 ■ Ld2ll A 0J
Permit Rescission:
If you checked (2), (3), or (4) and will not use a well for injection on this site in the future, you should request rescission
of the permit. Do you wish to rescind the permit?
Z Yes ❑ No
Certification:
"I hereby certify, under penalty of law, which I have personally examined and am familiar with the infortnat'ton submitted
in this document, and that to the best ofknowledge the information is true, accurate, and complete."
Signature Date
.tQ�l pre, kt' SA6y �]►►�f I/ S�•�ftvrs V
Pratt orlfype Name Title
, .2 5-,5 A
GLW68 Injection Well Status Form Rev. 3-1=2016 Page I of I

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Joey Cobarobius
Well Contractor Name (or well owner personally abandoning well on his/her property)
4055-A
NC Well Contractor Certification Number
Craigs Well Drilling, LLC
Company Name
2. Well Construction Permit#: W 10800014 -----------------List all applicable well construction pennits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
l!lhri gation
Non-Water Supply Well:
□Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □ Salinity Barrier
□Aquifer Test □ Stormwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop) □Tracer
□Geothermal (Heating/Cooling Return) □Other (explain under 7g)
4. Date well(s) abandoned: _1_0_/_7_/_1 _9 ___ _
Sa. Well location:
Graham Mosely
Facility/Owner Name Facility ID# (if applicable)
2137 Auburn Lane, Wilmington, NC 28405
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34 15 122 N 77 48 155
-----------
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
w
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one fonn.
6a. Well ID#: _________ _
6b. Total well depth: _5_4 ______ (ft.)
6c. Borehole diameter: _8 ______ (in.)
6d. Water level below ground surface: _2_4 ______ (ft.)
(4" steel) 6e. Outer casing length (if known): ________ (ft.)
6f. Inner casing/tubing length (if known): ______ (ft.)
6g. Screen length (ifkuown): __________ (ft.)
I For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:. _______________ _
7b. Approximate volume of water remaining in well(s): ______ (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used: _H_T_H ____________ _
7d. Amount of disinfectant used: _1_I_b_. __________ _
7e. Sealing materials used (check all that apply):
□ Neat Cement Grout
□ Sand Cement Grout
□ Concrete Grout
D Specialty Grout
D Bentonite Slurry
II Bentonite Chips or Pellets
D Dry Clay
□ Drill Cuttings
□ Gravel
□ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Hole Plug 7 bags
7g. Provide a brief description of the abandonment procedure:
Cut well below grade
Disinfected Well
Filled with Hole Plug
Capped with Hole Plug
8. Certification:
H-.M.~e 10/7/19
Signature ofCeitified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
IOa. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
IOb. For Injection Wells: In addition to sending the form to the address in !Oa
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
IOc. For Water Supplv & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
FormGW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
Water Resources ~
Fnvirwinlenw Quality
January 25, 2018
Graham and Maeomie Mosely
2137 Auburn Lane
Wilmington, NC 28405
Subject: Geothermal well sampling, results
Permit Number W10800014
New Hanover County
Dear Mr. and Mrs. Mosely:
� C3P�'�1ti
RGY COOPER
Goveynor
MICHAEL S. REGAN
sm elwy
LINDA CULPEPPER
Interim Director
On November 30, 2017 staff from the Division of Water Resources sampled the influent and
effluent from your geothermal heat pump system. The samples were analyzed by the Division's
laboratory for coliform, total dissolved solids, metals, nitrates and other inorganic constituents.
No exceedances of the State Groundwater Standards were observed except for iron (Fe) and
manganese (Mn). Iron and manganese levels present in both samples were above the State
standards of 300 uglL and 50 ug/L, respectively. Both iron and manganese are naturally
occurring and commonly found in groundwater in this region. A copy of the tab results are
enclosed for your review.
Should you have any questions concerning this letter, please feel free to contact me at (910) 796-
7215 or by email at geoff.kegley�,ncdenr.gov.
Sincerely,
�
7
Geoff Kegley
Water Quality Regional Operations Section
Wilmington Regional Office
Division of Water Resources. NCDENR
Enclosure: sample results
cc: DWR-WiRO files
Shristi Shrestha, DWR Central Office
State of North Carolina I Environmental Quality
1611 Mail Service Center I Raleigh, North Carolina 27699-16I1
919-707-9000

AC45604
Loe. Descr.:
County:
Region:
River Basin
Emergency
COC Yes/No
North Carolina Division of Water Resources Water Sciences Section Laborato ry Results
WI000014 E Sample ID: AC45604
New Hanover Collector: G KEGLEY VisitlD PO Number#
WIRO Report To WIRO Location ID: WIRO NLC Date Received: 12/01/2017
Collect Date: 11/30/2017 Priority ROUTINE Time Received: 08:10
Collect Time: .11.;1§ Sample Matrix: GROUNDWATER Labworks LoginlD MSWIFT
Sample Depth Loe. Type: WATER SUPPLY Delivery Method NC Courier
Final Report Date: 1/24118
Report Print Date: 01/2412018
Final Re port
If this report is labeled preliminary report, the results have not been validated. Do .not use for Regulatory purposes.
Result/ Units Method Anal'.'.lsis
CAS # Anal yte Name POL Qualifier Reference Date Validated b~
LAB
Sample temperature at receipt by lab 0.6 ·c 12/1/17 PGAUTHIER
MIC
Coliform, MF Fecal in liquid 1 B2Q1 CFU/100ml SM 9222 D-1997 12/1/17 ESTAFFORD1
Coliform, MF Total in liquid 1 B2Q1 CFU/100ml SM 9222 B-1997 12/1/17 ESTAFFORD1
NUT
NO2+NO3 as N in liquid 0.02 0.02 U mg/Las N EPA 353.2 REV 2 12/6/17 CGREEN
WET
Bromide 0.4 0.4 U mg/L EPA 300.0 rev2.1 12/5/17 CGREEN
Chloride 1.0 17 mg/L EPA 300.0 rev2.1 12/5117 CGREEN
Fluoride 0.4 0.4 U mg/L EPA 300.0 rev2.1 12/5/17 CGREEN
Sulfate 2.0 3.8 mg/L EPA 300.0 rev2.1 12/5/17 CGREEN
Total Dissolved. Solids in liquid 12 260 mg/L SM 2540 C-1997 12/5/17 CGREEN
MET
7440-22-4 Ag by ICPMS 1.0 1.0 U ug/L EPA 200.8 Rev5.4 1/4/18 ESTAFFORD1
7429-90-5 Al by ICP 50 50 U ug/L EPA 200.7 Rev4.4 1/12/18 ESTAFFORD1
7440-36-0 Antimony by ICPMS 10 10 U ug/L EPA 200.8 Rev5.4 1/4/18 ESTAFFORD1
7440-38-2 As by ICPMS 2.0 2.0 U ug/L EPA 200.8 Rev5.4 1/4/18 ESTAFFORD1
7440-38-3 Ba by ICP 10 18 ug/L EPA 200.7 Rev4.4 1/12/18 ESTAFFORD1
7440-41-7 Be by ICP 5.0 5.0 U ug/L EPA 200.7 Rev4.4 1/12/18 ESTAFFORD1
7440-70-2 Ca by ICP 0.10 79 mg/L EPA 200.7 Rev4.4 1112/18 ESTAFFORD1
7440-43-9 Cd by ICPMS 0.50 0.50 U ug/L EPA 200.8 RevS.4 1/4/18 ESTAFFORD1
7440-48-4 Cobalt by ICP 50 50 U ug/L EPA 200.7 Rev4.4 1/12/18 ESTAFFORD1
7440-47-3 Cr by ICPMS 5.0 5.0 U ug/L EPA 200.8 Rev5.4 1/4/18 ESTAFFORD1
7440-50-8 Cu by ICPMS 2.0 19 ug/L EPA 200.8 Rev5.4 1/4/18 ESTAFFORD1
7439-89-6 Fe by ICP 50 2900 ug/L EPA 200.7 Rev4.4 1/12/18 ESTAFFOR01
7440-09-7 K by ICP 0.10 0.87 mg/L EPA200.7 Rev4.4 1/12/18 ESTAFFORD1
7439-93-2 Li ICP 25 25 U ug/L EPA 200.7 Rev4.4 1/12/18 ESTAFFOR01
7439-95-4 Mg by ICP 0.10 2.7 mg/L EPA 200.7 Rev4.4 1/12/18 ESTAFFORD1
7439-96-5 Mn by ICP 10 99 ug/L EPA 200.7 Rev4.4 1/12/18 ESTAFFORD1
7439-98-7 Mo by ICPMS 10 10 U ug/L EPA 200.8 Rev5.4 1/4/18 ESTAFFORD1
7440-23-5 Na by ICP 0.10 12 mg/L EPA 200.7 Rev4.4 1/12/18 ESTAFFORD1
7440-02-0 Ni by ICPMS 2.0 2.0 U ug/L EPA 200.8 RevS.4 1/4/18 ESTAFFORD1
7439-92-1 Pb by ICPMS 2.0 2.0 U ug/L EPA 200.8 Rev5.4 1/4/18 ESTAFFORD1
7782-49-2 Se by ICPMS 1.0 1.0 U ug/L EPA 200.8 Rev5.4 1/4/18 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 (9191 733-3908
"Not Detected" or "U" does not indicate the sample is analyte free but that the analyte is not detected at or above the POL.
Page 1 of 2
,------------------------------------------------------·---
:NC ©'¾J.J( La6oratory Section 'Rgsufrs/Samp{e Comments/Qua{ifier (})e_fimtwns
Sample ID AC45604
CAS # Anal yte Name PQL Result/ Method Anal'.l'.:sis
Qualifier Units Reference Date V~lidated b i
7440-28-0 Thallium (Tl) ICPMS 20 2.0 U ug/L EPA 200.8 Revs 4 1/4/18 ESTAFFORD1
7440-62-2 V by ICP 10 10 U ug/L EPA 200.7 Rev4.4 1/12/18 ESTAFFORD1
7440-66-6 Zn by ICPMS 10 10 U ug/L EPA 200.8 Rev5.4 1/4/18 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
"Not Detected" or "U" does not indicate the sample is analyte free but that the analyte is not detected at or above the POL.
Page 2 of 2
AC45605 North Carolina Division of Water Resources Water Sciences Section Laborato ry Results
Loe . Descr.: WI000014 I Sample ID : AC45605
County : New Hanover Collector: G KEGLEY VisitlD PO Number#
Region : WIRO Report To WIRO Location ID: WIRO NLC Date Received : 12/01/2017
River Basin Collect Date: 11/30/2017 Priority ROUTINE Time Received : 08 :10
Emergency Collect Time: 11 :00 Sample Matrix: GROUNDWATER Labworks LoginlD MSWIFT
COC Yes/No Sample Depth Loe. Type: WATER SUPPLY Delivery Method NC Courier
Final Report Date: 1/24/18
Report Print Date: 01/24/2018
Final Re port
If this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
ResulU Units Method Analysis
CAS # Anal yte Name PQL Qualifier Reference Date Val ida ted b~
LAB
Sample temperature at receipt by lab 0.6 "C 1211117 PGAUTHIER
MIC
Coliform, MF Fecal in liquid 1 8201 CFUl100ml SM 9222 D-1997 12/1117 ESTAFFORD1
Coliform, MF Total in liquid 1 B2Q1 CFU/100ml SM 9222 8-1997 12/1/1 7 ESTAFFORD1
NUT
NO2+NO3 as N in liquid 0.02 0.02 U mg/Las N EPA 353.2 REV 2 1216117 CGREEN
WET
Bromide 04 0.4 U mg/L EPA 300.0 rev2 .1 12/6117 CGREEN
Chloride 1.0 17 mg/L EPA 300 .0 rev2 .1 12/6117 CGREEN
Fluoride 04 0.4 U mg/L EPA 300.0 rev2 .1 12/6117 CGREEN
Sulfate 2.0 3.9 mg/L EPA 300.0 rev2.1 12/6117 CGREEN
Total Dissolved Solids in liquid 12 260 mg/L SM 2540 C-1997 12/5117 CGREEN
MET
7440-22-4 Ag by ICPMS 1.0 1.0 U ug /L EPA 200.8 Rev5.4 114118 ESTAFFORD1
7429-90-5 Al by ICP 50 50 U ug/L EPA 200.7 Rev4.4 1112118 ESTAFFORD1
7440-36-0 Antimony by ICPMS 10 10 U ug/L EPA 200.8 Rev5.4 114/18 ESTAFFORD1
7440-38-2· Asby ICPMS 2 .0 2.0 U ug /L EPA 200 .8 Rev5.4 114/18 ESTAFFORD1
7440-38-3 Ba by ICP 10 17 ug /L EPA 200 .7 Rev4.4 1/12/18 ESTA FFORD1
7440-41-7 Be by ICP 5.0 5.0 U ug/L EPA 200.7 Rev4.4 1112118 ESTAFFORD1
7440-70-2 Ca by ICP 0.10 78 mg/L EPA 200.7 Rev4.4 1112118 ESTAFFORD1
7440-43-9 Cd by ICPMS 0.50 0.50 U ug/L EPA-200.8 Rev5.4 114/18 ESTAFFORD1
7440-48-4 Cobalt by ICP 50 50 U ug/L EPA 200. 7 Rev4.4 1112/18 ESTAFFORD1
7440-47-3 Cr by ICPMS 5.0 5.0 U ug/L EPA 200.8 Rev5.4 114/18 ESTAFFORD1
7440-50-8 Cu by ICPMS 2.0 2.0 U ug/L EPA 200.8 Rev5.4 114118 ESTAFFORD1
7439-89-6 Fe by ICP 50 2700 ug/L EPA 200 .7 Rev4.4 1112118 ESTAFFORD1
7440-09°7 K by ICP 0.10 0.84 rng/L EPA 200.7 Rev4.4 1/12118 ESTAFFORD1
7439-93-2 Li ICP 25 25 U ug/L EPA 200.7 Rev4.4 1112118 ESTAFFORD1
7439-95-4 Mg by ICP 0.10 2.6 mg/L EPA 200.7 Rev4.4 1/12118 ESTAFFORD1
7439-96-5 Mn by ICP 10 95 ug/L EPA 200.7 Rev4.4 1/12118 ESTAFFORD1
7439-98-7 Mo by ICPMS 10 10 U ug/L EPA 200.8 Rev5.4 1/4/18 ESTAFFORD1
7440-23-5 Na by ICP 0.10 12 mg/L EPA 200.7 Rev4.4 1/12118 ESTAFFORD1
7440-02-0 Ni by ICPMS 2.0 2.0 U ug/L EPA 200.8 Rev5.4 1/4/18 ESTAFFORD1
7439-92-1 Pb by ICPMS 2.0 2.0 U ug/L EPA 200.8 Rev5.4 114/18 ESTAFFORD1
7782-49-2 Se by ICPMS 1.0 1.0 U ug l l EPA 200.8 Rev5.4 1/4/18 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 (9191 733-3908
"Not Detected" or "U" does not indicate the sample is analyte free but that the analyte is not detected at or above the POL
Page 1 of 2
----·
:NC ID'!Vl\_ La6oratory Section 'i{f:su[t,!Sampf.e Cam ments/Qua[ifier<Definitions
Sample ID : AC45605
CAS # Anal yte Name PQL Result/ Method Analysis
Qua lifier Un it s Reference Date Validated by
7440-28-0 Thallium (Tl) ICPMS 2.0 2.0 U ug/L EPA 200 .8 RevS.4 114/18 ESTAFFORD1
7440-62-2 V by ICP 10 10 U ug/L EPA 200.7 Rev4.4 1/12/18 ESTAFFORD1
7440-66-6 Zn by ICPMS 10 10 U ug/L EPA 200.8 RevS.4 1/4/18 ESTAFFORD1
WSS.Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
"Not Detected" or "U" does not indicate the sample rs analyte free but that the analyte rs not detected at or above the POL
Page 2 of 2
Permit Number
Program Category
Ground Water
PennltType
WI0800014
Injection Heating/Cooling Water Return Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Graham and Maeomie Mosely SFR
Location Address
2137 Auburn Ln
Wilmington
Owner
Owner Name
Graham
Dates/Events
Orig lasue
11/20/1997
NC
App Received
9/6/2017
Reg ulated Activities
Heat Pump Injection
Outfall
Waterbody Name
28405
Mosely
Draft Initiated
Scheduled
Issuance Publlc Notice
Central Files: APS SWP
12/11/2017
Permit Tracking Slip
Status
In review
Version
Project Type
Renewal
Pennit Classification
Individual
Permit Contact Afflllation
Graham Mosely
2137 Auburn Ln
Wilmington NC 28405
Major/Minor
Minor
Region
Wilmington
County
New Hanover
Facility Contact Afflllatlon
Owner Type
Individual
Owner Affiliation
Graham Mosely
2137 Auburn Ln
Wilmington
Issue
12/13/2017
Effective
12/13/2017
NC 28405
Expiration
11/30/2022
Requested /Received Events
RO staff report requested
RO staff report received
Streamlndex Number Current Class
9n/17
1217/17
Subbasin
I'm
Water Resources
Snvironrnental Quality
Graham & Maeomie Mosley
2137 Auburn Ln
Wilmington, NC 28405
December 13, 2017
Re: Issuance of Injection Well Permit
Permit No. W10800014
Geothermal Heating/Cooling Water Return Well
New Hanover County
Dear Mr. and Mrs. Mosley:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
In accordance with your permit renewal application received on September 5, 2017, 1 am forwarding
Permit No. W10800014 for the continued operation of geothermal heating/cooling water return well
located at the above referenced address. This permit shall be effective December 13,2017, until
November 30, 2022, and shall be subject to the conditions and limitations stated therein.
Please Note:
Samples from the influent and effluent sampling ports of your geothermal well system
were collected on November 30, 2017. 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. If you have any questions regarding your permit or the Underground
Injection Control Program please call me at [phone].
Best Regards,
91 d
Shristi Shrestha
Underground Injection Control (UIC)- Hydrogeologist
Division of Water Resources, NCDEQ
Water Quality Regional Operations Seai9n Nt?tn[ng Compares
State ofhorlh Carolina I Environmental Quality I Division of Water Resources
water Quality Regional operations Section
1636 Mail Service Center I Raleigh, North Carolina 27699-1635
919-707-9129

cc: Morella Sanchez-King-Geoff Kegley, Wilmington Regional Office
Central Office File, WI0800014
New Hanover County Environmental Health Department
NORTH CAROLI YA
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
Graham & Maeomie Mosley
FOR THE CONTINUED OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER
RETURN WELL(S), defined in Title 15A North Carolina Administrative Code 02C .0224(a), which will be used
for the injection of heat pump effluent. The injection.well(s) located at 2137 Aurbum Ln, Wilmington, New
Hanover County, NC 28405 will be operated in accordance with the application submitted September 5, 2017,
and in conformity with the specifications and supporting data, all of which are filed with the Department of
Environmental Quality and are considered a part of this permit.
This permit is for continued 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 pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until November 30, 2022, and shall
be subject to the specified conditions and limitations set forth in this permit.
Permit issued this the 13'h day of December 2017.
For Linda Culpepper
Interim Director, Division of Water Resources
By Authority of the Environmental Management Commission.
Permit #WI08000I4 UICJSA7 Page 1 of 5
ver. 11/15/20I5

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 in accordance
with the requirements of rule 15A NCAC 02C .0107 except as required in Item #2 below.
2. Any injection well shall be constructed in accordance with the requirements of rule 15A NCAC 02C .0107
except that the entire length of the casing shall be grouted in such a way that there is no interconnection of
aquifers or zones having differences in water quality that would result in degradation of any aquifer or zone.
For screened wells, grout shall be emplaced from the top of the gravel pack to the land surface. For open-
end wells, the casing shall be grouted from the bottom of the casing to the land surface [15A NCAC 02C
.0224(d)(2),(3)].
3. Bentonite grout shall not be used to seal any water-bearing zone with a chloride concentration equal to or
greater than 1,500 milligrams per liter. In areas where elevated chloride levels are known to exist or are
probable, such as coastal areas, chloride levels shall be verified in the field to determine existing conditions.
[15A NCAC .0225(g)(8)].
4. The injection well system shall be constructed such that a sampling tap or other collection equipment
approved by the Director provides a functional source of water when the system is operational. Such
equipment shall provide the means to collect a water sample immediately after emerging from the water
supply well and immediately prior to injection into the return well [15A NCAC 02C .0224(d)(4)].
5. Each well shall be secured to reasonably insure against unauthorized access and use and shall be sealed
with a watertight cap or well seal as defined in G.S. 87-85(16).
6. Each well shall have permanently affixed an identification plate [15A NCAC 02C .0107(j)(2)].
Pennit#WI0800014 UIC/SA7
ver. 11/15/2015
Page 2 ofS
7. A completed Well Construction Record (Form GW-1) shall be submitted as described in Part V.5 of this
permit.
PART III -OPERATION AND USE CONDITIONS
1. The Permittee shall comply with the. conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and 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)].
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 IV -INSPECTIONS [15A NCAC 02C .021 l(k)]
1. Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable time for the purpose of determining compliance with this permit, may
inspect or copy any records that must be maintained under the terms and conditions of this permit, and may
obtain samples of groundwater, surface water, or injection fluids.
2. DWR representatives shall have reasonable access for purposes of inspection, observation, and sampling
associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary 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 [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)( 1)].
3. The Permittee shall report any monitoring or other_information that indicates noncompliance with a specific
permit condition, that a contaminant may cause a violation of applicable groundwater quality standards, or
that a malfunction of the injection system may cause the .injected fluids to migrate outside the approved
injection zone or area. As specified in rule 15A NCAC 02C .021 l(r), noncompliance notification shall be
as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence, to the Wilmington Regional Office, telephone number 910-796-7215.
(B) Written notification shall be made within five days of the occurrence and submitted to the addresses
in Item #5 below.
Permit#WI0800014 UIC/SA7
ver. 11/15/2015
Page 3 ofS
(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 Wilmington Regional Office
127 Cardinal Drive
Wilmington, NC 28405
PART VI-PERMIT RENEWAL [15A NCAC 02C .0224(c)]
As required by rule an application for permit renewal shall be made at least 120 days prior to the expiration
date of the permit. This permit condition does not apply if the Permittee chooses to discontinue operation
of the well for injection of effluent from the geothermal heating and cooling system associated with this
permit.
PART VII -CHANGE OF WELL STATUS [15A NCAC 02C .0240]
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 pmpose, 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 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).
Pennit#WI0800014 UIC/5A7
ver. 11/15/2015
Page 4 of5
(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 ofabandonment.
5. The written documentation required in Part VII (4)(F) shall be submitted to the addresses specified in Part
V.5 above.
Pennit #WI0800014 UIC/5A7
ver. 11/15/2015
Page 5 of5
Permit Number WI0800014
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Graham and Maeomie Mosely SFR
Location Address
2137 Auburn Ln
WIimington NC
Owner
Owner Name
Graham
Dates/Events
Orig Issue
11/20/1997
App Received
9/6/2017
Regulated. Activities
Heat Pump Injection
Outfall
Waterbody Name
28405
Mosely
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
12/8/2017
Permit Tracking Sllp
Status
In review
Version
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
Graham Mosely
2137 Auburn Ln
Wilmington NC 28405
Major/Minor
Minor
Region
Wilmington
County
New Hanover
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Graham Mosely
2137 Auburn Ln
Wilmington
Issue Effective
NC 28405
Expiration
Requested /Received Events
RO staff report requested
RO st~ff report received
Streamlndex Number Current Class
9nt17
12/7/17
Subbasin
North Carolina Department of Environmental Quality-Division of Water Resources
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Permit No. WI0800014
Date: 12/1/2017
To: Shristi Shrestha
Central Office Reviewer
County: New Hanover
Permittee/Applicant: Graham & Maeomie Mosley
Facility Name: Mosley geothermal well system
L GENERAL INFORMATION
I. This application is (check all that apply): D New ~ Renewal
D Minor Modification D Major Modification
a. Date of Inspection: l l /30/20 l 7
b. Person contacted and contact information: [e-mail]
c. Site visit conducted by: Geoff Kegley
d. Inspection Report Printed from BIMS attached: D Yes ~ No.
hECElVEO/NCDEQ/DWFt
DEC - 6 2017
'\later Quality Regionaf
l"'\r:pr-:i~ions Sectior-
e. Physical Address of Site including zip code: 2137 Auburn Lane. Wilmington. NC 28405
f. Driving Directions if rural site and/or no physical address: __
g. Latitude: Longitude:
Source of Lat/Long & Accuracy (i.e., Google Earth, GPS, etc.):_ Google Earth
11. DESCRIPTION OF INJECTION WELL(S) AND FACILITY
I. Type of injection system:
[8J Geothermal Heating/Cooling Water Return
0 In situ Groundwater Remediation
D Non-Discharge Groundwater Remediation
D Other (Specify: )
2 . For Geothermal Water Return Well(s) only
a. For existing geothermal system only:
Were samples collected from Influent/Effluent sampling ports? [8J Yes O No.
Provide well construction information from well tag: Alread accurately listed in BIMS
b. Does existing or proposed system use same well for water source and injection? D Yes ~ No
If No, please provide source/supply well construction info (i.e., depth, date drilled, well contractor,
etc.) and attached map and sketch location of supply well in relation to injection well and any other
features in Section IV of this Staff Report.
3 . Are there any potential pollution sources that may affect injection? 0 Yes [8J No
What is/are the pollution source(s)? ________________________ _
What is the distance of the injection well(s) from the pollution source(s)? ------------
4. What is the minimum distance of proposed injection wells from the property boundary? ______ _
5. Quality of drainage at site: D Good [8J Adequate D Poor
6. Flooding potential of site: [8J Low D Moderate D High
WQROS Staff Report Rev. 4/15/2016 Page I
7, For Groundwater Remediation Infection Systems only, is the proposed and/or existing groundwater monitoring
program (number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ❑ Yes ❑ No.
If No, attach map of existing monitoring well network if applicable and recommend any changes to the
groundwater -monitoring program.
g. Does the map included in the Application reasonably represent the actual site (property Iines, wells, surface
drainage)? ® Yes ❑ No. If No, or no map, please attach a sketch of the site. Show property boundaries,
buildings, wells, potential pollution sources, roads, approximate scale, and north arrow.
9. For Non-Discharee Groundwater Remediation systems only (i.e., permits with WQ prefix):
a. Are the treatment facilities adequate for the type of waste and disposal system? ❑ Yes ❑ No ❑ NIA.
If No, please explain:
b. Are the site conditions (soils, topography, depth to water table, etc.) consistent with what was reported by
the soil scientist and/or Professional Engineer? ❑ Yes ❑ No ❑ NIA. if no, please explain:
III, EVrtL UATION AND RECOMMENDATIONS
i . Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. if Yes, explain,
?. List any items that you would like WQRDS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
3. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
4. Recommendation
❑ Deny. If Deny, please state reasons:
❑ Hold pending receipt and review of additional information by Regional Office
❑ Issue upon receipt of needed additional information
® Issue �.
5. Signature of Report Preparers):
Signature of WQRDS Regional Supervisor:
Date: 1 Z 0 ! 'lto l }
WQROS Staff Report Rev. 4/15/2016 Page 2

IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS (Optional I /[Needed)
This review was conducted for a permit renewal request for a geothermal injection well heat pump
system for the Mosley residence. On November 30, 2017, staff visited the home to inspect the well
system. Source well water and water prior to re-injection were sampled for Metals, Total and Fecal
Coliform, Nitrates, Chloride, Sulfate and Total Dissolved Solids. Sampling results will be forwarded to
the Central Office and owner when received from laboratory. Injection well was blown out last year
to clean out iron bacteria build up in the well, otherwise system operation has been normal.
WQROS Staff Report Rev. 4/15/2016 Page 3
I

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW RE QUEST FORM
Date: September 7, 2017
To: Jim Gregson -Morella Sanchez-King
From: Shristi Shrestha, WQROS -Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
Permit Number: WI0800014
A. Applicant: Graham & Maeomie Mosley
B. Facilitv Name:
C. Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal
E. Comments/Other Information:
__ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a completed W OROS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy of
this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact person
listed above.
RO-WOROS Reviewer: __________________ Date: _____ _
COMMENTS:
NOTES: Please attach a copy of Gw-1 form if available.
FORM: WQROS-ARR ver. 092614 Page 1 ofl
K
Water Resources
Envirmmental Quality
September 7, 2017
Graham & Maeomie Mosley
2137 Auburn Ln
Wilmington, NC 28405
RE: Acknowledgement of Application No. WI0800014
Geothermal Heating/Cooling Water Return Well
New Hanover County
Dear Mr- and Mrs. Mosley:
ROY COOPER
Governor
MICHAEL S. REGAN
serrelaq
S. JAY ZIMMERMAN
Director
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit application and supporting documentation received on September 5, 2017, Your application
package has been assigned the number listed above, and the primary reviewer is Shristi Shrestha
Central and Wilmington 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 919-807-6406 or email at [e-mail]-
Sincerely,
For Debra J, Watts, Supervisor
Animal Feeding Operations & Groundwater
Protection Branch Division of Water
Resources
cc: Wilmington Regional Office, WQROS
Permit File W10800014
'Not I q Col
State of North Carolina I FmvirOn cnW Quality I Division of Water Resources
Water Quality Regional Operations Section
1636 Nlaa service Center I Raleigh, North Carolina 27699-1636
919-707-9129

North Carolina Department of Environmental Quality — Division of Water Resources
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELL(S)
In Accordance With the Provisions of I5A NCAC 42C .4224
GEOTHERMAL HEATING/COOLING WATER RETURN WELLS)
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 t` Renewal* Modification Permit Rescission Request*
*For Permit Renewals or Rescission Rcqucst, complete Sections A thru E, and M (signature page) only
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: 3 20 / PERMIT NO. WjQ,04= f, (leave blank if New Application)
A. 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 Q Geothermal 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 ` MM!� MMR
Record (GW-30).
❑ Yes, I wish to rescind the permit
Water uuu,,ty Regional
2. Current Ownership Status Operations Sectlon
Has there been a change of ownership since permit last issued? ❑ YES E'NO
If yes, indicate New Owner's contact information:
Name(s)
Mailing Address:
City:
State: Zip Code:
Day Tele No.: Email Address. ;
County:
B. STATUS OF APPLICANT (choose one) I"
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: A A 'w"4-- �'
Mailing Address:
City: LJ Z`W State:,4�aip Code:County I
Day Tele No.: S — -VS mac/ Cell No.:
EMAIL Address:131G7 M05 t' r' e e4ax 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: ~J}/1/f-/k ;# $A£ t),?tt,o~ ,&?/t2 .S e._.AJ V
~ /
Mailing Address: (J../8 z Av&uef?N LR.J}e
City: Jt}A..lnl~ z:&L State: L.{e.z.ip Code:-!J...~<! L'> County: Zd-,12&1
Day Tele No .: t/112 · :2 G<ti c fe5-6 Y: Email Address .: H1 9'.~ 0£<:: ~ec rr. v tJ&,n,t,
E. PHYSICAL LOCATION OF WELL(S) SITE
(1) Parcel Identification Number (PIN) of well site:_?....__ ________ County:A/2tf,,t/&' c/L:5 fl._
(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"-: -------------~EMAIL Address: __________ _
Address:---------------------------------
City: _________ Zip Code: ____ State : __ County: ________ _
Office Tele No.: Cell No.: Fax No.: _______ _
G. HV AC CONTRACTOR INFORMATION (if different than driller)
HV AC Contractor's Name: __________________________ _
NC HVAC Contractor License No.: _______________________ _
Company Name: ______________________________ _
Contact Person.~: -------------~EMAIL Address : __________ _
Address:---------------------------------
City: _________ Zip Code: ____ State: __ County: _________ _
Office Tele No.: Cell No.: Fax No.: ______ _
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES __ _
YES ----
NO ___ _
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 1 SA NCAC 02C .0107, 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; ·
(b) For open-end wells without screen, the casing shall be grouted from the bottom of the casing
to land surface.
(3) A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
( 1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
---~*EXISTING WELLS -------"PROPOSED WELLS
* For existing wells, please attach a copy of the Well Construction Record (Form GW-1). if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
( c) Casing depth below land surface
( d) Casing height "stickup" above land surface
( e) Grout material( s l surrounding casing and depth below land surface
Note: bentonite grouts are prohibited for sealing water-bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .0107(0(8 )
\ I
(t) Length of well screen or.open borehole and depth below land surface
I
(g) Length of sand or gravel packing around well screen and depth below land surface
K OPERATING DATA
(1) Injection Rate: Average (daily) gallons per minute (gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average ( daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) __ ° F.
L. SITE MAP-As specified in 15A NCAC 02C .0224(b)(4 ), attach a site-specific map that is scaled or otherwise
accurately indicates distances and orientations of the specified features from the injection well(s). The site map shall
include the following:
(1) All water supply wells, surface water bodies, and septic systems including drainfield, waste
application area, and repair area located within 250 feet of the injection well(s).
(2) Any other potential sources of contamination listed in 15A NCAC 02C .0107(a )(2 ) located within 250
feet of the proposed injection well(s).
(3) Property boundaries located within 250 feet of the parcel on which the proposed injection well(s) are
to be located.
(4) An arrow orienting the site to one of the cardinal directions (north, south, west, or east)
Geothermal Water Return Well Pennit Application Rev. 4-15-2016 Page3
NOTE. Inmost caves an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can them be drawn in by hand Also, a `layer' can be selected showing topographic contours or elevation
data
M. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .0211.( e) requires that all permit applications shall be signed as follows:
l . 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 person.(sl 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 Owner/Applicant
Print or Type Full Name and Title �- -
Signat&r of Property Owner pp cant
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-I5-2416 Page 4

GEOTHERMAL HEATING/COOLING WELL CONSTRUCTION DETAIL
Choose applicable Injection Well design and check the appropriale boxes. Fill in depths below land surface (BLS) and
details of well construction on the blank lines provided Use additional sheets as needed
Open -Hole Well Desi n
Proposed El Existing
❑ Injection; ❑ Supply;
❑ Dual Purpose
Record Depths Below
Land Surface (BLS)
an Lines Provided
Bottom of easing
(Ft. BLS) -
Total Depth
(Ft. BLS)
(Ft.)
Return or Supply Line
Casing
Grout
WELL DETAILS
Casing Material:
Casing Diameter (in.):
Grout Type:
Grout Depth (BLS):
Top of Bentonite Seal (if present):
Bottom of Bentonite Seal
Screen Material:
Screen Slot Size (in.):
Sand/Gravel Pack
Material Type:
Screened Well Desi n
Proposed LJ Existing
Injection; [:]Supply;
Dual Purpose
Record Depths Below
Land Surface (BLS) on
Lines Provided
Bentonite Seal (Ft BLS)
(ifpresem0 (Ft. BLS)
Bedrock
Bottom of casing
SandlGravcl Pack BLs}
open Hole
Screen
(Total Dcptli
Ft. BLS)
NC Certified Well Driller Name: Certification No.:

SENDER.•MPLETE THIS SECTION COMPLETE THIS SECTIONON DELIVERY
■ Complate items 1, 2, and S. Also complete n icy Haw
item 4 if Restricted Delivery is desired. ❑ Agmt
■ Print your name and address on the reverse ❑ Adds
so that we can return the card to you. I by (Printed Name c. Hats o ef!
■ Attach this card to ftte back of the mailplece, �� : y ,� 7
or on the front If spaoa permits.
1. Article Addressed to: D. is delivery address item 17 ❑
Yed
r YES, enter delivery address below: ❑ No
Graham & Maeomie Mosley
2137 Auburn Ln
Wilmington, NC 28405
2. Article !Number
(Transfer firm service label)
a. $etvice Type
❑ Certified Mail ❑ Express Mall.
❑ Rogtstered ❑ Rehun Receipt for Merchandise
❑ ln=W Marl 0 C.O.d.
4. Restricted Delivery? Fee) ❑ Yes
7012 1640 0000 9792 3-131
PS Form 3811, February 2004 Domestic Retum Receipt
�■ {D;>Mestf' ?-Uaff Only; No Insurance Coverage Providec
For deSivery inTormation visit our website at www.usps.coW,
>t
1� postage 5
Q'
CerNed Fee
C:1
r3 Return HeCeiptFee Postmark
q (Endorsomem Re lred) Hero
M Restrided peWeq Faa
Q _=ndorsement Required)
r-q _ Graham & Maeomie Mosley
ru 5e"r r 2137 Auburn Ln
m iresr,psi: Wilmington, NC28405
FL or PO Box Np-
Cir}S SiaW' 2UA
ra rorm 38u0, August 206 See Reverse Tor Instrpeilons
x»aea ae-Wts4o

Water Resources
F-nvim=ental Quality
August 22, 2017
CERTIFIED MAIL # 7012 1640 0000 9792 3131
RETURN RECEIPT REQUESTED
Graham & Maeomie Mosley
2137 Auburn Ln
Wilmington, NC 28405
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No. W10800014
New Hanover County
Dear Mr. and Mrs. Mosley:
RCY COOPER
Govenjor
MICHAEL S. REGAN
secrerw y
S. JAY ZIMMERMAN.
Director
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of
North Carolina, and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above -referenced operating permit for the
geothermal injection well system located on your property at the above referenced address was
Issued on July 30, 2012, and expires on November 30, 2017. Per permit conditions and
requirements per 15A NCAC 2C .0224(c), the renewal application must be submitted at least 120
calendar days prior to expiration of the permit if you wish to continue operating the injection well
on your property.
If Your Geothermal Water Return Well is Still Currently Being Used for 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://yortal.nedenr.org/web/wg/ao/gUro/permit-applications.
''Nothing Compares. .-
Stale of North Carolina [ Environmental Quality j Division of Water Resources
Water Quality Regional Operations Section
1636 Mall Service Center Raleigh, North Carolina 27699-1636
919-707-9129

If Your Geothermal_ Water Return Well is NO LONGER SeinF—Used far 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 regulatory requirements listed under NCAC Title 15A, Subchapter 2C, Section
.0240, When the well is plugged and abandoned, a well abandonment record (Form GW-30) must
be submitted to our office to certify that the abandonment was properly conducted.
If There has been a Chanp-e_of Ownership of the Property:
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change" Form must also be submitted in addition to the renewal application.
This form is not enclosed but can be found at the website listed above. Please submit the applicable
forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms in a timely manner may result in the assessment of civil
penalties in accordance with North Carolina General Statute 87-94. Thank you in advance for
your cooperation and timely response. if you have any questions, please contact me by phone at
[phone] or by email at shristi.shrestha dncdenr.gay.
Regards,
010AIMAZ
Shristi Shrestha
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: Wilmington- Regional Office -- WQROS w/o enclosures
Central Files - Permit No. W10800014 w/o enclosures

Permit Number W10800014
Central Files: AP5 S'NP
07/23112
Permit Tracking Slip
Program Category
Status
Project Type
Ground Water
In review
Renewal
Permit Type
Version
Permit Classification
Injection Heating/Cooling Water Return Well
Individual
Primary Reviewer
Permit Contact Affiliation
michael.rogers
Graham Mosely
Coastal SW Rule
2137 Auburn Ln
Wilmington
NC 28405
Permitted Flow
Facllit
Facility Name
MajorlMinor
Region
Graham and Maeomie Mosely 5FR
Minor
Wilmington
Location Address
County
2137 Auburn Ln
New Hanover
Wilmington NC 28405
Facility Contact Affiliation
Owner
Owner Name Owner Type
Individual
Graham Mosely Owner Affiliation
Graham Mosely
2137 Auburn Ln
QatesiEvents Wilmington NC 28405
Scheduled
Orig Issue App Received Draft Initiated Issuance
11/20/97 06/14/12
eautated Activities
Fleat Pump injection
Outfall NUI-
Public Notice CZ, Effective
—
INN
Ex
[�
Requested/Received Events
Rfl staff report requested
06/20/12
Rfl staff report received
07/20/12
Waterbody Name Stream Index Number Current Class Subbasin

Permit Number WI0800014
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facili
Facility Name
Graham and Maeomie Mosely SFR
Location Address
2137 Auburn Ln
Wilmington
Owner
Owner Name
Graham
Dates/Events
NC 28405
Mos!:)ly
Scheduled
Orig Issue
11/20/97
App Received Draft Initiated Issuance
06/14/12
Regulated Activities
Heat Pump Injection
Outfall NULL
Central Files: APS_ SWP_
08/07/12
Permit Tracking Slip
Status
Active
Project Type
Renewal
Version
3.00
Pennit Classification
Individual
Permit Contact Affiliation
Graham Mosely
2137 Auburn Ln
Wilmington
Major/Minor
Minor
NC
Region
Wilmington
County
New Hanover
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Graham Mosely
2137 Auburn Ln
Wilmington
Public Notice Issue
07/30/12
NC
Effective
07/30/12
Re quested/Received Events
RO staff report requested
RO staff report received
28405
28405
Expiration
11/30/17
06/20/12
07/20/12
Waterbody Name Stream Index Number Current Class Subbasin
AWA NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Graham and Maeomie Mosely
2137 Auburn Ln.
Wilmington, NC 28405
Re: Issuance oflnjection Well Permit
Permit No. WI0800014 ·
Issued to Graham and Maeomie Mosely
New Hanover County
Dear Mr. and Mrs. Mosely:
Charles Wakild, P.E.
Director
July 30, 2012
Dee Freeman
Secretary
In accordance with your application received June 14, 2012, I am forwarding Pennit No. WI0800014 for the operation of
a geothermal heating/cooling return well heat pump system located at the above referenced address. This permit shall be
effective from the date of issuance until November 30, 2017, and shall be subject to the conditions and limitations stated
therein.
The Wilmington Regional Office collected groundwater samples from your geothermal system on July 17, 2012. After
the laboratory analytical results are received, the results will be forwarded to you by the regional office.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an application to renew
the pel"Illit 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 DivisioIIof Water Quality. If you have any questions
regarding your permit or the Underground Injection Control Program please call me at [phone].
Best Regards,
AA_ Y n ~ /'V~ . ..J'«
Michael Rogers, P.G. (NC FL)
Environmental Specialist
cc: Morella Sanchez-King, Wilmington Regional Office
Central Offic File Wl08------.-
New Hanover County Environmental Health Dept.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] \ FAX: 919-B07-6496
Internet: www.n<;Waterguality.org
An Equal Opportunity\ Affirmative Action Employer · •
One . North Carolina
JVa{urally
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR l_HE 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
Graham and Maeomie Mosely
FOR THE OPERATION OF A GEOTHERMAL HEATING/COOLING WATER RETURN WELL, defined in
Title 15A North Carolina Administrative Code 2C .0224, which will be used for the injection of heat pump
effluent. This injection well is located at 2137 Auburn Ln., Wilmington, New Hanover County, NC 28405, and
will be constructed and operated in accordance with the application received June 14, 2012, and in conformity
with the specifications, 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 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 ~ffective, unless revoked, from the date of its issuancel.u~til November 30, 2017, and shall
be subject to the spedfied conditions and limitations set forth in Parts I through VIII hereof.
(lJ?
Permit issued this the ) day of ~ , 2012.
~\cJ,~
~Charles Wakild, P.E., Director ti Division of Water Quality
By Authority of the Environmental Management Commission.
Permit #WI0800014 UIC/Return Well
ver. 07 /2012
Page 1 of 5
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 (ISA NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit 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 sealed with a water-tight cap or well sealed, as defined in G.S. 87-85(16).
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
.0107G).
PART II-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.
4. 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.
PART III-PERFORMANCE STANDARDS
I. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it. unsatisfactory for normal use. In the event that the
Permit #WI0800014 UIC/Return Well
ver. 07/2012
Page 2 of 5
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 IV -OPERATIONS AND MAINTENANCE REQIDREMENTS
I. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the :Oivision 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.
PART V -INSPECTIONS
I. 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 ;hall 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 f9r collecting any necessary and appropriate samples associated with the
injection facility activities.
PART VI -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 Wilmington Regional Office, telephone number 910-796-7215, any of the following:
(A) Any occurrence at the injection facility that results in any tmusual operating circumstances;
(B) Any failure due to known or unknown reasons that r~nders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
Permit #WI0800014 UIC/Return Well
ver. 07 /2012
Page 3 of 5
3. Where tp.e Permittee becomes aware of an omission of any relevc)D.t 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 VII -PERMIT RENEWAL
In order to continue uninterrupted legal use of the injection facility for the stated purpose, the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
PART VIII-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 15A NCAC 2C .0240,
Abandonment and Change-of- Status of Wells.
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
.0240, 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 ofan 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 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 of drinking water and in accordance with the
tenns and conditions of the permit.
Permit #WI0800014 UIC/Return Well
ver. 07 /2012
Page 4 of 5
(G} 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.
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
Permit #WI0800014
Aquifer Protection Section-UIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
UIC/Return Well
ver. 07/2012
Page 5 of 5
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: July 17, 2012
To: Aq uifer Protection Section Central Office
Central Office Reviewer: Michael Ro gers
Regional Login No: Geoff Kegle y
County: New Hanover
Permittee: Graham Mosley
Project Name: Graham Mosley SA7
Application No.: WI00800014
L GENERAL INFORMATION
1. This application is (check all that apply): D New ~ 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 Distribution of Residuals
0 Attachment B included
D Surface Disposal
D 503 regulated D 503 exempt
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.
a. Date of site visit: Jul 17 . 2012
b. Person contacted and contact information: Graham Mosle 910-256-4564
c. Site visit conducted by: Geoff Ke gle y
d. Inspection Report Attached: [gl Yes or D No.
2. Is the following information entered into the BIMS record for this application correct?
[gl Yes or D No . If no , please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude: __
e. Regulated Activities/ Type of Wastes (e.g., subdivision, food processing, municipal wastewater): __
For Dis posal and Injection Sites:
(I f 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): __
b. Driving Directions: __
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude: __
RECEIVEDIDENR/DWQ
JUL 2 0 2012
Aquifer Protection Section
IL NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or minor
modifications, skip to next section)
Descri ption Of Waste (S) And Facilities
I. Please attach completed rating sheet. Facility Classification: __
2. Are the new treatment facilities adequate for the type of waste and disposal system?
FORM: WI0800014 Mosely staff report July 2012.doc
AQUIFER PROTECTION SECTION 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 Faci]ities -New, RenewaJ, And Modification
1. Type of injection system:
1:8] Heating/cooling water return flow (5A 7)
D Closed-loop heat pump system (5QM/5QW)
D 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 IZI No
3. Are there any potential pollution sources that may affect injection? D Yes 1:8] No
What is/are the pollution source(s)? n/a. What is the distance of the injection well(s ) from the pollution
source(s )? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? 31 ft.
5. Quality of drainage at site: 1:8] Good D Adequate D Poor
6. Flooding potential of site: 1:8] 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)? 1:8] 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 C8J 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 ves . explain:
3. For renewal or modification of g roundwater remediation permits (of any typ e ), will
continued/additional/modified in jections have an adverse im pact on mi 11ration of the plume or manae:ement of
the contamination incident? D Yes D No. If y es, explain:
4. Drilling contractor: Name: __
FORM: WI0800014 Mosely staff report July 2012.doc
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.: Submersible pump for source well
was replaced in February 2012 and one of the heat pump units was replaced in June 2012, otherwise operation
of system has not had any issues. Samples were taken and will be forwarded to central office and permittee
upon receipt from the lab. WiRO recommends issuance of permit renewal.
2, Attach Well Construction Data Sheet - if needed information is available
3. Do you foresee any problems with issuancelrenewal of this permit? ❑ Yes E No. If yes, please explain
briefly.
4. List any items that you would like APS Contral 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
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 reasons:
8. Signature of report preparers):
Signature ofAPS regional supervisor -
Date: la 2 of Z
FORM: WI4804014 Mosely staff report July 2012.doc to 3

Compliance Inspection Report
Permit: WI0800014
SOC:
County: New Hanover
Region: Wilmington
Effective: 12/04/07 Expiration: 11/30/12
Effective: Expiration:
Contact Person: Graham Mosely
Directions to Facility:
Title:
Owner: Graham Mosely
Facility: Graham and Mae Mosely SFR
2137 Auburn Ln
Wilmington NC 28405
Phone: [phone]
From downtown Wilmington take US17E appx 5 miles. Turn Ron Eastwood. Go appx 2.5 miles. L at Military Cutoff, R at Drysdale, Lat
Pembroke Jones, L at Verrazazano, Lat Pembroke Jones, L at Arboretum, R at Gull Point, L at Auburn. System Classifications:
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 07/17/2012
Primary Inspector: Geoff Kegley
Secondary lnspector(s):
Entry Time: 11 :00 AM
Certification: Phone:
Exit Time: 12:30 PM
Phone:
Reason for Inspection: Routine Inspection Type: Compliance Sampling
Permit Inspection Type: Injection Heating/Cooling Water Return Well
Facility Status: ■ Compliant O Not Compliant
Question Areas:
■Wells ■ System Operations
(See attachment summary)
Page: 1
Permit: WI0800014
Inspection Date: 07/17/2012
Owner • Facility: Graham Mosely
Inspection Type: Compliance Sampling Reason for Visit: Routine
Inspection Summary:
wells sampled and inspected as part of permit renewal review. Submersible pump for source well was replaced in
February 2012 and one of the heat pump units was replaced in June 2012, otherwise operation of system has not had
any issues. Samples were taken and will be forwarded to central office and permittee upon receipt from the lab.
System Operation
Is same well used as source well and injection well?
Is injection well capable of assimilating injected fluid?
Injection flow rate at time of inspection (gpm)
Has system owner/operator noticed any abnormalities (turbidity, air in system, poor heating/cooling, etc) in
system operation?
Comment on system operation
Is system operation and construction consistent with that described in application?
Describe inconsistencies between application and observed operation/construction
Comment:
Yes No NA NE
□•□□
•□□□
□■□□
•□□□
■DOD
Page: 2
A U EER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: .Tune 202012
To: ❑
Landon Davidson, ARO-APS
❑
Art Barnhardt, FRO-APS
❑
Andrew Pitner, MRO-APS
0
.Tay Zimmerman, RRO-APS
JUN 2 6 M2
❑ David May, WaRO-APS
® Morella Sanchez Ding, W iRO-APS
❑ Sherri Knight; W-SRO-APS
re� ; )lam: Michael Rogers Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E Mail.- Michael.Royers0)ncdenr.P_ov
RHEIVEOVEIRDWQ
A. Permit Number: WI 0800014 J U L 1 3n l f
B. Owner: Graham and Mae Mosie► AquifP.r Prot9C1f0f1 &,Cd0 n
C. Facility/Operation:
❑ Proposed ® Existing ❑ Facility ❑ Operation
D. Application:
1. Perm# Type: ❑ Animal ❑ SFR-Surface Irrigation[] Reuse ❑ H-R Infiltration
❑ Recycle ❑ LE Lagoon ❑ GW Remediation (ND)
® UIC — Geothermal Heating/Cooling Water Return Well
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
Z. Project Type: ❑ New ❑ Major Mod. ❑ Minor Mod. ® Renewal ❑ Renewal wl Mod.
E. Comments/Other Information: 1-1
NOTE_ Please return a completed APSARR after completing the site inspection and collecting water samples (if
applicable). At a later date, after the laboratory results are received by your office, send us a copy of the cover letter
& laboratory analytical results, which you send to the Permittee. Please record all information on the well tag, if
present, and put on staff report. Thanks.
® Return a completed APSARR after the site inspection. At a later date, after the lab results are
received, please send a copy of the cover letter &laboratory analytical results, which you send to
the Permittee.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
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 -Aquifer Protection Section contact person
listed above.
+ J'
RD-APS Reviewer: �'� � f � e-LA L C ��•i Date:
FORM: APSARR 07/06 Page 1 of 1

A QUIFER PROTECTION SECTION
APPLICATION REVIEW RE QUEST FORM
Date: June 20 , 2012
To: 0 Landon Davidson, ARO-APS
□ Art Barnhardt, FRO-APS
□ Andrew Pitner, MRO-APS
D Jay Zimmerman, RRO-APS
0 David May, WaRO-APS
IZ! Morella Sanchez King, WiRO-APS
0 Sherri Knight, W-SRO-APS
From: Michael Ro gers Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Mail: Michael.Ro gers @ncdenr.gov
A. Permit Number: WI 0800014
B. Owner: Graham and Mae Mosle ,
C. Facility/Operation: --.
D. Application:
1. Permit Type:
D Proposed
□ □
Animal
Recycle
IZ! Existing D Facility D Operation
D SFR-Surface Irrigation □ Reuse D H-R Infiltration
D I/E Lagoon D GW Remediation (ND)
1:8'.J UIC -Geothermal Heatin g/Cooling Water Return Well
For Residuals: D Land App. D D&M D Surface Disposal
D 503 D 503 Exempt D Animal
2. Project Type: D New D Major Mod. D Minor Mod. IZ! Renewal D Renewal w/ Mod.
E. Comments/Other Information: IXl
NOTE: Please return a completed APSARR after completing the site inspection and collecting water samples (if
applicable). At a later date, after the laboratory results are received by your office, send us a copy of the cover letter
& laboratory analytical results, which you send to the Permittee. Please record all information on the well tag, if
present, and put on staff report. Thanks.
1:8'.J Return a completed APSARR after the site inspection. At a later date, after the lab results are
received, please send a copy of the cover letter & laboratory analytical results, which you send to
the Permittee.
D Attach Well Construction Data Sheet.
D Attach Attachment B for Certification by the LAPCU.
D Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
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-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: Date: _____ _
FORM: APSARR 07/06 Page I of I
MCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Graham H. Mosely
Maeomie H. Mosely
2137 Auburn Ln.
Wiltnina on, NC 28405
Bear Mr. Mosely:
Division of Water Quality
Charles Wakild, P.E.
Director
.nine 19, 2012
Doe Freeman
Secretary
Subject: Acknowledgement of
Application No. W10800014
Graham and Mae Mosely SFR
Injection Heating/Cooling
Water [return Well System.
New Hanover County
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on 06/14/2012. Your application package has been assigned the number listed
above, and the primary reviewer is Michael Rogers.
Central and Wilmington 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 Aquifer Protection Section 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].
Sincerely,
,for !� rl. Wads
Groundwater Protection Unit Supervisor
CC.' Wilmington Regional Office, Aquifer Protection Section
Permit Vile WI080oul1�1
AQUIFER PROTECTION SECTION
1636 Mall Service Center, Raleigh, North Carallna 27699-1636
Locaton: 512 N. Salisbury St., Raleigh, North Carolina 27604 One
Phone: 919MO7.6464 I FAX: 91 M07.6496
ua
lnterret:www.ncwatemuallri.oro Art �I�91
An Egilal Opportapity lAtilrmaheAdon EmpluVw - " - - " - - - V

06/1442m , 10.54 S102564554 GH MO MOSELY PAGE 02
NORTH CAROLINA DEPARTM NT OF ENVIRONMENT AND NATURAL RESOURCF5
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE WECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0200
OPEN -LOOP GEOTHERMAL INJECTION WELLS
These wells discharge groundwater directly into the subsurface as part of a geotherlr+al heating and cooling system
(check. one) New Applications kf_�' Renewal's Modification
* ,For renewals complete Parts A-C and the sigrtatwe page.
Print or Type Information and Mail to the Address on the Last Page. Illegible applications Will Be Returned As Incon:ple►e,
DATE: I 2!a I p—
PERMIT NO. 40/ (leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Non-Goverrmicnt: Individual Residence Business/Organization
Government: State Municipal County Federal
D. PERII+ T APPLICANT — For individual residences, list ewhh owner an property deed. For ail others,
state name of entity and name of person delegated authority to sign on behalfof the business or agency:
Mailing Address: A%/.? 7 ,r3,oeaA_1 419-Mac-
City: ACz of-, *1 I rss' YW t/ State: Alle Zip Code: igoe�.s- County'4. Rs
Day Tele No.. r Cel t No.:
Ito fn
LMA1L Address:�tr��,��r�.�
C. LOCATION OF WELL SITE — Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: County: /V 9""4E7&
(2) Physical Address (if different thm mailing address):
City: State: NC Zip Code:
D. WELL DRILLER INFORMATION
Well Driiling Contractor's Name:
NC Well D :illiing Contractor Certification No.:
Company Name:
Contact Person: EMA i L ddres -
Address:
City: Zip Code: State- County:
Office Tele No.: Cell No.: Fax No.:
GPU/lJlC SA7 PeKmit Applisaion (Revi:�d 3)18r2011) Page 1

06/14/2012 .10:5a 9102564564 GH Mn MOSELY PAGE 03
J. CER'll'1FICATION (to be signed as required below or by that person's authorized agent)
I SA NCAC 02C .0211(b) requires that all permit applications shall be signed as follows:
I . for a corporation: by a responsible corporate officer,
2. for a partnersb ip or sole proprietorship: by a general partner or the proprietor, respectively;
3, for a municipality or a states, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4, for all others' by the well owner (which means l ' os listed a roperty d
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicaut that names and authorizes their agent to sign this application on their behaM
" I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in fts document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe Oiat the informmion is true, accurate arid
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, rnaivtair4 repair, and if applicable, abandon the
injection well and all reiated appurtenances in accordance with the approved specifications and conditions of
the pennit',
Signature ofPrWerty Owner/Applicant
trip ��
Print or Type Hall Name
Signature of Property awnexlApplicW
Print or Type hull Name .!
Signature of Authorized Agent, if any
Print or Type pull Name
Submit two copies of the oornpleted application package to:
DWQ - Aquifer Protevctiou Section
1636 Mad Service Center
Raleigh, NC: 27699-1636
Telephone (919) 807-"64
GFUARC SA? Pernik Application (wised 311W011) page 4

Q� WA � Michael F. Easiey, Govemor
' P William G. Ross Jr., Secretary
r North Carolina Department of Environment and Natural Rasaurces
7 -!
Coleco K Sullins, Director
-`� Division or Water Quality
February 26"', 2008
Graham and Mae Mosely
2137 Auburn Lane
Wilmington, NC 28405 Re: Injection Well Water Quality Analysis
Permit No. W10800014
Issued to Graham and Mae Mosely
New Hanover County
Dear Mr. And Mrs. Mosely:
The Division of Water Quality, Aquifer Protection Section conducted an inspection of your geothermal
underground injection (L IC) well on February 7`t', 2008. Rebecca Gerhart and Geoff Kegley collected water samples from
both the influent and effluent spigot. Samples were analyzed for lead (Pb), manganese (Mn), and iron (Fe) concentration.
For lead., the analytical results indicate a concentration of 10 micrograms per liter (ugll). The maximum
contaminate level (MCL) for lead in drinking water, as issued by the EPA, is 15 ugli. We are aware that Mr. Michael
Rogers mentions a previous sampling event indicating a higher Pb leveI of 140 ugll in his letter to you dated December
02007. However, given the results of this inspection and the fact that samples collected from your geothermal system in
previous years did not indicate any exceedances for lead, it appears that the concentration of 140 ugll was an anomaly.
The concentrations of manganese and iron collected from the influent spigot were 92 ugll and 2500 ugll,
respectively. The MCL for manganese is 50 ugll and the MCL for iron is 300 ugll. Exceedances for these two parameters
have been reported in previous years; the analytical results of this sampling even are consistent with historic data.
It is the responsibility of the Division to advise you that groundwater from your geothermal LIC source well
should not be used for any purpose other than circulation through the geothermal system. Do not use this water for
drinking or irrigation.
Copies of the laboratory results (Lab Reports AB26482-83) have been enclosed for your review and your records.
If you have any questions regarding the sampling event or procedures, please do not hesitate to contact Rebecca Gerhart at
[phone]. If you have any questions about your permit or the Underground Injection Control Program, please call
Mr. Michael Rogers at [phone].
CC: (with attachments)
Michael Rogers DWQ-APS
1636 Mail Service Center
Raleigh, NC 27699
Qu Qi DWQ-APS
1636 Mail Service Center
Raleigh, NC 27699
WtRO-APS (wlout attachements)
North Carolina Division of Water Quality 127 Cardinal Drive Ext. Wilmington, NC 28405-3845
lntemet: ter uali .ur
An Equal OpportunitylAffirmative Action Employer— 50% Recycledh0% Post Consumer Paper
Very truli yours,
Rebecca S. Gerhart
Environmental Sr. Technician
YahmclYll;
Phone [phone] Customer Service
FAX [phone]U 1-877-623-6748

NC Division of Water Quality Laboratory ~ect1on Kesuns
Loe. Descr.: MOSELY RESIDENCE
Location ID : WIROAPNLC
County:
River Basin
Sample ID :
PO Number#
Report To WIROAP
Vi s itlD
Region: WiRO Date Received:
Collector : R GERHART Time Received:
Sample Matrix: GROUNDWATER
Loe. Type : WATER SUPPLY
Sample Depth
Labwo rk s LoginlD
Da te Reported:
Collect Date: 02/07/2008
Collect Time:: 10:30 \ ~Mve".\-~~
nalyte Name
LAB
Sample temperature at receipt by lab
MET
Fe by ICP
Mn by ICPMS
Pb by ICPMS
PQL
50
10
10
Result
1.3
2500
92
Qualifier
10 U
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
Page 1 of 1
Units
·c
ug/L
ug/L
ug/L
AB26482
8G0138
02/08/2008
08:30
MMATHIS
02/26/2008
Approved By
MMATHIS
EST AFFORD
EST AFFORD
ESTAFFORD
-I
f\JC □(vision of Water Quality Laboratory Section Results
Loe . Descr.: MOSELY RESIDENCE
Location ID : WIROAPNLC
County:
River Basin
Sample ID:
PO Number#
Report To WIROAP VisitlD
Region: WiRO Date Received:
Collector: RGERHART Time Received:
Sample Matriic GROUNDWATER
Loe . Type: WATER SUPPLY
Sample Depth
Labworks LoginlD
Date Reported:
Collect Date : 02/07/2008
Collect Time :: 10:20 ~ w,~w\-~·Yl
nalyte Name
LAB
Sample temperature at receipt by lab
MET
Fe by ICP
Mn by ICPMS
Pb by ICPMS
PQL
50
10
10
Result
1 .3
2600
94
Qualifier
10 U
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
Page 1 of 1
Units
ug/L
ug/L
ug/L
AB26483
8G0139
02/08/2008
08:30
MMATHIS
02/26/2008
Approved By
MMATHIS
ESTAFFORD
EST AFFORD
ESTAFFORD
MCDENK
North Carolina Department of Environmelit and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Waltild, P.E.
Govemor Director
June 19, 2012
Graham H. Mosely-
Maeomie H Mosety.
2137 Aubum Ln.
Wilmington, NC 28405
Dear Mr. Mosely:
Dee Freeman
secretary
Subject: Ac}-riowledgenient of
Applicadon No. NVI0800014
Graharn and Mae Moseiv SFR
Injection Heating/r-ooliug
Water Return. Well Systurn
New Hanover County
Tire Aquifer Protection Section acknowledges raccipt of your permit application and supixating
docitmentation received on 0611412012, Your application package has been assiWted the number listed
above, wid ilze pruna.ry reviewer is Michael Rogws.
Central xrid Wilmington Regional Office stair will perform a. detailed revilew of fire provided
application, and may contact you wit71. a requesx fbr additional information. To ensure maximum
efficiency its Processing permit appEc'—lions., the Aquifer Protection &eotion requests your assistance in
providing a timely and complete response to airy additional infonnatsan requests.
Phase now that pfocessing standard review permt applications may take as long as 60 to 90 clays
aftex receipt of a complete application. If you have any questions, please contact
Miohael Rogers at (919)1107-6406 or michael.rugers[@ncder►r.gov.
Sincerely,
for �r J. Watts
Groundwater Ptotection Unit Supervasor
ca: Wilmington Regional Office, Aquifer Protection Section
Permit file W10800014
AWIFER PROT C *N ACTIN
1536 Merl Sesv�.v Center, RakNri, Nom GnrDnna 27699-163b
l."tkHl' 512 N. Sgsbary .Y . Raleigh, North Gmlina 27£44
rFwm; y19-6074s4 ! FAX. 9ZS--(!7-6496
A,i Egiom Cpsorwiirj . AOrrmvt+ d yp f GMoloyof
+t1rrr
N�&i14lf
RECEIVEDIDENRIDW4
Jul- 0 3 26-I
AVifer Protection 5ecdon

Beverly Eaves Perdue
Governor
SA
~CDENR
North Carolina Department of Environment and Natural Resources
Division of Water .Quality
Charles Wakild, P. E.
Director
June 26, 2012
Graham and Mae Mosely
213 7 Auburn Lane .
Wilmington, NC 28405
Subject: Notice of Expiration (NOE)
5A7 Geothermal Injection Well
-Permit No. WI0800014
New Hanover County
Dear Mr. and Mrs. Mosely:
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quali_ty (DWQ); is entrusted to pr~tect the groundwater quality and resources of the State of
.North Carolina,Jmd i~ responsible. for the regulatiQn qf {nj ection·well · construction and operation
' ••• .,.,.~.,,...,,,,. • ...,,. 1>-,;,,o•••••'.'t;•• ... ,.,,.,.,. !., ••',.i.f "';f ,•'"t ~,•.•,f,~: •/,,.A .",l,r~.--.•,.•~ •-h, \~ .", .••' ~
acthiities withiir.the state~" .Our re.cords indicate,thafthe ~above'-refet~nced bpera:titig permit:,for
.. . . . ;,, ,,. ·· .. · .. -'t " -~· .,., .... _,-~. -·~-··-~t ,: .. i. ':r-:: --J.1·_.•r _ ... ":r•f•½:-, -i-j' -;-..)~.q ...... , ' f . '1'"'· 'f -t-i-.... ~ ... -'
the underground injection ·;, welt . syst~in ,, fo~ated :::on. ,,yolµ'. -::i:i.rop·erty·.·.:.at : ·21~ 7 ~'.A:ubµm_'.f:arie in
• .-. • • '• . • ; . f-' •· : :,-..l "' ·•,"';,,• :.~·~,"_-;,.l·J\. ·_,-r~i•·,·•, . ./ •~--~,·· 'l.~ ., ~1!l!'°•:1<i t e. -~--':~~~-,-:~•
. :W,1Jm1ngto~, NC, which was issued to you on December 4, 2007, and expires on November'30,
,_, . , ' -• , . ; -. -l .. : ., . . • • . '· '. ~ •• , ,•. -. . , • , . . , .t ._ • ~ . " . . . . -·, . . . .
.'-}012; is sorn due_'f,9r'·rene'Yal?:(,IFyo~ \vis11·,to''keep'•this · r5'ermit and ppetate _th~:-~njection well
system, the permit ihust be renewed and _issued in your 11ame.
If Your Injection Weli is Currently Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory -requirements listed under NCAC Title I SA, Subchapter
2C_, S~~?OH_ :021 .~, -~:~ -~ac.~.,~~His plugged and abandoned, the well abandonment record
(Form GW-30) m.ust b~ ~ubmitt~<l: to 9ur office to certify that the abandonment was properly
conducted.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be· shbmitt~d. 'The GW-30 and Name/Ownership
Change forms can be found at http://portal.ncdenr.org/web/wg/aps/g:v,rpro/reporting-forms.
If Your Injection Well is Currentl y Active:
,·4
i, .•
•:.IfJlie ';,inj_.e.ttiqi :well system is still · active ~nd you ::f \t,}~:~~,:'.;-~~t?~~~~t;{ti~?}~h~wal
~pp,Ji¢.~~~pif'J11u~t be submitted within 120 calendar days of the expiratfott::of•'ybttr •tferrnit.
According to our records, you must submit your permit renewal by August 2,:.20:12,.
AQUIFER PROTECTION SECTION
1636 Mail Seivice Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone : [phone] I FAX: [phone]
Internet: www .ncwaterguality.org
An Equ al Opportunity I Affill1ative Action Employer
RECEIVED/DENR/DWQ
JUL O 3 2012
Aquifer Protection Section
NOnehC 1· ort aro 1na
lvntural/11
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit one of the following
enclosed forms:
A. Application for Permit (Renewal) to Construct and/or Use a Wells) for Injection with
Geothermal Heat Pump System for Type 5A7 Wells) if the injection well system on your
property is still active.
1Eelle
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate forms to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available on-line at the DWQ website at
http : //portal , n c denr, orglweblwq/aysl gwprolpermit-appli cati o n s#geot hermApps.
Thank you in advance for your cooperation and timely resprse. If you have any questions,
please contact me by phone at [phone] or by email at e6c.,.smithQa ncdenr.!_,ov.
Sincerely, f
r�
Eric G. Smith, P.G.
Hydrogeologist
4
Enclosures
cc: Wilmington Regional Office - APS w/o enclosures
APS Central files - Permit No. W10800014 w/o enclosures
2

'M'A
NCDENR
· North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Graham and Mae Mosely
213 7 Auburn Lane
Wilmington, NC 28405
Charles Wakild, P. E.
Director
June 26, 2012
Subject: Notice of Expiration (NOE)
5A7 Geothermal Injection Well
Permit No. WI0800014
New Hanover County
Dear Mr. and Mrs. Mosely:
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Quality (DWQ) 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 underground injection well system located on your property at 2137 Auburn Lane in
Wilmington, NC, which was issued to you on December 4, 2007, and expires on November 30,
2012, is soon due for renewal. If you wish to keep this permit and operate the injection well
system, the permit must be renewed and issued in your name.
If Your Injection Well is Currentlv Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter
2C, Section .0214. When each well is plugged and abandoned, the well abandonment record
(Form GW-30) must be submitted to our office to certify that the abandonment was properly
conducted.
If there has been a change of ownership of the property, an Injection Well Permit
Name/Ownership Change Form must also be submitted. The GW-30 and Name/Ownership
Change forms can be found at http://portal.ncdenr.om./web/wq/aps/gwpro/reporting-fom1s.
If Your Injection Well is Currently Active:
If the injection well system is still active and you wish to renew your permit, the renewal
application must be submitted within 120 calendar days of the expiration of your permit.
According to our records, you must submit your permit renewal by August 2, 2012.
AQUIFER PROTECTION SECTION
1636 Mail Service Centei, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] \ FAX: 919-807.i.,496
Internet: www.ncwaterquality.org
An l=n11~l ()nonrh mitv \ AffimHtthu1 A,,..finn :=mnlf\vrM
NOnehC 1· ort aro 1na
;Natural/11
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit one of the following
enclosed forms:
A. Application for Permit (Renewal) to Construct and/or Use a Well(s) for Injection with
Geothermal Heat Pump System for Type 5A7 Well(s) if the injection well system on your
property is still active.
-OR-
B. Status of Injection Well System if the injection well system is inactive or has been
temporarily or permanently abandoned.
Please submit the appropriate forms to:
Aquifer Protection Section
Groundwater Protection Unit
UIC Program
163 6 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties
in accordance with North Carolina General Statute 87-94. For your convenience, a renewal
application and a UIC well system status form are attached along with a self-addressed envelope.
The above referenced forms are also available on-line at the DWQ website at
htt p://portal.ncdenr.org/web/wq/ap s/gw pro/permit-app lications#rz eothermApp s.
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 eric.g .smithca),ncdenr .gov.
Sincerely, c~
Eric G. Smith, P.G.
Hydro geologist
Enclosures
cc: Wilmington Regional Office -APS w/o enclosures
APS C entral Files -Permit No. WI0800014 w/o enclosures
Permit Number W10800014
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael,rogers
Permitted Flow
Facility
Facility Name
Graham and Mae Mosely SFR
Location Address
2137 Auburn Ln
Wilmington NC 28405
Owner
Owner Name
Graham Mosely
❑a#es.lEvents
Scheduled
Orig Issue App Received Drat Initiated Issuance
11/20/97 09/13107
Regulated Activities
Heat Pump Injection
Outfall NULL
Gsntral Files: APS SWP
12/04/07
Permit Tracking Slip
Status Project Type
In review Renewal
Version Permit Classification
Individual
Permit Contact Affiliation
Major/Minor Region
Minor Wilmington
County
New Hanover
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Graham Mosely
2137 Auburn Ln
Wilmington NC 28405
Public Notice Issue Effective
17,1 �
st ReweeMk c;elued_ Events
RO staff report requested
RO staff report received
Expiration
-1:2l
09114/07
11 /29/07
Waterhody Name Stream Index Number Current Class Subbasin

Michael F_ Easley, Gowmor
William G. Ross Jr„ 5reretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
December 4. 2007
Graham and Mae Mosely
2137 Auburn Lane
Wilmington, NC 28405
Re: Issuance of Injection Well Permit
Permit No. WIOSOOD14
Issued to Graham and Mae Mosely
New Hanover County
Dear Mr. and Mrs. Mosely:
In accordance with your signed application received September 13, 2007. 1 am forwarding
Permit No. W10800014 for the operation of a 5A7 geothermal underground injection well (UIC)
heat pump system located at 2137 Auburn Lane, Wilmington, New Hanover County, North
Carolina 28405. This permit shall be effective f-om the date of issuance until November 30.
2012, and shall be subject to the conditions and Limitations stated therein. For your information;
a review of the laboratory analytical results of the influent samples collected from your
geothermal system (attached) shows exceedances for certain parameters.
For lead, the concentration was 140 micrograms per liter (fig/L). The maximum contamination
level (MCL) for lead is 15 µg/L. Samples collected from your geothermal system in previous
years and analyzed for lead did not indicate any exceedances.
For iron and manganese, the concentrations were 2400 }rg/L and 90 µglL, respectively. The
MCL for iron is 300 µg/L and the MCL for manganese is 50 4g/1, Exceedances for these
compounds have been reported in samples collected in previous years.
We are not sure of the causes for these exceedances in the influent samples. These may be
natural occurring, but we do not have sufficient data to make a determination on the origins. In
order to confirm these elevated samples were collected from the influent spigot, the Wilmington
Regional Office requests that you have the geothermal system checked by a well driller or
plumber and confirm the influent and effluent spigots are properly labeled. Please provide the
results of this inspection to this office within 30 (thirty) days.
Due to the above exceedances, the groundwater from this UIC source well should not be used for
any purposes other than being circulated through the geothermal system (i.e. do not use for
drinking or irrigation).
oft:
N Carolina
Nalurally
Aquifer Protection Section 1636 Mail 5ervica Centcr Raleigh. NC 27699-1636 Tn4bonc: {919j 733-3221
Internet: hmt w+w.newaum alitv.orz 2728 Capital Boulevard Raleigh, NC 27604 Fax I : f919] 7154)589
Fax 2: {919) 715-6048
An Equal OppartunitylAffirma5ve Action Emoioyer— 50%Recy0ed130 % Post Consumer Paper Customer Service: [phone]

Please pay special attention to the bolded language in permit conditions in Part I,
paragraphs 7 and 8. Copies of the GW-1 forms . shall be retained on-site for inspection.
Also, a well ID plate must be affixed to the geothermal system. Your heat pump and well
contractors should provide this information. Please retain these recor~s so that in the
event your property is sold or transferred, the new Permittee will have this information.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit
an application to renew the permit four (4) 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 (UIC) Program please call Mr. Qu Qi at [phone] or
me at [phone].
Best Regards,
~J~~··
Michael Rogers, Environmental Specialist
cc: Charlie Stehman -Wilmington Regional Office
New Hanover Environmental Health Department
Central Office File
Attachment(s)
WI0800014 Page2
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
GRAHAM AND MAE MOSELY
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL, defined in Title 15A 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 2137 Auburn Lane, Wilmington, Nortb Carolina,
and will be operated in accordance with the application received September 13, 2007, and in
conformity with the specifications and supporting data submitted, 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 only, and does not waive any provisions of the Water Use Act or
any other applicable Laws, Rules, or Regulations. Operation and use 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 November 30,
2012, and shall be subject to the specified conditions and limitations set forth in Parts I through
V111 hereof.
Permit issued this the day of De e, r 2007
�oleen H. Sullins, Director
Division of Water Quality
By Authority of the Environinental Management Commission.
WI0900014 Page 3

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 .copy of completed Well Construction Record (Form GW-1) must be submitted for each
injection well to: DENR-Division of Water Quality, Aquifer Protection Section UIC-Staff,
1636 Mail Service Center, Raleigh, NC 27699-1636, within 30 days of completion of well
construction. Per the requirements of2C .0213(h), the original form must be submitted to
the address shown on the form. Copies of the GW-1 forms shall be retained on-site and
available for inspection.
9. The geothermal system shall be inspected by a well driller or plumber to confirm the
influent and effluent spigots are properly labeled.
PART II -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:ofWater 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
WI0800014 Page4
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 Ill-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 assiinilate the injected fluid, the
Permittee shall take iinmediate 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 IV -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.
PART V-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.
WI0800014 Page5
3. Provisions shall be made for collecting any necessary and appropriate samples associated
with the injection facility activities.
PART VI -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 orfirst
knowledge of the occurrence, to the Wilmington Regional Office, telephone number (910)
796-7269, any of the following:
(A) Any occurrence at the injection facility, which 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 VII -PERMIT RENEW AL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
PART VIII -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 discontinuation of 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 15A NCAC 2C .0214, including but not limited to the following:
WI0800014 Page 6
(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
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 of 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 VIII (1) and (2) (G) shall be submitted to:
WI0800014
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636'Mail Service Center
Raleigh, NC 27699-1636
Page7
Re: Sample ID AB2276~ (Graham Mosely)
1 of 1
Subject: Re: Sample ID AB22769 (Graham Mosely)
From: Ellen Stafford <[e-mail]>
Date: Wed, 05 Dec 2007 15:06:55 -0500
To: Michael Rogers <[e-mail]>
Hi Micha~l,
Yes, that was a data entry error. The Pb result is l 40ug/L, the result has been corrected in
Labworks and you should receive an amended report shortly. Sorry about that.
Ellen
Michael Rogers wrote:
The lab results for Pb for the above is 140 U. However, the PQL is
10. Is this an error? If not, then the minimum detection level is way
over the MCL. Should there be a notation on the lab reporting sheet if
this is the case?
Thanks
0
[envirocheim]n
ANALYTICAL & CONSULTING
CHEMISTS
Customer
NCDENR DWQ
127 N. Cardinal Drive Ext.
Wilmington, NC 28405
Attn: G. Kegley
Date Sampled:
Sampled By:
10/11/07
G. Kegley
MOSLEY V.LC. WELL:
Environmental Chemists, Inc.
6602 Windmill Way • Wilmington, NC 28405
[phone] (Lab) • (910) 392- 4424 (Fax)
710 6owsertown Road • Manteo, NC 27954
[phone]
NCDENR: DWQ CERTMCATE #94. DLS CEATIRCATE 437729
REPORT OF ANALYSIS
Date of Report: October 18, 2007
Purchase Order #:
Report Nlmber: 7-10016
Report To: G. Kegley
°fie ED
Lab
Fecal Conform,
colonies1100 mL
Total Colilorm,
colonies1100 mL
I
# 22597
< I
< I
E
# 22598
< 1
< 1
Date Anatyzed
10/11/07
10/11/07
Method Cade
SM 9222 D
SM 9222 B
Comments:
Reviewed by: 1 t t'C

_ rJiN v iHoNN1ENTAL C1-1 EM ISTS, IN
Sample Collection and Cl ain of Custody
NCDMR: DWQ Certillcmfe #94, DLS Cerlificnlr 031719
Analytical & Cons uiling Chem istq
Collected BY: D"M- Dw{�r - [�. KE!fiLE1 --
Samole Tvne: I = Influent, E = Effluent, W =Well, ST =Stream, SO =Soil, SL- Sludre Othcr:
Sample Identifiention
_T�
C f+.ol'O
6602 %Vindmifl IVay
Wilmington, NC 28405
Phowt-. [phone]
Fax: (91 Q) 342-4424
Ernai1:EchemW,'4'0ao1.c0m
Report No: 7 — 1001
PRESERVATION
r p 1 ANALYSIS REQUESTED
x z 1 Q
1
I 'FecAJ 6o wr^ E
r C P---
C t 1
- I C _ P_ ` f
NQTJCE- I)EXIILORINATION : Samples for Ammon ia,'I'KN, Cyanide, Phenol, and Bacteria must be dechlorinated
(1_2-I)in less in the field at the time of collection. Set* reverse side for instructions.
l - i
I r.msfer Relinquished By: Date1Time Received Bv: Datr'I 1n111
TCITlperature. when Receivecl:�� Accepted: I7cjec ed:_ itesRmple Requested: _
D,olivered By:_ - _ _ Received 13y: -- Date: a -a: -7 T ime: Comments: nicnts: -- -- - - - — - - - -- - - - - - - --- - -
Collection
a
p �,
G u
C ?
---- 4
w
E.,
°G4
G`
y
.G e Ji
s .a
DATF TEMPT
C
_?-
_

` (D'W Laboraton, tiection WesuCts
County:
NEW HANOVER
Sample ID:
AB22769
lA�
River Basin
ti a� ,
PO Number #
7G0766
1011212007
Report To
VVIRQAP
�a �G
Date Received:
08-.20
>=i
Time Received:
Collector
Region:
G KEG! EY
WiRO
a `v'mft., Y
Latrvorlcs Loginll7
MNIATHIS
{late Reported:
1215107
Sample Matrix:
GROUNDWATER
Loc. Type.
WATER SUPPLY
Report Generated:
1210512007
Emergency Yes1No
1TsitID
COC YeslNo
YES
Loc. Descr.-. GRAHAM MOSELY
Location M:
8P0GSWI0800014
Collect Date. 110111112007
Collect Time-: 15:30
Sample Depth
Sampie Qualifiers and Comments
err ca C.-.10
Z. w v
DEC 17 tea?
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwglab.org under Staff Access
A -Value reported is the average of two or more determinations
S1-Countable meftraoes with a20 colonies; Estimated
82- Counts from all filters were zero.
83- Countable membranes with more than 60 or 80 colonies; Estimated
64-Fllters have counts of both >60 or 80 and < 20; Estimated
85-Too many colonies were present; too numerous to count {TNTC)
32- Reported value failed to meet OC criteria for either precision or accuracy; Estimated
.f3-The sample matrix interfered with the ability to make any accurate determination; Estimated
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample; Estimated
N1-The component has been tentatively identifier! based on mass spectral library search and has an estimated value
N3-Estimated ccmcBntfation is c PO and >MDL
NE -No established POL
P-Elevated POL due to matrix interference andfor Sampie dilution
01-Holding time exceeded prior to receipt at isb.
02- Holding time exceeded following receipt by lab
POL- Practical i]uantJWon Limit-sub]ect to change due to instrument sensitivity
tl- Sam pies analyzed for this compound but not detected
x1- Sample not analyzed far this compound
Laboratory Sec don>> 1623 Mall Service Center, Raleigh, NC 27699.1623 1919) 733-3 90 8 Page 'I of 3

:NC '1YWQ La6oratory Section ~sults Sample ID AB22769
Location ID: 8P065WI0800014 Collect Date: 10/1112007
Loe. l>eJ!cr.: GRAHAM MOSELY Collect Time:: 15:30
Visit ID
CAS# Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
Sample temperature at receipt by lab 1.7 MMATHIS JGOODWIN
Method Reference 10/12/07 10/12/07
WET
Ion Chromatography _TITLE_ mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 10/12107 10/1~7
Total Dissolved Solids In llquld 12 262 mg/L JSTALEY MOVERMAN
Method Reference APHA2540C.18TH 10/15/07 10/17/07
Chloride 1.0 20 mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 10/12107 10/16/07
Ruot1de 0.4 0.4 u mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 10/12107 10/16/07
Sulfate 2.0 2.0 u mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 10/12107 10/16/07
NUT
N02+N03 as N In lquld 0.02 0.02 u mg/LasN MAJAYI MOVERMAN
Method Reference Lac10-107-04-1-c 10/12/07 10/17/07
MET
7429-90-5 Al bylCP 50 50 u ug/L SGOSS EST AFFORD
Method Reference EPA200.7 10/15/07 11/20/07
7440-70-2 CabylCP 0.10 81 mg/L SGOSS EST AFFORD
Method Reference EPA200.7 10/12/07 11/20/07
7440-47-3 CrbylCPMS 10 10 u ug/L JJURGEVICH EST AFFORD
Method Reference EPA200.8 10/16/07 11/20/07
7440-50-8 CubylCPMS 2.0 250 ug/L JJURGEVICH EST AFFORD
Method Reference EPA200.8 10/26/07 11/20/07
7440-48-4 FebylCP 50 2400 ugl SGOSS EST AFFORD
Method Reference EPA200.7 10/15/07 11/20/07
7440-09-7 KbylCP 0.10 0.73 mg/L SGOSS ESTAFFORD
Method Reference EPA200.7 10/12/07 11/20/07
7439-95-4 MgbylCP 0.10 2.5 mg/L SGOSS EST AFFORD
Method Reference EPA200.7 10/12/07 11/20/07
7439-96-5 MnbylCPMS 10 90 ug/L SGOSS EST AFFORD
Method Reference EPA200.8 10/15/07 11/20/07
7440-23-4 NabylCP 0.10 12 mg/L SGOSS EST AFFORD
Method Reference EPA200.7 10/12107 11/20/07
7440-02-0 NlbylCPMS 10 10 u ug/L JJURGEVICH EST AFFORD
Method Reference EPA200.8 10/16/07 11/20/07
Laboratory Section» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of3
Location ID:
Loe. De.~cr.:
Visit ID
8P065WI0800014
GRAHAM MOSELY
CAS# Analyte Name
7439-92-1 Pb by ICPMS
Method Reference
7 440-66-6 Zn by ICPMS
Method Reference
EPA200.8
EPA200.8
WC <D'WQ, La6oratory Section (Rssu[ts
PQL Result Qualifier
10 140
10 590
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
Units
ug/L
ug/L
Sample ID
Collect Date:
Collect Time::
Analyst/Date
JJURGEVICH
10/16/07
JJURGEVICH
10/16/07
Page 3 of 3
AB22769
10/11/2007
15:30
Approved By /Date
EST AFFORD
12/5/07
EST AFFORD
11/20/07
North Carolina
GROUNDWATER FIELD/LAB FORM L.000e Lore epartment of Environment and Natural Resources
QIVI5ION OF WATER QUALITY -GROUNDWATER SECTION
Location code 6W1 SOID014 SAMPLF TYPE
County V� �r bOey IQK Water
Quad No Serial No. ❑ soil
Lat Lang. ❑ Other
XChain of Custody
Report To: ARO, FRO, MRO, RRO, WaR0 IR
SAMPLE per— ���
Routine Lab Numbe
❑ Emergency Date Received 0 & Time:a 2. 0
Rec'd By: 1 (,) From:Bu , Hand Del.,
Other:
Data Entry By. Ck:
WSRO, Kinston FO, Fed. Trust, Central Off., Other, Date Reported:
Shipped by: Bu <ie Hand Del., Other. Purpose:
Collector(s),. Kge' Lzy Hate Time 1 S: 3o Baseline, Campiairrt, m iia LUST, Pesticide Study, Federal Trust, Other,
FIELD ANALYSES Owner t`"mi`°nol
pH aoo Spec. Cond,94 at 251C Location or Site_ e-$1_ -
Temple IC Odor Description of sampling point_ - :Wr F t
Appearance Sampling Method Sample Interval
Field Analysis By: Remarks FKifn D. a . e
Tt
LABORATORY ANALYSES {f umping time, alrtemp., eta)
BOO 310 mg1L
C013 High 340 mg&
CUD Low 335 rnglL
Colifoam: MF Fecal 31616 1100ma
Coliform- MF Total 31504 1100m1
TO 690 "It.
Turbidity 76 NTU
Residue, Total Suspended 530 mglL
pH 403 units
Alkalinity to pH C6 410 mglL
Aikalfnliyto pH a.3416 mglL
Carbonate 445 rnglL
Bicarbonate 440 mg/L
Carbon diordde 405 mg1L
Chloride 240 mgA-
Chromium: Hex 1032 ugIL
Color: True 80 cu
Cyanide 720 mglL
Lab
piss. Solids 70300 mglL
Flucrfde 951 M91L
Hardness; Total 900 mglL
Hardness (non•carb) 902 mg1l
Phenols 32730 u94
5pedfic Cond_ 95 NMhoslcm
Sulfate 945 mglL
Sulfide 745 mgrL
OH and Grease mglL
NH3 as N a lfl mglL
TKN as N 525 rng1L
N% + NO3 as N 630 mglL
P: Total as P 665 mglL
Nitrate (NO3 as M 620 n►gIL
Nitrite (NOz as N) 615 mglL
GW-54 REV_ 7103 For Dissolved Analysia-suhmft filtered sample and wdle'DIS- in block.
AgSil%W 46566 u
)C
Al -Aluminum 46557 u
As-Arsenlc411155t u
Ba-asnum 46550 0 IL
Ce-Caldum 46552 AVL
Cd-Cadmium 46559 u IL
Cr-Chramlum 4e559 u ll-
Cu-Copper46562
Fe Iron 46563 0 IL
Ffg-Mercury 71000 u91L
_
i[-Potassium 46555 MOIL
Mg -Magnesium 46554 m
Mn-Manganese 46565 y IL
Na-Sodlum 46556 m
Prl-Nickel u
Ph -Lead 46554 u IL
Se -Selenium unlL
)[
zn-lino 46567 k
Nitrogen Pesticides
Acid Herbicides
TPH-Gasoline Range
i TPH-8TEX Gasoline Rena*
I &11I 5E OI+ILY j 1�
Temperature on arrirvai (°C): f ,

XC (D`jj)Q La6oratoa ,Section Wesults
Gounty: NEW HANOVER Sample ID: AB22766
River Basing VYA��RP PQ Number# 7GOT65
Report To WIROAP Date Received: 101IM007
Collector: G KEGLEY Time Received: O$ 20
Region: W1RO oNZ _Z70ft-W
Y Labworks LoginlD MMATHIS
Sample Matrix: GROUNDWATER Date Reported; f il20147
Lac. Type: WAIN SWPPLY Report Generated: 1112112007
Emergency Yes)No
V sit10
COc YeslNo
Lac. Descr.; GRAHAM MdSELY
Location ID: BP065WI0800014 Coilect Date: 1001112007. Collect Time:; 15:00 Sample Depth
Sample Qualifiers and Comments
RBICOIVED
BY:
NOV 2 7 2007
Routine Qualifiers
Fof a more detailed description of these qualifier codes refer to www.dwglab.org under Staff Access
A -Value reported is the average of two or more determinations N3-Estimated concentration is c PQL and 7MDL
91-Countable membranes with <70 colonies; Estimated
NE -No established PQL
02- Courns from all filters were zero.
P-Elevated PQL due to matrix interference andlor sample dilution
83- Countable membranes with more 1Yran 64 or 80 Colonies; Estimated
94•Filters have counts of both �60 or 8o and a 20; Estimated Q1-Holding 5me exceed ad prior to receipt at lab.
BS-Too many colonies were present; too numerous 10 taunt (TNTC) 42- Holding time exceeded following receipt by lab
PQL- Practical Quantitation Limit -subject to change due to instrument sensitivity
J2- Reported value failed to meet QC criteria for either precision or acwracy; Estimated
J3-The sample matrix interfered with the ability to make any accurate determination; Estimated i!- Samples analyzed for this compound but not detected
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample; Estimated X1- Sample not analyzed for this Compound
N1-The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
Laboratory Section>> 1623 Mall Service Center, Raleigh, NC 21699-1623 1919) 733.3906 Page 1 of 3

:NC <JYWQ La6oratory Section c.R.§sults Sample ID AB22768
Location ID: BP065WI0800014 Collect Date: 10/1112007
Loe. Descr.: GRAHAM MOSELY Collect Time:: 15:00
Visit ID
GAS# Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
Sample temperature at receipt by lab 1.7 ·c MMATHIS JGOOOWIN
Method Reference 10/12/07 10/12107
WET
Ion Chromatography _TITLE_ mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 10/12/07 10/16107
Total DISSOived Solids In llquld 12 260 mg/L JSTALEY MOVERMAN
Method Reference APHA2540C-18TH 10/15/07 10/17/07
Chlorlde 1.0 20 mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 10/12/07 10/16/07
FluoJ1de 0.4 0.4 u mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 10/12/07 10/16/07
Sulfate 2 .0 2.3 mg/L MIBRAHIM MOVERMAN
Method Reference EPA300.0 10/12/07 10/16/07
NUT
N02+N03 as N In llquld 0 .02 0.02 u mg/LasN MAJAYI MOVERMAN
Method Reference Lac10-107-04-1-c 10/12/07 10/17/07
MET . ,L .,
7429-90-5 AlbylCP 50 i.J , .1:, 64 ug/L SGOSS ESTAFFORD
Method Reference EPA200.7 ··; L 10/15/07 11120/07
7440-70-2 CabylCP 0 .10 81 mg/L SGOSS EST AFFORD
Method Reference EPA200.7 10112/07 11120/07
7440-47-3 CrbylCPMS 10 10 u ug/L JJURGEVICH EST AFFORD
Method Reference EPA200.8 10/16/07 11120/07
7440-50-8 CUbylCPMS 2 .0 2.4 ug/L JJURGEVICH ESTAFFORO
Method Reference EPA200.8 10/26/07 11120/07
7440-48-4 FebylCP 50 2400 ug/L SGOSS EST AFFORD
Method Reference EPA200.7 10/15107 11120/07
7440-09-7 KbylCP 0 .10 0.74 mg/L SGOSS EST AFFORD
Method Reference EPA200.7 10112/07 11120/07
7439-95-4 MgbylCP 0 .10 2.5 mg/L SGOSS EST AFFORD
Method Reference EPA200.7 10112/07 11120/07
7439-96•5 MnbylCPMS 10 89 ug/L SGOSS ESTAFFORO
Method Reference EPA200.8 10115107 11120/07
7440-23-4 NabylCP 0 .10 12 mg/L SGOSS ESTAFFORO
Method Reference EPA 200.7 10/12/07 11120/07
7440-02-0 NlbylCPMS 10 10 u ug/L JJURGEVICH EST AFFORD
Method Reference EPA200.8 10/16/07 11120107
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of 3
Location ID:
Loe. Descr.:
Visit ID
8P065Wl0800014
GRAHAM MOSELY
CAS # Analyte Name
7439-92-1 Pb by ICPMS
Method Reference
7440-66-6 Zn by ICPMS
Method Reference
EPA200.8
EPA200.8
:NC <DWQ £a6oratory Section ~su{ts
PQL Result Qualifier
10 10 U
10 10 U
·:v
Laboratory Section» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone]
Units
ug/L
ug/L
Sample ID
Collect Date:
Collect Time::
AnalysVDate
JJURGEVICH
10116/07
JJURGEVICH
10116107
Page 3 of 3
AB22768
10/11/2007
15:00
Approved By /Date
EST AFFORD
11120/07
EST AFFORD
11120/07
North Cawlina
GROUNDWATER FIELD/LAB FORMLooe�%Departmen(ofEnvironment and Natural Resources
l7VISION OF WATER QUALITY-GROUNDMTER SECTION
Location Code_ `A Q!&0d011 _ _ 5AMe LE TYPE SAMPLE PRIORITY � /�
County A et ,) ROL44OV-C.►� _ .Water 1�t Routine Lab NumheM 1- -- �*`L� ZU
Quad No Serial No. Sall El Emergency Date received,$ CAI Time6);
LaL Long. ❑ Other Rec'd By P#tWFrom:BLis, (� Hand Del.,
�� � 0 Chain of Custody Other:
Report To: ARO, FRO, MRO, RRO, WaRO. I Data Entry By; Ck.
WSRO, Kinston FO, Fed. Trust, Central Off., Other- Date Reported
Shipped by: Bus, ❑uri , Hand Del., Other Purpose.
Collectors} Cam. k� ��c �' Date O Time r S-- 0 Baseline, Complaint, ❑m lien LUST, Pesticide Study, Federal Trust, other,
FIELD ANALYSES Owner "r-4 l l"'.)
pH 40o Spec. Cond. g4 at 25°C Location or Site G IMC11 L U
Temp.ld °C Odor Description of sampling paint ,qsA-+-
Appearance Sampling Method ` Sample lntenlal
Field Analysis By_ Remarks um° 'e'er °
LABORATORY ANALYSES lPurnping bme, air I"p , eic.l
BOO 310
mgA -
COD High 340
mg/L^
COD Low 335
M91L
Colironn: MF Fecal 31616
rloorrml
Cobfow lull• Total 31504
1100H
TOC 680
mgh.
Turbidity 76
NTU
Residue, Total Suspended 530
mglL
y[
Dims- Solids 70300 mgA -
Fludride 951 mgk
Hardness Total 900 mglL
Hardness (non -Garb) 902 mg/L
Phenals 32730 u94
Specifie Cond- 95 pMhosicm
sulrale 945 mgAL
Sulfide 745 mglL
Ag-Silver 46566
AI -Aluminum 46557
As -Arsenic 46551
Be -Barium 46558
Ca -Calcium 46552
Ca -Cadmium 46559
Cr-Chronuum 46559
Cu-Copper 46562
Fe -Iran 46563
pH 403 units
Oil and Grease mgrL
-
jC
Hg-Mercury 71900 w0l.
K-Polassirm 46555 - AIL_
Mg Magnesium 46554 m AL
—
Alkalimly to pH 4.5 410 mglL
_ _
Alkalfnily to pH 61 415 mglL
Mn_Mangamse 46565 u9il.
Carbonate 445 mgll
Bicarbonals440 nigIL
NH3 as N 510 mg1L
TKN as N 625 mgrL
NO2 + NO, as N 630 mgrL
P_Tolal as P 665 mglL
Nltrale (NOl as N)62o mgAL
x
Na-Sodium 46555 m lL
A
_
Ni-Nickel u 1L
Pb-Lead 46564 UYL
se -selenium ug1L
2rw7urrc 46567 u IL
Carbon diordde 405 mg1L
Chloride 94U _ mg1L
Chromium Hex 1032 uglL
Color. True 8o Cu
Nitrite (NO2 as N] 615 mg1L
Cyanide 720 mgrL
y
Lab Comments — — —
GW-54 REV. 7103 For DlssoWed Analysis -submit klie red sample and wrile -Dl5" in block
pryerwchlon ne ?eel irides
❑r anoprlosphorus Pesticides
Nvlrogers Pestcides
Acid Herhicides
PCBs
SemiuolaMe Opanics
TPH-Olesel Range Y__
Volatile Organics {VOA bollle
in TPH-Ga.o e R..
TPH- BTEK Gasoline Ranee
LAB USE ONLY
Temperature oil arrival (`C):

[Fwd: WI0800014]
1 of 1
Subject: [Fwd: WI0800014]
From: Qu Qi <[e-mail]>
Date: Tue, 13 Nov 2007 15:48:25 -0500
To: Michael Rogers <[e-mail]>
--------Original Message --------
Subject: WI0800014
Date: Fri, 12 Oct 2007 15:28:50 -0400
From: Geoff Kegley <Geoff.Kegle y @ncmail.net>
To: QU QI <[e-mail]>
Qu,
Just to let you know ... the sampling was done for permit WI0800014 yesterday. I will
forward the results when I receive them.
Have a good weekend,
Geoff
Qu Qi <[e-mail]>
Underground Injection Control Program Manager
NCDENR
Division of Water Quality
11/13/2007 3:49 PM
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 9/21/2007
To: Aquifer Protection Section Central Office
Central Office Reviewer: Micahel Rogers
Regional Login No: _Geoff Keglev
County: New Hanover
Permittee: Graham Mosel
Project Name: Graham Moser 5A7
Application No.: W100800014
L GENERAL INFORMATION
1 • This application is (cheek all that apply): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ 1Aecycic ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment 13 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 Z No.
a. Date of site visit: - — r-r 1 J'J S �� AY- 41
b. Person contacted and contact information:
c. Site visit conducted by: __
d. Inspection Report Attached: ❑ Yes or ❑ No.
2. is the following information entered into the DIMS 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 Treatment Facilities:
a• Location:
b. Driving Directions:
c• USGS Quadrangle Map name and number:
d. Latitude: Longitude:
e, Regulated Activities 1 Type of Wastes (e.g., subdivision, food processing, municipal wastewater),
For Disposal and Inflection Sites: -
tlf multi 1p a sites either indicate which sites the information applies to. command paste a new section into the
document for each site. or attach additional pages for each site
a. Locations): _ _
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
11. NL'WAND MAJOR Mt7DIFICATIONAPPLICATIONS (this section not needed for renewals or minor
li 20ications. skier to next section)
Description Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification:
2. Are the new treatment facilities adequate for the type of waste and disposal system?
FORM: Graham Mosely 5A7 staff report Sept07 l

AQUIFER PROTECTION SECTION 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:
[gl 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 (SL/"Non-Discharge")
D Other (Specify: -~
2. Does system use same well for water source and injection? D Yes 0 No
3. Are there any potential pollution sources that may affect injection? D Yes r:g] No
What is/are the pollution source(s)? n/a. 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? 31 ft.
5. Quality of drainage at site: r:g] Good D Adequate D Poor
6. Flooding potential of site: r:g] 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)? ~ 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 Onl v:
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 0 No. lf v es. exp lain :
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 y es. exp lain:
3. For renewal or modification of g roundwater remediation permits (of an v typ e ). will
continued/additional/modified in jections have an adverse im pact on mi i!ration of the p lume or management of
the contamination incident? D Yes D No. If 1 es . ex )lain:
4. Drilling contractor: Name: __
FORM: Graham Mosely 5A7 staff report Sept07 ti ~
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet -if needed information is available
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
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. Signatureofreportpreparer(s): ~ ~~ ~(?1/4-?
Signature of APS regional supervise: ---~-__\.,~:).+...J-=L..__Rti::c-'I...J,.,...£ -!::-===-----------
Date: ----+i -1--J '-~-..... /~6=--+--7-
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM : Graham Mosely 5A7 staff report Sept07 /) 5
A QUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: September 14 . 2007
To: D Landon Davidson, ARO-APS
□ Art Barnhardt, FRO-APS
0 Andrew Pitner, MRO-APS
D Jay Zimmerman, RRO-APS
□ David May, WaRO-APS
[8J Charlie Stehman, WiRO-APS
□ Sherri Knight, W-SRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: (919 ) 715-6166 Fax: (919 ) 715-0588
E-Mail: Michael.Ro [e-mail]
A. Permit Number: WI 0800014
B. Owner: Graham Moselv
C. Facility/Operation: __
D Proposed [gJ Existing D Facility D Operation
D. Application:
1. Permit Type: D Animal O SFR-Surface Irrigation □ Reuse O H-R Infiltration
D Recycle D VE Lagoon D GW Remediation (ND)
[8J UIC -(5A7) open loop geothermal __
For Residuals: D Land App. 0 D&M
D 503 D 503 Exempt
D Surface Disposal
D Animal
2. Project Type: D New D Major Mod. D Minor Mod. [gJ Renewal D Renewal w/ Mod.
E. Comments/Other Information: D I would like to accompany you on a site visit.
NOTE: The requested day s for the submittal of the staff rep ort (SR) has changed. Per the request of
Debra Watts , the requested dates for the submittal of the SR have been changed to 2 weeks for a UIC
re port, and 4 weeks for a SFR re port.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 14 calendar days, please take the following actions:
[8J Return a Completed APSARR Form.
D Attach Well Construction Data Sheet
D Attach Attachment B for Certification by the LAPCU.
D Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
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-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: --------------------Date: _____ _
FORM: APSARR 07/06 Page 1 of 1
4� W A TF9� Michael F. Easley, Governor
Wiliiam G. Ross Jr„ Secretary
rNorth Carolina Depattment of Enviromuent and Natural Resources
,r Cohen H. Sullins Dh=lor
Division ofWater Quality
September 13, 2007
GRAHAM MOSLEY
ENT & AUDIOLOGY ASSOCIATES
2137 AUBURN LANE
WILMINGTON, NC 28405
Subject: Acknowledgement of Application No. WI0800014
Mosley, Graham - SFR
Injection HeatmglCooling Water Return Well (5A7)
New Hanover County
Dear MR MOSLEY:
The Aquifer Protection Section of the Division of Water Quality (the Division) acknowledges receipt of
your permit application and supporting materials on September 13, 2007. This application package has
been assigned the number listed above and will be reviewed by Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if
necessary. To ensure the maximum 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 recommendations 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 by phone at [phone] or by email 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 htt2:llh2Q.enr.state.nc,udocunrlentsldwcLor(,chart.l+df.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAIUNG INQUHUES
ON THIS PROJECT.
Sincerely,
f For ra J. Watts
Supervisor
cc: Wilmington Regional office, Aquifer Protection Section
Permit Application File W10800014
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636
lntemet: www.r wateryuality.ora Location: 2728 Capital Boulevard Raleigh. NC 27604
An Equal CpportuniilrlAfftrma ve Action Employer 5D% Reepcled110% Post Consumer Paper
Telephone:
Fax 1;
Fax 2:
Customer Service:
�� Carolina
�lll�
[phone]
[phone]
[phone]
[phone]

iac i :%a -CRO PKA
DEPARTMENT OF WV 0NNWNT, IEi 1 L iaq—l)NA i uRAL, i�si iia7t[�.S
RENEWAL APPLICATION FOR PERMIT TO USE WELL(S) FOR INJECTION WYIU A
IMAT PUMP SMEM
Type 5A7 and 5QM WeW
j In accordance with the provisions of NCAC Title 15A; 02C,0200 r��C l
complete applicat km and mail in address art the back page e 1 ENf� 1(I
AGW
TO: DIRECTOR,NORTH CAROLINA DMSION OF WATER QUALITY SEF
]JA T E: . 20 0 .2
A. PERMIT APPLICANT
f-ermft umber: &&lUKV EP,*/� k Wmuff—R0ti0, liged . at the botiom QI each page of your permii)
Name: �/ 4L AEa +C v - -
City: -7-4- State-, Zip eode: Pf�_l
coon y: 1/ P rE
B. PROPERTY OWNER (if different from applicant)
Name.
Address:
City: State: Zip coda`
County: Telephone:
C. STATUS OF APPLICANT
Private: Federal: Commercial: State: Public:
Wative American Lands:
D7 FACILITY (SITE) DATA {Fill out ONLY if the Status of Owner is Federal, State, Public or Commercial) -
Name of Business or FacWiy:
Address:
city -
State: dig code_
County: _--. _ _ Telephone:
Coutact Person:
Smmlard Industrial Code(s) Wind wscn"be cotY mewid utut4ty:
Revised 7106 OWAAC-57 HPPR Page I of-3

i3. it.ijECii33-+i riC:i::'r_iiJiiRE (Sv"iry an) iukxLaiRiiiwas io iiw it j4.:Udwi pi kAg1twu s'ii= Uku issuari" i» i1w
previous itllectionpermit)
i . 'w%LL u SL :s(w c) 1.. ;i j.::.: ou user? as i U .T'Y ) vvcik's j 1, ziWu: +si wu ;:;li:)VVw e?
(1) ne injection opera -don't YE��__ ivii �
(2) Your personal consumption? YES NO !E�
ftED
G. CONSTRUCMON DATA
���
Isix;6iN. aUl And ail is ct:iiii;adons w iiii: welt Uasoui or scruals sillw aw i33 22ti: 01 � L1�rILlN
injection permit.
(iw //C--
(2 ) NC SitiW Rugulaeiions (I3A NCAC, 2C:, Swii<ai d32W'j rctluim iiu; p amii. u- io ma" provisions fslr
monitoring weu nead processes- A faucet on both nti-meth (gmunawaler entering beau pump) and
eftluerit (water being injected into the well} tines is required- Is there a faucet on:
sa...._.a 1.r., r: Liu Y
(n) an The effluent line-?
H. CURRENT OPERATING DATA
[I ) .injection rate: Average (may) goons per mmule Wm) 64�
(2) Injection volume: Average (daily) gallons per day (gpd) !]� V / O it 5
(3) irgecuon pressure: Average (may) pounds •per square incn (psi) 1�
(4) Injection temperature: Annual Average degrees Fahrenheit (°F) �'4—
Attach a diagram showing any modhflcaaom to injection equipment since the issuance of the previous injection
hermit inciWing ii c onginmring lavoin of the (1) injection cqu4 Fn and (2) exterior pipia&rriulsing asso,wiaied
wim me iigjectian vperauan. i�te rnanul"acilueT's orociiura. ii; aeuriied, shauiu satisry Lt j. ���%�"
J. LOCATION OF WELL(S) Attach a trap
iriUlr#& a mkI inap Luau bu-drawn) "Ming: dw oyka-Awkhz k5l 4W W'!—S4iV'w wwswri 4w i*060rzz W'4:41(5) Ono
any exiaf en4 well(s) or waste 4isposai facilities such as septic tanks or drain lieids located wrthin limit feet of uie
ground -source heat pump well system; include buildings, property lines, surface water bodies, any other
poV&W wirocs of groundwater coniatnmbon. Labei " ieahues cieariv and imiu 3e a north arrow io indwate
oncniation le- V 1,0a S _� I3"7 0 7 -r-A- e— T ,
K. PERMIT LIST-: Attach a list of all permits or construction approvals, received or applied For by the applicant
dun are related ro frze siie. LXampies Include: (i) hazardous Waste Management program persons under RCRA
(%) NC Div— iiiii Of isfiiir iriiHl.ii) iii:si-_DitQ;batrgc P.GTmiis
(3) Sewage I reaunem and Disposal inerrnits
L. OTHER MOiIMCA'HONS: Indicate any other modifications to the injection well system (equipment, fluid,
Bic..' Vb* [lR'v'? cvrcils;ed --611C$ the i.gmi rwe of filenmvinl1S iii iw.t ifi i.i_�i�?:i i4i3 a U,avc not hom wied
elsewhere on tins apphcaiion- /Q }
Revimd 7ru6 GW UIG37 HPR Page 2 of 3

"I tcatiiy ,=Kay, mane:-pelidity e[ Id", UK i 19tVC PMWI lliiy VXahiI� dUd elit'iWlli� - WI`L h the iiAM1+J AIM
submitted in this document and all attachments thereto and that, haled on my inquiry of those individuals
�it7ii L1i51iC IV r[ 3�ii7ilr-bis-
complete, i and aware that there arc stgnifivant pests}tics, including the poem-Wi#.y of fines and imprisoameni, for
YYri.rIU I. i•cr e,rii •+rssxi 4t4 r. i .v acs iu •f�+eltkE � ifl,iit�fyit�:r 1�z =fin 3i r°3'?i: �'J1C� Y'.7 UYtt jgjtX;i-.)a WL:i=
and all relates appurtenances M- $C[�am= with the approved specificatxms and conditions o 60 Permit.
{Signattue of Well Owner or Authorized
If authorized agent is acting on beWof the well owner,
authonmw the above agent.
N, CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other properly rights in
t11+J Yv iillidJ, i'1 will iA' 14uI jilUp�aty eiii;i lint 4"S+LiS{I Llk:llUu V W W:IaiW Ll 14;; liilki vhiK:i ilk U W�kS411�i
of contrary agreement to wnt4.)
If the property is awned by someone other than the applicant, the property owner hereby consents to allow the
spp;iuw.i IQ uperdw an irl,�a:u�,rl YV41;.(b) as uuiiilwd iu'ukw appli6t*.ivu mid "i ii, abail W id1S: wavousiaiii►y of aw
applicant to ensure that the injection well(s) conform to the Well Cou4truction Stmxk4s (Title 13A NOAC
Subchapter 2C -02W)
(Signature of property Owner if Different From Applicant)
Please return the completed Application package to: AQ[I�A Pr,�q11
UIC Program 5EP 1'1110AIS, c,
Aquifer Protection Section .9 e0o?
North Carolina i)EN --WWQ
1636 Mail Service Center
Raleigi4 NC 271699-1636
Telephone: [phone]
itevixd 7/06 OWIUlc-57 HPF, i'aje 3 of 3

New Ha.qover County
PARID: R05107-004-042-000
MOSELY GRAHAM H MAE OMIE H
r -26 -
,l D 3h
I
1h
--
'L
2137 AUBURN LN
11 of 1 J
·-·~
C 1
·-,_
A 311'
--.-6 -J
E
9
A MAIN, 1665 Sq. Ft. 8 1S FR ONE STORY FRAME, 495 Sq. Ft.
C WOOD DECK, 495 Sq. Ft. 0 GARAGE,FULL ATTIC FINISHED, 780 Sq. Ft.
E MASONRY STOOP, 63 Sq. Ft.
http://etax.nhcgov.com/Forrns/Sketch.aspx?Print= 1&pin=R05107-004-042-000
Page 1 of 1
9/14/2007
Page 1 of 1
f
http://etax.nhcgov.com/images/maps/397141813468M.jpg 9/14/2007
Wilmington, NC to 2137 Auburn Ln, Wilmington, NC 28405 - Google Maps
Page 1 of l
0 )gle Start Wilmington, NC Get Google Maps on your phone
End 2137 Auburn Ln T"tftword`1GMAWto46fi453
Wilmington, NC 28405
Travel 11.5 mi — about 30 mins
Wilmington, NC
Drive: 11.5 mi — about 30 mins
1. Head north on S 3rd St/US-17-BR
toward Market St
2. Turn right at Market St1US-17-BR N
�► 3. Turn right at Eastwood Rd/US-74
'4" 4. Turn left at Military Cutoff Rd
-0 5. Turn right at Drysdale Dr
"Im 5. Turn left at Pembroke Jones Dr
4' 7. Turn left at Verrazzano Dr
4- 8. Turn left at Pembroke Jones Dr
'Ilm 9. Turn left at Arboretum Dr
10. Turn right at Gull Point Rd
} 11. Turn left at Auburn Ln
2137 Auburn Ln
Wilmington, NC 28405
Overview
210 ft na. .re4' B
� 17
4.7 mi
12 gins
2.5
-` 7S � 9ata tiYdgJ�lSwl�e
2. 5 Ml @bacr
4 mins
Sta rt
0.3 mi
1 min
x
0.3 mi t ^r s
1 min
Wit ton
0.4 mi
1 min
� F
d $g
< {�ra[igl St a
0.3 mi M f
0.8 mi End
2 mins
1.9 Mi a
S mins
0.1 mi e -
335 ft,
FP. 10
!or
These directions are for planning purposes only_ You may find that Map data @2007 NAVTE�
cons(r•uction projects, traffic, or other events may cause road
conditions to differ from the map results.
Map data @2007 NAVTEQTM
bttp:lltnaps.google.comlmaps?f=d&hl=en&geocode=&time=&date=&ttype=&saddr=wihn... 12/4/2007

DIVISION OF WATER QUALITY
GROUNDWATER SECTION
May 16, 2003
MEMORANDUM
To: Charles Stehman, Ph. D., L.G., Regional Groundwater Supervisor
Groundwater Section
Wilmington Regional Office
From: Mark Pritzl PI-P Mark. Pri1z1@ncnsaiL net
Hydrogeological Technician H
UIC Group
Groundwater Section
Raleigh Central Office
Re: Issuance of a Open -Loop Geothermal Injection Well System (Type SA7.):
Permit Number WI0800014 to operate a well for the injection of an open -loop
ground -source heat pump system has been issued to Mr. Graham Mosely, in Wilmington, North
Carolina. This is a renewal permit and the Underground Injection Control Group
appreciates Ms. Rossi's assistance with the inspection and review tasks. Please retain the
application and paper work for the W1RO-LTIC files. If you have any questions regarding this
permit or the UTC program, please contact me at [phone].
cc; CO-UIC Files
Enciosures

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE 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
Graham H. Mosely
FOR THE OPERATION OF A TYPE 5A7 INJECTION WELL(S), defined'in Title 15A North
Carolina Administrative Code 2C .0209(e)(3)(A), which will be used for the injection of heat
pump effluent. This system is located at 2137 Auburn Lane, Wilmington, in New Hanover
County, North Carolina, and will be operated in accordance with the application received on
December 3, 2002, and in conformity with the specifications and supporting data submitted, 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 only, and does not waive any provisions of the Water Use Act or any
other applicable Laws, Rules, or Regulations. Operation ·and use 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, 2008,
and shall be subject to the specified conditions and limitations set forth in Parts I through IX
hereof.
Permit issued this the ~ day of \"\~ , 2003.
~ ~-G0'-~_
Ted L. Bush, Jr., Assistant Chief
Groundwater Section
Division of Water Quality
By Authority of the Environmental Management Commission.
PermitNo. WI0800014
ver.3/01 GW/UIC-5
Page 1 of5
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 injection well shall have permanently affixed an identification plate.
PART II-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the hature, 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.
PermitNo. WI0800014
ver.3/01 GW/UIC-5
Page 2 of5
PART III -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 IV -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.
PART V -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.
Permit No . WI0800014
ver .3/01 GW/UIC-5
Page 3 of5
PART VI -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 Wilmington Regional Office, telephone number (910)
395-3900, any of the following:
(A) Any occurrence at the injection facility which 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 Permittce.
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 VII-PERMIT RENEWAL
The Permittee shall, at least three (3) months prior to the expiration of this permit,
request an extension.
PART VIII -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 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:
Permit No. WI0800014
ver.3/01 GW/UIC-5
Page4of5
(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) The 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) Drilled wells 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, neat-cement shall be injected into the well completely
filling it from the bottom of the casing to the top.
(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 of 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 Vill (1) and (2) (G) shall be submitted to:
Groundwater Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
PART IX-OPERATION AND USE SPECIAL CONDITIONS
None
Permit No. WI0800014
ver.3/01 GW/UIC-5
Page 5 of 5
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina artment of Environment and Natural Resources
May 12, 2003
Mr, Graham H. Mosely
2137 Auburn Lane
Wilmington, NC 28405
Dear Mr. Mosely:
Alan W. Klimek, P.E. Director
Division of Water Quality
In accordance with your renewal application received on Dcccmber 3, 2002, we are forwarding
Perrtvt No. WIOS00014 for the operation of a geothermal heat pump injection well at 2137
Auburn Lane, Wilmington, NC, in New Hanover County. A copy of the laboratory test results of
water samples collected on April 14, 2003 is also enclosed.
Tl-is pen -nit shall be effective from the date of issuance until May 31, 2008, 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 three
months prior to its expiration date.
If you have any questions regarding your permit please contact me at (919) 715-61 G5 or Evan
Dane at (919) 715-51 d5.
cc: CD-UTC Files
WIRO-UIC Files
ARMosures
�DEhR —
Customer Service
1 804 623-7748
Sincerely,
4S
Marie Pritzl
Hydrogeological Technician
Underground Injection Control Program
Division of Water quality 1 Groundwater Section
1636 Masi Service Center Raleigh, NC 27699-1636
Phone: [phone] Fax: t919) 716-0588 Internet: http://gw.ehnr.state.rtc.us

MEMORANDUM May 13, 2003
To: Mr. Graham H. Mosely
From: flf, Mark Pritzl tel. [phone]
Re: Groundwater Sampling Results from April 14, 2003
Influent Water Sample Effluent Water Sam ple
Coliform, total <1/100 ml Coliform, total <1/100 ml
Coliform, fecal <1/100 ml Coliform, fecal <1/100 ml
pH ns pH ns
Chloride, Cl 17 mg/L Chloride, Cl 17 mg/L
Dissolved Solids 260mg/L Dissolved Solids 260 mg/L
NO2-+ NO3-as N <0.02 mg/L NO2-+ NO3-as N <0.02 mg/L
NH3 asN ns NH3 asN ns
Aluminum, Al <50 ug/L Aluminum, Al <50 ug/L
Calcium, Ca 77 mg/L Calcium, Ca 80 ug/L
Chromium, Cr <25 ug/L Chromium, Cr <25 ug/L
Copper, Cu 6.3 ug/L Copper, Cu 2.6 ug/L
Iron,Fe 2,000 ug/L Iron,Fe 2,000 ug/L
Mercury, Hg ns Mercury, Hg ns
Potassium, K 0.74 mg/L Potassium, K 0.75 mg/L
Magnesium, Mg 2.3 mg/L Magnesium, Mg 2.3 mg/L
Manganese, Mn 73 ug/L Manganese,Mn 75 ug/L
Sodium, Na 10 mg/L Sodium, Na 10 mg/L
Nickel, Ni <10 ug/L Nickel, Ni <10 ug/L
Lead, Pb <10 ug/L Lead, Pb <10 ug/L
Selenium, Se ns Selenium, Se ns
Zinc, Zn <10 ug/L Zinc, Zn <10 ug/L
State Groundwater Quality Standards:
Classifications and Water Quality Standards Applicable To The Groundwater's of North Carolina
(North Carolina Administrative Code Title 15A: 02L.200)
Coliform, total <1/100 ml
Colifom1, fecal <1/100 ml
Chloride <250 mg/L
Total Dissolved Solids <500 mg/L
NO2-+ NO3-as N <10 mg/L
Cadmium <5.0 ug/L
Chromium, Cr <50 ug/L
Copper, Cu <1,000 ug/L
Iron, Fe <300 ug/L
Manganese,Mn <50ug/L
Nickel, Ni <100 ug/L
Lead, Pb <15 ug/L
Zinc, Zn <2,100 ug/L
Arsenic, As <50 ug/L
Mercury, Hg <1.lug/L
Barium, Ba <2,000 ug/L
Zinc, Zn <2,100 ug/L
mg/L = milligrams per liter = parts per million
ug/L = micrograms per liter= parts per billion
1,000 ug/L == 1 mg/L
ns = not sampled
➔
➔
(lgram/l,000grams)/1,000grams
(lgram/1,000,000grams)/1,000grams
MEMORANDUM
To:
From:
RE:
Mark Pritzl
Hydrogeological Technician II
Underground Injection Control Group (UIC)
Central Office (CO)
Diane Rossi GOR-
Hydrogeological Technician II
Groundwater Section
Wilmington Regional Office (WIRO)
Routine Sampling of Mr. Mosely's Geothermal Injection Well System
Permit Renewal #WI0800014 under Graham H. Mosely
On April 14, 2003, the Mosely injection well system was inspected and sampled per your request
March 28, 2003. The wells were sampled for chlorides, TDS, nitrate/nitrite, P-total and vairous
metals. A field pH was not conducted. Analytical results are attached for your review as well as
the inspection form (Form B). Should you have questions concerning these results please call m t:;
at [phone]. o ~ w
cc: WiRO-GWS
s:\gws\diane\mosely2003.well.may
:I: > -<
N
ca
i
North Carol;,:.. Department of Environment and NL _ .ral Resources
Division of Water Quality - Groundwater Section
INJECTION FACILITY INSPECTION REPORT - FORM B
INJECTION WELL PERMIT NO. �" o S 0001 i'I
NAME OF OWNER fil f- u �-A
ADDRESS OF OWNER_ ,� E "�i Z A 0 rUrn ' �-
y
DATE q-1 y- 0 3
(Streetl road or lot and subdivision, county, town)
LOCATION OF INJECTION WELL (and source well(s), if applicable)
L' filk f� �) ��Ivl�l t,•y'ci f�[` v!/ ec�", -` � Tr' )I r3iY
(Street road or lot and subdivision, county, town, ifdierent than owner's address, plus description of locatian on sate)
Potential pollution source
Potential pollution source
Potential pollution source � n k le- -
Minimum distance of well from property boundary
Quality of drainage at site 6,cod
(good, adequa te, poor)
GPS Data: ("'-vrce d)
Latitude: 3 y 15 b 7, '7 5
Distance from well
Distance from well
5ourc'a- r
Distance from well i�
1, fo ar,e F ��
�rxP 3 ! ���.,11- ,-o►�.
Flooding potential of site t'} 1 "'-P
(high,moderate,low)
Longitude: 77 96 I e9, 3
DRAW SKETCH OF SITE (Show property boundaries, buildings, wells, potential pollution sources, roads, approximate scale, and
north arrow.).
w
nux
�c-�GUr•n t7r-•r'v�
ve�e'1411'a.1 ¢ ¢7" s
; A )t +i c-�' ,,)e. l�
DESCRIBE INJECTION SYSTEM (vertical closed loop, encased borehole or cased water well; separate source well and
injection well; combination source and injection well, or other description as applicable)
50t)rre keJ? and G� f(
Ver.3101 GWMC-2

INXECTION�:.�CMITY INSPECTION REPORT -FORM ( ,.:ONTINUED)
WELL CONSTRUCTION
Date constructed
a- l q - 17
Drilling contractor: Name
(f S We ��
d.f-;
Address
Certification number � i q L o
Total depth of well = '
Total depth of source well
(if applicable)
Inspection point
Measurement Meets minimum standards
Comments
Yes
No
Casing
Depth
Diameter
Height (A.L.S.)
Grout
Depth
i1
Screens
Depth(s)
Length(s)
pr pub OwAe-r
I.D. Plate
4d ,, ee>
Static water level
We tts I
Well yield
Enclosure
Enclosure floor
(concrete)
Sampling port
k%1A
(labeled)
�o
Water tight pipe entry
Well enclosure entry
Vent
Functioning of heat pump system (Determine from the owner if heat pump fisnctions properly)
545"o-7- 7,JYf ong--�P y e 7GFe.lA, -
T
INSPECTOR ;��,,,� �� ; Office 0
WITNESS Address
WITNESS Address
Ver.3101 GWIUIC-2

COUNTY-
NI W IIANOVER
'QUAR N0:
REtURTTO
►VIR0
COLUCTOR(S) ;
C ROSSI
DATE•
4/14/2003
'I IMF.!
PURPOSE'.
LABORATORY ANAI.YIRIR
DIVISION OF WATER QUALITY
Chemkiry I.ahnrmfory Repnri 7 Croond ►Vater QnallIy
WJPLE PRI08ITY
�ROU7INE Lj1-.NIF.RGf:NCY
Rrl;inrtaS Offirr FRI Ci1A1N t]f CUS1Y71]Y ❑
z
WD SAAIPLETYI'li
e00310 m L
WD I ligh 340 mrjL
COU Low 335 mvjL
Cnlilarm MP Fecal31616 100ml
Coliforue MFTotal 31%4 1100m1
TOC 1
Turbifily N 1 U
Residue., Sus Ynded 530 m L
fntalSuspended solids m L
1 I units
.Altollpsity to 1,114.5 m • L
la 410,3 IL
kW-Alkallnitni
rbonate m L
arbonale m • L
an dioxide
C
_AIL
Clifarlde 17 m 11_
Clvumfum. Ilex 1032 urj L
Color: T rue 110 cv,
C snlde720 m L
COA MERTS :
Uvnrr:
Location or Site;
Description of sampling point
Sampling Method:
Remarks:
1.3tMIARI AIOS1s1.V
X
❑iss. Solids 703M 260 m L
nuoride 951 m L
I laniness: total900 mrZI.
Hardness: Lpon-catbj 902 m IL
Phenols 32730 v •IL
S if'tc condl 95 umlloslctn2
Sulfate m IL
Sulfide 745 mjjL
WAS m ,.Il.
Oil and Crease m •1 L
Silica m It,
Burn
l'urmaldeh do m 1.
NR3asN610 m 11.
1 KN as N 625 m L
X
NO2 +NO3 as n 630 0.02U myj L
P:Total as 1' 665 0.12 m&j 1.
I" m •I [_
R-Silver4656fi
u L
X
Al-Aluminum46557
501.1
u IL
As -Arsenic 46551
u L
fia-Barium 46558
u L
X
Ca -Calcium 46552
f30
m L
Cd-Cad tom 46559
u IL
X
Cr-Chromium 46560
25U
u IL
x
Cu- Copper 1042
2.6
u L
H
Pe- Iran I045
2,000 u • L
II - Mercury 719W
u• L
X
K-Potassium 46555
0.75
rn •11.
k
hi - Mn • uwium 927
2.3
m • 1.
x
I Mn-Mon arse I055
75
uVIL
X
No-Sudlum929
10
m• L
Y
Ni-Nickel
LOU
u L
X
Pb-Lead 46564
10U
u L
Se-Srlenlum
u •/f.
X I7_r
_ZWc 4656,7
10U
u • t.
1shNumber
M-0372
Date Received :
4/13/2003
Time Received
9:00 AM
ReceiveddBily
I7S
�e1CRSe� 6y
!
RIS
Dale reported :
$1112003
Organochlorine Pesticides
Organophosphorus Pesticides
Nitrogen Pesticides
Acid Herbicides
5emivofatEfe9
TPH-Diesel Range
Vnlatile Orgnnles {VOA Inkid ]
I I'11-(:asnlinr Range
1111.RI'CX Casufine RanrC -
3ga372

rth
GROUNDWATER FIELD/LAB FORM �`� ironmentaiina
Qepartment of Environment and fVatlmal Resources
DIVISION OF WATER QUALfiY-GROUNDWATER SECTION
�E TYPE SAMPLE PRIORITY
County. .1ye(d 11047 flit 69-r— Z-W- ater ❑ Routine Lab Number +�
❑ sail ❑ Emeruencv }
Quad No _ Serial No.� Date Received 1 � Time
Lat. � T Long. ❑Other_ Rey d Sy; rom;Bus, ourit? Hand Del.,
�� Chain of Cuslody Other:_
Report To: ARD, FRO, MR0. RRO. WaRD6iRD} Data Entry By: Ck:
Data
WSRD, Kinston FD, F .Tryst, Central Dff-, Dther:Reported: � _ _
Shipped ay 8u. t o iQr,' Hand Del„ plher:_ Purpose: f �]
Collector{sy:_ ASS Date Time r Baseline, Complyi t, mplianC6l, LUST, Pesticide Study, FederaF Trust, Other:____
9ELDANALYSES - Owner_ r444 5" 1°�'°'"y
_ dH 4rn Spec. Cond.m at 25°C Location or Site v ��I he it I.r�.-. z r
Temp.rd °C Odor Descriplion of sampling paint _-
Appearance r f Sampling Melhod_ Sample intervat— _
Field Analysis By: Remarks,
LABQRATORY
ANALYSES
I
Ipurnpingbme,
Air
lcrr r.,elc-T
600310 mg1L
VZ
piss- Solids 70300 mg/L.
Ag•$11Yer 46566 ug1L
Qrganochierine Pesticides
CDC High 340 mg1L
Ftuorlde 951 mg/L
Al-Alurnlnum 46557 uglL
Olganophosphdrus Pesticldes
COD Low 335 mglL
Hardness: Total 900 mglL
As -Arsenic 46551 ug7L
Wfogen Paslicldes
Cofirorm: MF Fecal 31616 1100rrll
Hardness (ran-carb go mglL
13e-Ranum 46556 ug1L
Acid Herbicides
Colifornr: MP Total 315,04 If40rril
phenols 32730 ug1l
Cs•Calclum 46552 mg1L
Pees
TOC 680 mglL
Speclric Cond. 85 uM110elcm
Cd-Cadmlum 46559 uglL
Turbldily 76 NTU
Sullale 945 mg1L
Cr-Chromium 46559 ug1L
Residue, Suspended 530 my1L
Sutrids 745 mglL
f.
Cu-Copper 46562 ug1L
V,'
Fe -Iron 46563 ug1L
Semlvolalile Organlcs
Oil and Grease mg1L
Hg-Mercury 71900 t1g?L
TP1-l-bleset Range
pH A(13 unlls
K-Polesslurn 46555 mglt
Alkalinity I pH 4.5 410 mg/L
L/
Mg-Magneslum 46554 moll.
Alkalinity to W 8.3 415 mg1L
I
V
Mn-Manganese 46565 uglL
Volatile Organfcs (VOA boltle)
Carbonale 445 mglL
NH, as N 610 mg1L
t48-Sodium 46556 Ing/L
TPH-Gasoline Flange
6Icarbonala 440 mgtL
TKN as N 625 rng1L
L/
NI -Nickel ug1L
TPH-BTEX Gasoline Range
Carbon d1om1de 405 mg1L
NO, ; NO, as N 6317 mg1L
L/
Pb-Lead 46584 ug/L
Chlodde 940 mg1L
_t
p: T0181 es p 565 mg1L
50•Sel°nlurn ug1L
Chromium; Hex 1032 ug1L
Iy/
Zn-ZJnc 46567 IIgIL
_
Cofor- True 84 CU
LA13 USEONLY
Temperalurr, on arrivat:k . D
Cyanide 720 m011.
Lab Comments
GW•54 REV. 12187 For DissoTved Analysis -submit Miered sample end wrlIa -d1S' In block. T�

COUNTY ,
NEW IIANOVER
QUAD NQ.
REPORT TO
►V1RU
COLLECTOR(s) :
C ROSsi
DATA
4/14/2003
TIME:
PURPOSE.
LARORATORV ANAI.VSIc
Regional Office
QUA 310 m L
COD 1 fi h 3.1i1 rnu L
COD Low 335 m L
Coliforrm MF recaf 31616 jMnil
Cnliform; MP Total 31504 1O]Om1
TO C m 11
Turbl[4 NTU
Residue.. Sus ended 530 m L
Total Sus perided solids !nnlf.
units
H
:A�L.Iiinijllo 114.5 m L
lk.16 4e vi18.3 m L
Carbonate m L
x jthJOTj4de
te=-arbOnate mrj L
on dioxide m L
17 m L
mium ilex 1032 u L
r. True80 e.p•
IC
nide 720 m L
COMMENTS
Owner,
Lncabun or Site:
Uascriplion of sampling Point
Sampling klelhod-
Remarks
DIVISION OF WATER QUALITY
Chemis" Lxbwstary Report 1 Cronsd Water Qvilily
SAMPLE PRIORITY
ROUTINE EMERGENCY
CIIATN DF CUSTOLiY ❑
l
0 SAMPLE TYPE
G"tAhl 141U51 LV .,
r
Usv,54dids 70;131p 260 m • I.
Maori& 951 m • 1.
Hardness: total 9W m • [.
Hardness: non-carb 902 m • L
Phermis 32730 u • L
fife Coix1.95 umhns/cm2
Sulfate m L
5ulfide 745 mFIL
AIQAS h+ 1_
061 alul [:n asr mrjl,
Silica n)rjI.
Tioron
Curmaldels •de m L
N113asN6t0 m L
TKN as N 625 mpjL
X
NDZ +NO3 as n 630 0.021.1 m +/L
P. Totai as P 665 0.11 m L
T O4 m L
A •5tiver 46566
+r • L
X
Al -Al umhsum46557
50U
udl-
As-Arsenic 46551
u • L
Do-Ilariurn 46558
u • L
7O
Ca-Cakium46552
77
nl L
Cd-Cadium46554
u • 4
X
CvChrorn1um46560
25U
u • L
X
Cu-Copper 1042
6.3
u L
X
Fe- Iron 1045
2,000 u'/L
F 1 •• A4rrcur 719t10
++ • t.
Y
K-PalnaglurrtW55
0.74
+s+•/L
X
M • Magnesium 927
2.3
m /L
R
Mn-ManrAncse 1055
73
u L
X
Na-Sodium 929
10
m /L
X
Nl-Nickel
IOU
Up./]-
X
Pb-Lead 46564
IOU
u L
Se-Sclenin
u /L
X
7n_Ziur 46567
IOU
u L
Lab Number
3G0371
pare Rrrrived
411542003
Time Received :
9-00 Ahi
Received By
r
Releascds
!
Date reported :
14112093
r h '141 f! k'111 if 11114' l S'sHl' 141r\
[]r'ar+n has Iunus I'csticidrw
Nitra ^ln Pesticides
Acid I lerbicicfcs
5e"votatiies
ITI-1-Diesel Range
Vola il4! OI •anus VOA Fulllc
i PI I-Gasatinc Ran e
f111-131EX Gasoline Range
3goalt

GROUNDWATER FIELD/LAB FORM
County_ &,e-w pCi,oye r
Quad No — Serial Nm _
Lat. i Long.
Report To: ARO, FRO, MRO, RRO, WaRO wiZC
Department of Envfronment and Natural Resources
❑IVIStON OF WATER GIUALITY-GROUNDWATER SECTION
SAMPLE TYPE SAMPLE PRIORITY
erater ❑ Routine
Sail ❑ Emeraencv(D
❑ Other
YJ Chain of Custody
WSRO, Kinston FO, Fed. Trust, Central Orf-, Other,_ _
Shipped by: Bus, urier Hand qel-, Other: Purpose:
Collector[s): JCC65I Date I Time L�-3a Baseline Cnmpla
'IELD ANALYSES Owner lYA 'au�
-pH m -=_ Spec. Co 94 __ at 25°C Localton or Site I -
Temp.ln _ OG Odor_ ___`_—_ __�__ Description or sampling point__
Appearance_ 0 Sampling Method_ _
Lab Number`'3
r//
Date Received ! _Time'
Rec'd By- From:Bus, L1rie nand Del.,
Other:_
Data Entry By: Ck: r
Data
Reported:
'T, Pesticide Study, Federal Trust, Other:_
erx:)
Sample Interval --
Field Analysis By- 1
LJIBQRATORY_ ANALYSES
_ RemarksT
""""'....... ;'
tnergy iw)hmn.a�rUmr..file-)
Ag-Sllver 46566 ug/L Organocthlorina Pesticides
Al.Afuminum 46557 ug& Organvphosphorua Pesticides
As -Arsenic 46551 ug1L Nllrogen Peslfcldes
Be -Barium 4655B ug1L Acid Herbltldes
Ca•Calclum 46552 mg7L PCBs
Cd•Cedmlurn 46559 u911-
GOD 310 mg7L
piss. Solids 70300 rnglL
Fluoride 951 mglt
COD High 340 mg1L
COD Low 335 mg/L
Hardness: Total 900 mg&
CoNform: MP Fecal 31616 7t00m1
Hardness tnon�-erb 902 mgrL
Phenois 3273D uglt
specific Cond. 95 uMtros7cm
Sulfate 945 mglL
Cotllorm: MF Total 31504 1100m1
TOG 680 mg7L
Turbidity 76 N1U
Cr-Chromlum 46559 ugfL
Cu-Copper 46502 uglL
Fe -Iron 45563 uglL
Resldve. Suspended 530 mQIL
Sulf1d6 745 mg1L
Semlvolatife organics
Olt and Grease mglL
Hg-Mercury T1900 uglL
TPH-Ofa$s1 Runge
pH 403 units
K-Potassium 46555 mglL
Afkarnity to pH 4.5 410 rng/L
Mg -Magnesium 46554 mg/L
AJkaiirtiry to PH 6.3 415 mg1L
Mn-Manganesa 46565 ug7L
Volatifn Organics {VOA botlle)
Carbonate 445 mg1L
NH] as N 610 mglL
!l--�
Na-Sodium 46555 mglL
TPH•Gasoffne Range
Blearbonate 440 mglL
TKN as N 525 mQIL
NI•Nlckal ug/L
TPH-BTEX Gasollna Range
Carbon dioxide 405 mglL
NQr + NCB es N 630 mglt.
L{
Pb-Lead 46564 vWL
Chloride 940 mg1L
P: Total as P 665 rngIL
Se-Selenivm upri.
Chromlum: Hex 1032 Wt.
2n-2inc 46567 ugli
Color. True 80 Cu
�1A� NLY
Temperature on arrival: D
Cyanide 720 mglL
Lab Comments
GW-y1 REV, t2IR7 Fur aissalvedAnalysis-submit flfercd sample and wrlIa't)IS' Inblock-

EV
rachern;
Analytical & Consulting Chemists
ENVIRONMENTAL CHEMISTS, INC
Sample Collection and Chain of Custody
NCDENR; DWQ Cert11k k N94, DL8 CerdfieAte #377Z9
Collected Ste_ N C- '7 E
Snmtile Tvne: 1 = Influent_ V = Rff1nPnf_ W =WP11_ IRT . Q%trpem_ .go =Cnel_ CYa Ci,,aaP nthpr!
6602 Wind mill way
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Em a lk EEb ernwJR aal.co m
Report No:
Sample Identification
�@Cc. }
Collection
DATE TIME TEMP
.�
u
•
u=
u
R
PRESERVATION-
ANALYSIS REQUESTED
°z
x
6
t
x
-
x
©
{�
G
G
+L
T /1 Y G C"
G
G
F-�cd)
C
• 1
cI 644
G�
G
y 1 J
�7 R{
7 9 b`'�J
a 5
C
P
v X�-
G
G
C
P
G
G
C
G
_P
G
C
TP
---
G
G
C
P
_ —
G_
G
C
P
G
G
C P
G G _
NOTICE — DECHLORINATIUN : Samples for Ammonia, TKN, Cyanide, Phenol, and Bacteria must be dechlorinated
0.2 i )m or less in the field at the time of collection. See reverse side for instructions.
Transfer
Relinquished By:
Date/Time
Received By:
Date/Time
Z.
2.
Temperature wh it _Received: Accepted: _ej
Delivered By:_ '�c'— - Received By:
Comments:
jRjpsample Requested:
Date: t� Time: :. 5O Ife

• # w
ANALYTICAL & CONSULTING
CHEMISTS
Customer:
Environmental Chemists, Inc.
6602 Windmill Way - Wilmington, North Carolina 28465
[phone] (Lab) - [phone] (Fax) APR
EchernW@,aol.com
� F <
NCDENR: DWQ CERTIFICATE #94, DLS CERTIFICATE #37729
NCDENR-GROUNDWATER SECTION
127 N. Cardinal Drive Ext.
Wilmington, NC 25405
Attn: Diane Rossi
REPORT OF ANALYSIS
Date Sampled: 04/14/03
Sampled By: Diane Rossi
GROUNDWATER:
Sample ID
Fecal Coliform, coloniesll ll0 mL
Total Coliform, colonies/140 mL
Comments:
Reviewed by: IC - t,_ -. -
Date of Report: April 21, 2003
Purchase Order #:
Report Number: 3-2030
Report To: Diane Rossi
Project: Mosley Well

DIVISION OF WATER QUALITY
GROUNDWATER SECTION
March 28, 2003
MEMORANDUM
To: Charles Stehman, Ph.D., L.G., Regional Groundwater Supervisor
Groundwater Section
Wilmington Regional Office
From: Mark Pritzl M~[e-mail]
Hydrogeological Technician II
Underground Injection Control Group (UIC)
Central Office (CO)
Re: Permit renewal# WI0800014 under Graham H. Mosely; request for inspection and
routine sampling of Mr. Mosely's geothermal injection well system. This system is
located at 2137 Auburn Lane, Wilmington, NC 28405.
1. Please review the injection well permit renewal and submit any comments to the CO-UIC.
Retain the application for your UIC files.
2. Inspect the injection well site to verify that the location and construction plans submitted in
the application are accurate and the NCAC Title 15A 2C .0200 standards are being complied
with, using the enclosed Injection Facility Inspection Report (form B) as appropriate.
3. Collect samples from the influent and effluent sampling ports and submit the results to
the CO-UIC.
You are requested to return the completed Injection Facility Inspection Report (form B) to the
CO-UIC by April 28, 2003. If the inspection can not be accomplished by this date, please
inform the CO-UIC. The UIC group greatly appreciates Dianne Rossi's assistance with this
review. If you have any questions regarding this review or the UIC program, please contact
me at [phone].
cc: . CO-UIC Files
Enclosures
F \NAT Michael F. Easley, Governor
�G William G. Ross Jr., Secretary
Q
North Carolina'. . artment of Environment and Natural Resources
�] r Alan W. Klimek, P.E. Director
7 . i Division of Water Qualify
p -t
December 4, 2002
Mr. Graham H. Mosely
2137 Auburn Lane
Wilmington, NC 28405
Dear Mr. Mosely;
Your application for a permit to use a well for the injection of geothermal heat pump
effluent has been received and is under review. A member of the Groundwater Section's
Wilmington Regional Office staff will be contacting you to arrange an inspection of the injection
well and collect water samples as part of the review.
If you have any questions regarding the permit or injection well rules please contact me at
[phone] or Evan Kane at [phone].
Sincerely,
X4,0-A--
Mark Pritzl
Hydrogeological Technician
Underground Injection Control Program
cc: CO-UIC Files
WIRQ-UIC Files
ARA
NM MR
Customer Service Division of Water Quality I Groundwater Section
1 800 E23-7748 1636 Mail Service Center Raleigh, NC 27699•1636
Phone: [phone] Fax; [phone] Internet: hhpWgw.ehnr.state.nc.us

MEMORANDUM
DIVISION OF WATER QUALITY
GROUNDWATER SECTION
December 4, 2002
To: Charles Stehman, Ph. D., L.G., Regional Groundwater Supervisor
Groundwater Section
Wilmington Regional Office
From: Mark Pritzl {11-f? [e-mail]
Hydrogeological Technician II
Underground Injection Control Group (UIC)
Central Office (CO)
Re: Permit renewal# WI0800014 under Graham H. Mosely; request for inspection and
routine sampling of Mr. Mosely's geothermal injection well system. This system is
located at 213 7 Auburn Lane, Wilmington, NC 28405.
1. Please review the injection well permit renewal and submit any comments to the CO-UIC.
Retain the application for your UIC files.
2. Inspect the injection well site to verify that the location and construction plans submitted in
the application are accurate and the NCAC Title 15A 2C .0200 standards are being complied
with, using the enclosed Injection Facility Inspection Report (form B) as appropriate.
3. Collect samples from the influent and effluent sampling ports and submit the results to
the CO-UIC.
You are requested to return the completed Injection Facility Inspection Report (form B) to the
CO-UIC by December 20, 2002. If the inspection can not be accomplished by this date,
please inform the CO-UIC. The UIC group greatly appreciates Dianne Rossi's assistance
with this review. If you have any questions regarding this review or the UIC program, please
contact me at [phone].
cc: CO-UIC Files
Enclosures
NORTH CAROL INA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
APPLICATION FOR PERMIT RENEWAL TO USE A WELL(S) FOR INJECTION WITH
A HEAT PUMP SYSTEM
TO:
A.
ffm
C.
E.
Type 5A7 and 5QM Wells
In accordance with the provisions of NCAC Title 1 SA: 02C.0200
complete application and mail to address on the back page.
DIRECTOR, NORTH CAROLINA DrVfMION OF WATER QUALITY Q 000114
DATE: .EC . _ 20jg_f_-
SYSTEM CLASSIFICATION: Does the system re -circulate only potable water without any additives such as
corrosion inhibitors or antifreezes in continuous piping which isolates the fluid from the environment?
YES If yes, do not complete this form_ A forth GW-57 CL, (Notification Of Intent To Constl'W A
Closed -hoop Geothermal -Water -Only Injection Well System), should be completed.
NO 'f If no, then continue completing this form.
PERMIT APPLICANT
Name,
Address:
City: aij
County:
_ Stater Zip code.•
Telephone:
PROPERTY OWNER (if different from applicant)
Name:
--T
Address:
City, —
Caunty:
STATUS OF APPLICANT
State: Zip code:
Telephone:
Private; ►,-" Federal: Commerccia% State: Public:
Native American Lands:
FACHIT'Y (SITE) DATA (Fill out ONLY if fhe Status of Owner is Federal, State, Public or Comn=cial).
Name of Business or Facility:
City: _ State: Zip code:
County: _ Telephone: Contact Pemon:
Standard Industrial Code(s) which describe commercial facility.
OW-57 IOR (Jan, 20DO) Page I of 3

F.
G.
H.
INJECTION PROCEDURE (specify any modifications to the injection procedure since the issuance of the
previous injection permit)
.d/tJ /JJ,()JJ.JE1e,4r10A/:s k&m ~!!1G1u&L /!c-gm,y
WELL USE Is( are) the injection well(s) also used as the supply well(s) for either of the following?
(1) The injectionoperation? YES__ NO X
(2) Your personal consumption? YES__ NO x ·~
CONSTRUCTION DATA
(1) Specify any and all modifications to the well casing, grout or screens since the issuance of the previous
injection permit.
(2) NC. State Regulations (15A NCAC, 2C, Section .0200) require the permittee to make provisions for
monitoring well bead processes. A faucet on both influent (grrnmdwater entering heat pump) and
effluent (water being injected into the well) lines is required. Is there a faucet on:
(a) the influent line? yes / no __
(b) on the effluent line? yes ✓ no __
I. CURRENT OPERATING DATA
(1) Injection rate: Average (daily) ;Z~ gallons per minute (gpm)
(2) Injection volume: Average (daily)/,!J,5~t>ga11ons per day (gpd)
Average (daily)~ c;; () pounds per square inch (psi)
.
(3) Injection pressure: -:::c: ~C>j?S-/
(4) Injection temperature: Annual Average 20 degrees Fahrenheit {° F)
J. INJECTION-RELATED EQUIPMENT
Attach a diagram showing any modifications to injection equipment since the issuance of the previous injection
permit including the engineering layout of the (1) injection equipment, and (2) exterior piping/tubing associated
with the injection operation. The manufacturer's brochure, if detailed, should satisfy (1). ,,d/t!P /J'l~ OS ,
K. LOCATION OF WELL(S) Attach a map
Include a site map (can be drawn) showing: the orientation of and distances between the injection well(s) and
any existing well( s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet of the
ground-source heat pwnp well system; inclu~ buildings, property lines, surface water bodies, any other potential
sources of grotmdwater contamination. Label all features clearly and include a north arrow to indicate . ,/
orientation. ,,1/IJ GKIS -r,,.;~ l<,J£t.t."5'".. w,'/.srE Pl~ PIP.SNL. F'd{J/i.,/ r,e=:.s-~ ~ PR1d/v
n~-/,..,,l>s Wtf'fl/,U 1P'f) rT, 1
L. PERMIT LIST: Attach a list of all permits or construction approvals, received or applied for by the applicant
that are related to the site.
EX'11lJPles include:
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non-Discharge permits
(3) Sewage Treatment and Disposal Permits
GW-57 HPR (Jan, 2000) Page 2 of3
M. OTHER MODIFICATIONS: Indicate any other modifications to the injection well system
(equipment, fluid, operation, etc.) that have occurred since the issuance of the
previous injection permit and have not been noted elsewhere on this application.
N. CERTIFICATION
"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, t relieve that the information is true, accurate and
complete, I am aware that there are significant penalties, including the possibility of fines and imprisonment, for
subrnitting raise information. I agree to operate, maintain, repair, and if applicable, abandon the injection well
and all related appurtenances in accordance with the approved specifications and conditions of the Peiruit."
tSignatm of Well Owner or Authorizeccl Agent)
If author ed agenr is acting on behalf of the well owner,
please supply a letter .signed ty the owner
authori,+ing the above agent.
O. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other property rights in the
well(s). A well is real property and its construction on land rests ownership in the land owner in the absence of
contrary agreement in writing.)
If the property is owned by someone other than the applicant, the property owner hereby consents to allow the
applicant to operate an injection well(s) as outlined in this application and that it shall be the responsibility of the
applicant to ensure that the injection well(s) conform to the Wcll Construction Standards (Title 15A NCAC
Subchapter 2C .0200)
(Signature of Property Owner if Different F,76, Applicant)
Please return the completed Application package to:
UIC Program
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
(Telephone: [phone])
OW-57 HPR (lam, 2000) Page 3 OF 3

r ► �
.•� 5 � 22 4p, �1% 14
CD 1B '
\Ac, }�,� 23 x 16 13 -- -
l� �
.00
24 ICL 17
tiI v'y 11 a QCK'�
20 21 26 25 S 10
i2p - - 27 10 10 El
0A
`23 32 31 B K 29l irryy �Iljs r B
28 4 a B
33 5 � 17 1 s y g
r LEE SNORE PL. 6 1s
1 3 4 �+ 18 O
34 35 38 , 174
9 8 37 3B i 2 1� 19 13
1j 14 �+Y � 24 23 G�
45 44 17 20
7 46 42 41
43 3 1 25 22
�
ct Q-115 i
21 14
16 47 AUBURN LANE I,31 26�12
5D 16
52 a 61
51 gg
30 27 16 11
1 49 50 53 60 29 1 19 -
z 58 62 28 2 20 10
14 15 54 3 3 21
13 57 83 4 �
1P Sit 1& 22 63 13 22
11 ¢T 17 21 55 56 641. A 47 12
1
g l0 !� 20 6
8 LANE ` 1B 19 L V P3 66 fi5 ���ry►a , 414G +'dam* 10 g g 7
41
40 3g 36 3� 29 25 69
r� *s� 24 6B 67 p 39 38 G£ LAMP
�
42 28 53 37 29 2H
36 26 36 30
� 30 7
g 31 . 8 Jfi 31
46 32 ' � 34
POND 33 vo
34 -11
9 2
47 _
c
+ 3 1
1 r, 4
PEMBROKE JONES PARK
AT LANDFALL
LOT 39, BLOCK 17
DATE: AUGUST 20, 1997
SCALE.1 "=400'
Exhibit Ma
Grohom H. & Mae Omie H. Moaely
2137 Auburn Lane
Wilmington, SIC 28405
4
3
z
1
7
MUIRFIELO PLACI
- AT LANDFALL
25
26
27
37
38
Prepared By.
EBBS SURVEYING COMPANY, INC
72M 111;ZGumvff,FS AVENUE - 9LRPE 103
Wil"GTON, NORTH CARDUNA 2603 'TELL (910) 255-DD02

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT CO:tvlMISSION
DEPARTMENT OF ENVIRONMENT , HEALTH, AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S)
FOR INJECTION WITH A HEAT PUMP SYSTEM
In accordance with the provisions of NCAC Title 15A: 02C.0200
complete application and .mail to address on the back page.
Type 5A7/5QM Wells
TQ DIRECTOR, NORTH CAROLINA DMSION OF WATER QUALITY
DATE: It? ~tJt/, , 19_!l_Z •
Please type or print clearly.
A. SYSTEM CLASSIFICATION Does the proposed system re-circulate only potable
water without any additives such as corrosion inhibitors or antifreezes in continuous
piping which isolates the fluid from the environment?
YES If yes, do not complete this form. A form GW-57 CL, (Notification
Of Intent To Construct A Closed-Loop Geothermal-Water-Only
Injection Well System), should be completed.
:N) _x If no, then continue completing this form.
B. PERMIT APPLICANT
Name: ~HAO! ti /7k~L ~I
Address: d2/ _f 7 M/.1$t/ ,R,tl/ ~#/VG
City: f/J;L t?1 l,,UG' z,t)~ //J~ Zip code: d'gs(t} S-
County:,;(/ i/JJAllve~ TelepJ10ne: 0~., 4s ·~ . ¥-~ <;c'
C/;t:> -tb'i{C:, · L/-!D~
C. PROPERTY OWNER (if different from applicant)
Name: Us td6&Vb-
Address: _______________________ _
City: ___________ _ Zip code: _________ _
County: _______ _
D. STATUS OF APPLICANT
Private: ~
State:
Federal:
Public: __
Telephone: __________ _
Commercial: __ _
Native American Lands: ----
E. FACILITY (SITE) DATA (Fill out ONLY if the Status of Owner is Federal, State, Public
or Commercial).
Name of Business or Facility: _______________ _
GW-57 HP (March 1997) Page 1 of 4
Address:
City:
County:
Contact Person:
Zip code:
Telephone:
Standard Industrial Code(s) which describe commercial facility:
F. HEAT PUMP CONTRACTOR DATA
•
Name: 4 .(, " .0-'IF1�
57?.e
Address: / 7Y S A/
yF�
`,f7AIL217—X a el /,,f�
City: 'y Zip code: �rp� County: v �=
Telephone: �I,PF Contact Person: ,1413. 1VI-<
Gr- INJECTION PROCEDURE fBrieflv describe how the injection wellfsl will be
H. WELL USE Will the injection well(s) also be used as the supply well(s) for
either of the following?
(a) The injection operation? YES NO—`
(b) Your personal consumption? YES NO---X�
1. CONSTRUCTION DATA (CHECK ONE)
EMSTING WELL(S) being proposed for use as an injection well(s).
Attach a copy of Form GW-1 (Well Construction Record) and furnish items 1-6.
If Form GW 1 is not available, furnish the data to the best of your knowledge.
PROPOSED WELLS) to be constructed for use as an injection
well(s). Furnish items 1-6 as PROPOSED construction specifications. Submit
Form GW-1 after construction.
t
(1) Well Drilling Contractor's Name: ,g 7
NC Driller Registration number. /-- 0
(2) Date to be constructed: -I f - 4? ;7 Number of borings:
Approximate depth of each boring: -5 feet
(3) Well casing: Is the well(s) cased?
(a) YES If yes, then provide casing information below.
Casing type: Galvanized steel _ Black steel Plastic
Other (specify)
r
Casing depth-, from toZ ft. (reference to land surface)
Casing extends above ground �� inches
(b) ND
used.}
GW-57 HP (March 1997) Page 2 of 4

(4) Grout (material surrounding well casing andlorpiping):
(a) Grout type: Cement +_f- Bentonite—; Other (specify)
(b) Grouted surface and grout depth (reference to land surface):
around closed -loop piping; from to ft.
'around well casing; from a to ft.
(5) Screens (if applicable):
(a) Depth: From to feet below ground surface
(6) NC. State Regulations (15A NCAC, 2C, Section .0200) require the permittee to make
provisions for monitoring well head processes. A faucet on both influent
(groundwater entering heat pump) and effluent (water being injected into the
well) lines is required. Will there bet�a faucet on:
(a) the influent line? yes 'na_ (b) on the effluent line?yes no
NOTE: THE WELL. DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXM ING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
J. PROPOSED OPERATING DATA
(a) Injection rate: Average (daily)gallons per minute (gpm)
(b) Injection volume: Average (daily) a560 eallons per day (gpd)
(c) Injection pressure: Average (daily) WO (psi)
(d) Injection temperature: Annual Average%-: ° F.
K. INJECTION FLUID DATA
(1) Fluid Source. If underground, from what depth, formation and type of
r cklsediment unit will the fluid be drawne.g., granite, limestone, sand).
p- tea, s l
r g Depth: Ar Formation:42 -10 Z unit
(a) SOURCE WELL CONSTRUCTION INFORMATION (if different from injection well).
Attach a copy of Form GW-1 (Well Construction Record). If Form GW-1 is not
available, provide the data in part I of this application to the best of your
knowledge.
(2) Chemical Analysis of Source Water. The following chemical characteristics
MUST accompany this application:
PH _ r Total hardness ppm (parts per mullion or mg/1);
Ironer ppm- Chloride. ppm; ]Nitrate ppm;
Coliform bacteria 5 L* ounts114am1
NOTE: Assistance in determining these values may be obtained by contacting: your local or county
health official, a commercial water -testing laboratory, your well drilling contractor, or the
regional Hydrogeologist, NC Dept. of Environment, Health, and Natural Resources.
-;.4,vk,
L. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the (1) injection �?
r equipment, and (2) exterior piping/tubing associated with the injection
operation. The manufacturer's brochure, if detailed, should satisfy (1).
r 1 f N�AT rdJ �F
GW-57 HP (March 1997) Pane 3 of 4
tJaZI, svll,e0z! =
dUEec L-

M. LOCATION OF WELL(S) Attach two maps
(1) Include a site map (can be drawn) showing: 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 located within 1000 feet of the ground-source
heat pump well system; include buildings, property lines, surface water bodies,
any other potential sources of groundwater contamination. Label all features
clearly and include a north arrow to indicate orientation.
(2) Include a topographic map of the area extending one mile from the property
boundaries and indicate the facility's location and map name.
N. PERMIT LIST: Attach a list of all permits or construction approvals, received or
applied for by the applicant that are related to the site.
Examples include:
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non-Discharge permits
(3) Sewage Treatment and Disposal Permits
0. CERTIFICATION
"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
appur:te~ances in accordance with the approved specifications an~ditions of the .
Perm11. · , , /' 7 /??;? c aL~
· ,,,7 .c (Signature of Owner or Authorized gent)
Please supply a letter signed by the owner
authorizing the above agent, if authorized agent is signer.
P. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other
. property rights in the well being constructed. A well is real property and its
construction on land rests ownership in the land owner in the absence of
contrary agreement in writing.)
If the property is owned by someone other than the applicant, the property owner
hereby consents to allow the applicant to construct an injection well(s) as outlined
in this application and that it shall be the responsibility of the applicant to
ensure that the injection well(s) conform to the Well Constru~n Standards . / .
(Title 15A NCAC s.ubchapter 2C .0200) ~ 77 ~~ ~
GW-57 HP (March 1997)
(Signature of Property Owner if Different Proa? Applicant)
I
Please return the completed Application package to:
Underground Injection Control Program
Groundwater Section
North Carolina DEHNR-DWQ
PO. Box 29578
Raleigh, NC 27626-0578
· · (telephone: [phone])
Page 4of 4
_ r 20
i G �21 19
L� 22
f • tea. �I% t4
23 Is S6 13
24 y }7_ 1
f .�s 1
20 /21 26 25 10
i`� 10 - C
22'*-- 27 10 A El1
S A
.123 32 31 9 --
1,� ► e
29 28 4 4 8 ►
33 5 17 16 ► 9
` LEE 34 SHORE pPL.3 15
ri
� � 36 � to �� 114
9 $ B 37 3s �_ z 1'�►�,0 19 A 13
10 45 44 17 B + 24 23 20 L -
43 3 .' 15 zz �
7 4-64241 25
r Ci: C94.. 21 15 14
& 47 AUBURN t,4N£ O 31 26 F+ 16 12
5D
i 52 4 61 30 27 '0<
51 2 59 18 I
49 50 53 60 29. # lot
58 fit 28 2 24 10
14 S5 54 3 3 21
13 57 63 4
12 t lfi 22 63 13 22
11 17 21 55 56 6A 34 ,' 42 S2 T 23
LANE 18 19 23 66 41 �10 9 8 7 24
�41� � 39 38 25 24 `� fi9 fib S7 � 9 380�£ LAH� 26 25 �
4x 29 53 37 29 28 27
38 `29 26, a} 30
35 30 27
5 31 . a , X 31
46 32 ►" i 34
POND 33 " ` " '
34 1�•r
8 x ���� �..► �Y 5354
47 6 8 52
51
` 3 i 5O
s 4 aa� 1a1
7
PEMBROKE JONES PARK
AT LANDFALL
LOT 39, BLOCK 17
DATE. -AUGUST 20. 1997
SCALE:1'=400'
Exhibit Ma❑
FOR:
Graham H. & Mae Omie H. Mveely
2137 Auburn Lane
Wilmington, NC 26405
MUIRF1ELD PLACE
AT LANDFALL
9 f0 43
42
11
37
38
Prepared By.
DBBS SURVEYING COMPANY, INC..
7226 VWClnUV111.E AVENUE - BUI'E"d 103
WUMNGTON, 14ORTi1 CAROUNA 28403 rELF- (910) 968--0402

..
:;~nvirochem . . z
ENVIRONMENTAL CHEMISTS, INC
Sa mple Collect ion an d Chain of Custody
Clien t: L1ro1ham fl1osle v
Collected By: Gi/t,,n I '
~~m ole 1\roe: Influent. Effluent.. W ell . Stream. Soil . Other~
SAMPLE COLLECTION BOTTLE LAB PRESERVATION
IDENTIFICATION DATE TIME ID m NONE u.s o. HNO , NaOH THIO
I lo/t 15 11:zo I Kn~7
~ lt/Js-/f:zo 2 2o32
OTHER
6601 Windmill Way
Wilmington, NC 28405
Phone: [phone]
FAX: [phone]
Re port No: --J -J?'flO
ANALYSIS REQUESTED
t lf-, (, tl ef/4 h
-I
(!_t-, NO -I I/
~ ,
Maximum Holding Time Between Collecti.on and Analysis: BOD 48 Ho urs, Coliform in Wastewater 6 Hours,
Coliform in Drinking Water 30 Htmn,
Transfer Relinquished By: Date/Time Received By: Date/Time
1
,.
2 I
Ueceived with~t 'j. ~~lled to~: Yes No ~ :1J
1
~cept~d: j Re·ected:
Delivered By: ·" ) ~/ ·cA --t-/"') Received By ~I(. r ·~ hlvv..~ Date: Jo I /~ ',r Time: /// ¥0 II
I ) . ,
Comments:
I
-Oqql
en . „ Environmental Chemists, Inc.
MAILING ADDRESS: TELEPHONE: SHIPPING ADDRESS:
P.O. Box 1037 [phone] (Office) 6602 Windmill Way
Wrightsville Beach, [phone] (Lab) Wilmington,
CONSULTING North Carolina 28480 [phone] (Fax) North Carolina 29405
CHEMISTS NCDEHNR: DWQ CERTIFICATE #94, DI.S CERTIFICATE #37729
NCDEHNR - DWQ Certificate No. 94
REPORT OF ANALYSIS
Customer: Graham Mosely
737 Mean Drive
Wilmington, N.0 28405
Date Sampled: 10/ 15/97
Sampled By: Client
Report To: Graham Mosely
Date of Report:
Purchase Order No.:
Report Number:
October 21, 1997
7-2990
Sample ID
SOURCE
( Before)
08037
INJECTION WELL
( After )
# 8038
PH, units
7.01
6.93
Total Hardness as CaCO, ppm
214
202
Iron, Fe ppm
2.31
1.62
Chloride, Cl -
21.9
23.9
Nitrate Nitrogen, NO,--N ppm
r 0.1
< 0.1
" Coliform Bacteria, Present 1 Absent
Absent
Absent
Comments:
See Attached for Bacteria
Reviewed by I ak.c-'.and approved for release to the client
k

Memorandum
To: Marcus Geist
From: Seth Chipman~
Re: Graham Mosely -Heat Pump compliance/sampling
Marcus: Here are the effluent results from Graham Mosely's heat pump system . I apologize for
the lack of influent data, as I neglected to to bring enough sampling containers with me on that
date. If this poses a problem, let me know.
,.o co --· -..... _,.
~ ,.
:;.:• C, :;o ~ ~~ ---cc: WiRO, GWS ...0 l
~ -:P'-.....
::r:. . \ --' . )
(.,l )
s:\~eth\mosely.mar N ' -.
DIVISION OF WATER QUALITY
Chemistry Laborntory Report/ Ground Water Quality
COUNTY: NEWIIANO\'ER SAMPLE PRIORITY
QUAD NO: e]ROUTINE □EMERGENCY
REPORTTO : _W_IR_o ________ Regional Office ~ CHAIN OF CUSTODY
El SAMPLE TYPE [] CDOALTLEE. CTOR(S) : _c_n_,r_~_I_A_N ____ _
1/6/98
TIME:
PURPOSE: Owner: GRAHAM MOSELY
Location or Site:
Description of sampling point ________________________ _
Sampling Method:
Remarks:
LABORATORY ANALYSIS
BOD 310 mg/L X Diss. Solids 70300 240 mg/L Ag-Silver 46566
CODHigh340 mg/L Fluoride 951 mg/L Al-Aluminum 46557
CODLowJJS mg/L X Hardness: total 900 200 mg/L As-Arsenic 4655 I
X Coliform: MF Fecal 31616 <1 /100,nl Hardness: (non-carb) 902 mg,'L Ba-Barium 46558
X Coliform: MF Total 31504 <1 1100ml Phenols 32730 ug/L Ca-Calcium 46552
TOC mg/I Specific Cond. 95 umhos/cm2 Cd-Cadium 46559
Turbitity NTU Sulfate mg/L X Cr-Chromium 46560
Residue., Suspended 530 mg/L Sulfide 745 mg/L X Cu-Copper I 042
Total Suspended solids mg/L MllAS mg/L X Fe-Iron I 045
Oil and Grease mg/L I-lg-Mercury 71900
X pH 7.5 units Silica mg/L K-Potassium 46555
Alkalinity to pl-I 4.5 mg/L Boron X Mg-Magnesium 927
Alkalinity to pH 8.3 mg/L Formuldchyde mg/L X Mn-M1111ganc5c_ 1055
Carbonate mg/L NH3 as N 610 0.17 mg/L Na• Sodium 929
'licarbonate mg/L TKN as N 625 mg/L X Ni-Nickel
.arbon dioxide mg/L X NO2 +NOJ as n 630 <0,01 mg/L X Pb-Lead 46564 -X Chloride 20 mg/L P: Total as P 665 mg/L Se-Selenium
Chromium: Hex 1032 ug/L PO4 mg,'L X Zn Zinc 46567
Color: True 80 C.U.
Cyanide720 mg/L
COl\ll\lENTS:
Lab Number : 8G0043
Date Received 1/7198
Time Received 9;30
Received By OS
Released By DS
Date reported : l/18198
ug/L Organochlorine Pesticides
ug/L Organophosphorus Pesticides
ug,'L Nitrogen Pesticides
ug/L
mg/L Acid Herbicides
ug,'L
<25 ug/L Semi volatiles
3.0 ug/L TPH-Diesel Range
2,400 ug/L
ug/L Volalilc Orgonics (VOA bo<llc)
mg,'L
2.5 rng/L TPl·I-Gasolinc Range
75 ug/L TPH-BTEX Gasoline Range
mg/L
<10 ug,'L
<10 ug/L
ug/L
10 ug,'L
8G0043.JAN
GROUNDWATER FIELDILAB FORM' -`County SAMPLETYPE
SAMPIX PRIORITY
Quad No Serial No. Water ❑ Aovilne
0Soll [IEmergency 1
Lat. Lang. r 0 other l
Report To. AHO, FRO, MRO, RRO, WaRo� Ili ) Chaln of Custody
WSRO, Kinston FO, Fed. Trust, Central C]It�Ottlsr�
Shlpped by: S and Del.. Other pufpose:
C011eutoDate �� Time _ I f J" Base m,
North Carolina
Degmrtmant of Environment and Natural Resowees
DIVISION OF WATER QUALITY - GROUNDWATER SECTION
Lab Number
Date Recei+red Tim
0 Reed try ` � � Frorm Sus, ..curie Hand Del.,
Other.
Data Entry By: Ck.
Date Reporter!:
Pesticide S.udy, Federal Trus7: Other:
FIELD A NALn ES Owner � C �� ��-.,f�: s4-j e l -
pH40 Spat. Cond.g4 at 250 C
t
ANALISES
Location or site _ r
Desclipthn of sampli�y.pdnt r1
Sampling Method rL mple interval
r%jwp "'°
Remarks:
rpurW 115 6F a sv WrIP. Ot�L
EOD 310 r it
1 J lids 70RM
- Sliver 46606 a fl
ar anochlorine Pesticdes
COD High 340 IT 4
Flourlds 1351 M-Pil
Al -Aluminum 40557 u
OrgwWbosphorus Poslicldea
COD Low 335 rn
es na
AS-&§8rk1C4655j u
Nilro2en Pesticides
Colifnrm: MF Feral 3t615 i1caml
_ _
Hardness non-caj17 9tt2 m A
B8 -Barium 46558 u_rl
Aoki Herblddrs
Coll form: MF Tofal 31504 110orn1
pbfs 3273 V14
Ca - Calaum 46552 MQA
PC S
TDC eao
Turbidity 76 wu
$yedfic C nt}. j5 uhlhnsl I :
Cd - Cadmium 46550 It
Swale 045 marl
Cr - Chromium 49530 ygA
Residua- Srrspanded 53) "A
Sulfide 745 rnq�
t/
Cu -C er46W c A
Fe - km 46603
Semi iclatlla Organ€ss
.J
Oil and Unease miiA
Hp - GAsrcelry 719f1n UO
TPH - Diesel Ftange
pfi 403 unll•
— - -
K - Patasslurr145555 rn
Fkalinity to pFi 4.5 41r1 mgA
N - Ma neslum 46954 in I
Alkalinity to pH 8.3 415 rng4
M" - Manganese 46585 A
--
Carbonale 445 rrQ
NH as N 610 rn Il
W - Sodium 46559 r 1
Volatile Organics (VOA W111e)
Bicarbonole_440 mgrl
xFCN sN t; 5 mo
- I
TPH-G8sallne Range
Grborl dioxide 405 rngJi
wo,
NIK,NO ss N Co A
�
P5 - Lead 46554 tal
TPH - BTEX Gasollre Range
Chloride 94C frigll
P: Total as P 665 MO.1
Se - Selenium t1 A
Chrornium: Her, 1032 uqAA
Color: True 80 Cu
Zn - Zinc4ss67 u
Cyanide 720 mgA
Lab Comments:
GW S4 EV_ 7aR7 For a€ssol red Analysis - sulxrrit flttered sample and wrlle 111)15" In block.

DMSION OF WATER QUALITY
GROUNDWATER SECTION
November 20, 1997
MEMORANDUM
To: Charles Stehman
Groundwater Section
Wilmington Regional Office
From: Marcus Geist ;1A0
UIC Group
Groundwater Section
Raleigh Central Office
Re: Request for routine sampling/inspection of the injection well owned and operated by Mr.
Graham Mosely of Wilmington.
1. Please inspect the injection well facility to visually determine the integrity of wellhead
construction, the presence and accessibility of eftluent and influent taps, and other
requirements for compliance with the NCAC Tl5A:02C.0200 standards, using the
enclosed Injection Faciltty Inspection Report (form B) as a guide. A copy of the
complete permit is enclosed for your files.
2. Please sample the influent and effluent using the Sampling/Inspection Procedure for
Injection Wells as a guide. Complete the enclosed Groundwater Field/Lab Report (form
GW-54).
3. Please return any comments and sample and inspect the injection well facility by
December 19, 1997 (within 3 weeks). (If sampling and inspection cannot be
accomplished by this date, please inform RCO-UIC.) Send a copy of the completed
Injection Facility Inspection Report (form B) to RCO-UIC and request the DWQ lab to
send a copy of the Groundwater Field/ Lab Report (form GW-54) to RCO-UIC. The
UIC group greatly appreciates the Regional Groundwater Section staff who assist with the
completion ofUIC program activities. Please call me if you have any questions (919)
715-6166.
cc : UIC Files
WIROFiles
Enclosures
C:\WPDOCS\SHELLS\PERMIT\ASKRWSAM.DOC
State of North Carolin1
Department of Environr1 ,ent,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
GROUNDWATER SECTION
November 20, 1997
Graham Mosely
2137 Auburn Lane
Wilmington, NC 28405
Dear Mr. Mosely:
In accordance with your application dated November 10, 1997, we are forwarding Permit No.
WI0800014 for the operation of a geothermal heat pump injection well at 213 7 Auburn Road, in
Wilmington, NC in New Hanover County.
This permit shall be effective from the date ofissuance until November 30, 2002, and shall be
subject to the conditions and limitations stated therein, including the requirement to notify this
office by telephone 48 hours prior to initiation of operation of the facility.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit
an application to renew the permit three months prior to its expiration date. If you have any
questions regarding your permit please contact me at (919) 715 -6166 or Amy Axon at (919)
715-6165.
cc: UICFiles
WIROFiles
Sinc~rely,
ft~{j ti, ~
Marcus A. Geist
Underground Injection Control Program
C:\WPDOCS\PERMITS\ARCHIVES\FY1998\TRANMOSELY.DOC
Enclosures
Groundwater Section
P.O. Box 29578, Raleigh, North Carolina 27626-0578
2728 Capital Blvd., Raleigh, North Carolina 27604
Voice 919/733-3221 FAX [phone]
An Equal Opportunity/Affirmative Action Employer
50% recycled/ 10% post-consumer paper
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE 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
Graham H. Mosely
FOR THE OPERATION OF AN INJECTION WELL for the purpose ofinjecting heat pump
eflluent. This well is located at 2137 Auburn Lane Wilmington, North Carolina, in New Hanover
County, and will be operated in accordance with the application dated November 10, 1997, and in
conformity with the specifications and supporting data submitted, 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 only, and does not waive any provisions of the Water Use Act or any
other applicable Laws, Rules, or Regulations. Operation and use of an injection well shall be in
compliance with Title ISA 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 November 30,
2002, and shall be subject to the specified conditions and limitations set forth in Parts I through X
hereof.
Permit No. WI0800014
Permit issued this the ~~_yember;-1~97.
~ I --;J ~. I . L LI-:;-~
T~ L. Bush, Jr., Assistant Chief
Groundwater Section
Division of Water Quality
By Authority of the Environmental Management Commission.
PAGE 1 OF6
PART I-WELL CONSTRUCTION GENERAL CONDffiONS
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 injection well shall have a permanently affixed identification plate.
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection
well, to the Division of Water Quality (Division), within 30 days of completion of well
construction.
PART Il -WELL CONSTRUCTION SPECIAL CONDffiONS
NONE
PART ID-OPERATION AND USE GENERAL CONDffiONS
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.
Permit No. WI0800014 PAGE2 OF6
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.
3 . At least forty-eight ( 48) hours prior to the initiation of the operation of the facility for
injection, the Permittee must notify by telephone the Groundwater 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.
PermitNo. WI0800014 PAGE3 OF6
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 Wilmington Regional Office~ telephone number (910)
395-3900, any of the following:
(A) Any occurrence at the injection facility which 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.
Permit No. WI0800014 PAGE4 OF6
PART VIll-PERl\flT RENEWAL
The Permittee shall, at least three (3) months prior to the expiration of this permit,
request an extension.
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 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.
(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
of drinking water and in accordance with the terms and conditions of the
permit.
Permit No. WI08000 I 4 PAGE 5 OF 6
(G) The Pennittee 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 (I) and (2) (G) shall be submitted to :
Groundwater Section -UIC Staff
DENR-Division ofWater Quality
P.O. Box 29578
Raleigh, NC 27626-0578
PART X -OPERATION AND USE SPECIAL CONDffiONS
NONE
NOTHING FOLLOWS
Pennit No. WI0800014 PAGE6 OF6
North Carolina - Department of Environr, Health, and Naturai Resources ROp OFFICE USE ONLY
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535 ADNO. SEPAL NO.
Phone {919) 733.3221 It Low. RO
kw Basin
WELL CONSTRUCTION RECORD - Cocl,
DRILLING CONTRACTOR: sr �L GW-1 !<nt
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: �� PERMIT NUMBER:
.J
1. WELL LOCATION: (Show sketch of the iocati below)
Nearest Towns: •- ram ' 7g2jc.1 0,4 County: , &)
W"e" r-V'#is 1 i"'O�' /9c=.VC7
(Road, Oo rnro4rity. or Subdivision and Lot.No.) DEPTH DRILLING LOG
2. OWNER �J f t �� From To r Formation esu DO
ADDRESS
{Street or Route No.}
City or Town State Zip Code
3. DATE DRILLED ' USE OF WELL�.,��� -*
4. TOTAL DEPTH
5. CU_MNGS COLLECTED YES ❑ NO®
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOU1
7. STATIC WATER LEVEL Below Top of Casing: �2L FT.
(Use '+' if Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface'
Casing Terminated atior beIow land surface Is illegal unless a variance Is Issued
In accordance with I SA N C 2C .0118
9. YIELD (gpm): METHOD OF TEST _
10. WATER ZONES (depth):"
11. CHLORINATION: Type Amount If additional space is needed use back of form
12. CASING:
Wall Thickness
LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
f �C' . �� s ECG
From To Ft. .� f - - �--- Roads, or ether map reference points)
From To Ft. _
From To Ft. Ste`
13. GROUT:
Depth Mat rial Method
From To �_ Ft %V_�F& 2R 617 Ire c-
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft in, in.
From To Ft. in. in.
From -To-Ft.- in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From Ta Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC POANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TTW5-,RECO -+.4S BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE Oti;ONTRACTOR OR AGENT DATE
GW-1 REV, 9191 Submit original to Division of 7=rn ronrnemal Management and copy to well owner.

E P,354,000 i E P,',�S3AC1Q "}S5(1QQ
E15'S7006 MATCH SHEET 44.01 E2,958,OOp E g�yyg p _
�j E 236Q.000 g
�- f `1-• �'� Undo
nII}y'' `ag'r� �313.0'� r x24.0 x28.84
`S`F ���..rr,�•}•'" 6 ` /�r. ;'•� }' �, N+=� -. _— I •'J• �' � 1 � IIV'f���
�tNI$9.576.Tx ;YrrA6 e�.'i , %39.0 �� --2k
� E2,S54,871.45 ,. r r � A— ` - y � r f � •� � � '1ti ,.. ���`fff ! " '--.• � _�- ,
� ~ � 7RlG.fL. �'�� x r+''• k46.P \�,� ��� •_ f -� i i � � � } I
JJ \\\
I x45.1, m 46 xas.Q
40.3 Dense Foliage —••"`r - ��
K45'�Y + !8• -r .. - V r .34� 9vnse FGlroge _
Camerar. `1 + �/ �' \ 5' - `"k-•� fir'
', j%' - ".may ! `' \ • - - ° j`j -__ - ;^,*J ��'
fIII r O
473 _ "•ram f ',;� x26. �1
_ _ ,3•�`` 45.01 I � k � I --� f f1 -,- \l{ +-' I 3i7 �' ; •'`�
r F 1'• y �% f �� _ I 2R gQ` V 926.r
I 'Dense a:oGope � I` � � �C'�•;-
��
�, ����:::y�"'-111 ,. 1 fff j � 3Q.a / //,,rr Ems✓ _ �/ � �rre� - �o
,I .-- rw-oti t'-- ... -- •.'!"l. ��. �' 26f
wij rrr J x i 7 0•9 y
t III 4y f x25A 11 %IB.S ' % '308 '(�1 /1 26' lx27.6 �W
-
0�Ik44/-
r
/1 1 r `..•.�"+ kIZS f %29.i T"10� _�-.- x27,p =
h / S , y.• _ o.nu Fruc
r i f r � qe
��cc k162 �
2Ssx r/ x xz0_y� � _ x24.55 -
5y 2s.r
XISA
�� of + 1 I
x n
v r� 248 x84.6 f
x 23A 1 T.3X
� r I
l x a. IV
+ 4l, -r` f__ �' t 2� -r` =•J F - -- �� f.t x15.9 vp :4-
21.0 ~�8. v_ 0vnse� x20F '1
_ y� _
MON.CN RRL�S <Z0.9 ? 4me
£L '53.0 in
x2'A9 ' +_ it-�"'. �• •� ./� - /�(r
26.2 % ��l AB. , ,� � � � �r k_�� - J�/Jf� +`1• r
25.5 k20.5 I� �(
��,r
22 x 24.6 1
f � C--r 7 i . �''� !�' '14.9� � � �24,2 � ' � � �� l�� ,!• � �. _. Y --��� i�
to
5.5
�} , ------------
Danes Fpl a ; K29.8
f+• �Z` L 24A '� 1 �� l , i F-age
xCL
NC1WE5-
t xe`�-,ram- m♦ l = ��_ r'-�� Y _ S
MATCIi SHEET
INDEX TO
ADJOINING
SECTIONS

MATCH SHEET 44_-03,
,J 4 —� ! r* r' �L } j - _ .•:a� yC1 i� _dam.
ij f
! z, �, _
y , 1
J
T
N. N
E oy urn
._ x
JIJrI -� A
ib
LIN
I 1 ' ��_ �/I�+�'� j f � 's � , • , u�,�/�t� a ,' j
} ��JJ l I �• � � J- F I�
1 _ -
f
l rl` r N m
wx go
-
.l N
! f
1'o
to
"'A
Ix
ca
u, i F i � � I I fE , � �x� p�t /• f L �I - 4
;rh I ❑ o � `� � Im
f � _
f
I �
x.m iz�� •�o
Nrs5p00 N187,000 N IWoo MATCtt SHEET 45-03 N t89,A00 N 1901000
7711
MAPPING LEGEND PREPARED By PREPARED FOR
TOPOGRAPHIC MAP=r.E... ;� o"�;' zx aa,oa� Er .. NEW FwHovea
u C.
PATE 6F MAP 19'/S N0 x __ Q s r CHPCAGO AERIAL COU Y J
MEIN HANDVER COUNTY, N. C• PATE OF REV1SIOk FEE. Ig73 N �"r` - _—L" — �W.� �_ ia:ia` i"r S4RVEY NOR I AR
y _ — T..IL n co. ra.r k,. i
v x 1 r T.. r..c. ..ir.
DATE OF AERIAL PHOTO r .EkfM�'AgN *ow[e -• �� rE NLf�rr as,.av 1AOE E'�sralrEH, 2140 WOLF R0. 80 0 OF
eaa spp Fe Cr E+'c,� r�•r Ei.E rO.E✓• .9LC pES PLAINES ILL. µMI
MAP NUMBER �A} ^�4 ".� 9 o Lawn ,E.sri N. C. SYA7E PLANE COpRpINATE SYSTEM fi001B L4 MINGTON, N.C.
SCALE i 220 CON, INT, 2 FEET o �••• ELEVA710N OAT0A1=MEAN SEA LEVEL murn ..[ 28401

MATCH SHEET W-09
i�
i
Line
f r,
CR
1 jj } o6I' 1
1 f�
'T 1 J
pqLL
1 �_
511
u f oti
G - �
r--
m
i.i%� � � �_ �i�_ },F •.• - ,fit �, : i�j
)/pi
s
/ m
y
o • I I 1 { r Jt �
1 � a
4
N182�UW N163,000 N I04,000 MATCH SIIEET 51-02 NIB5,ODQ NlBGpDo
mw-
200010—mv— SON—� MAPPING LEI3£ND PREPARED BY PREPARED FOR
TOPOGRAPHIC YAP DATE DF MAP 1975 m x o �+..eo.a Q •�o�^ �[ ew ooe sae NEW HANOvER
�o�nve r� CH1CSUR AERIAL O Y
[� =� •rrrr oe•corlvur SURVEY
NEMt HAHOYER COUNTY, H. C. GATE OF RfV45f0N y�x — _ __fe•,L n cnrew x•ci NOW i
CA A
ip a b---�r+c r+ui [."� I.•*.n �,� .ewe .1- 1— n.wrlwr 2140 WOLF RD,
DATE OF AERIAL PHOtQ FEB. 1973 x z v. a r..,ar,waor roar _— _ _ .e �,rr n ro.sr .xs 0C HemFEET m�,4 — — ® AESPLAiNE51LL. EMAP NUMBER 5I—OI C�NMGe14 H.C. STATE PLANE COORDINATE SYSTEM 8DD18 EN4 N H. .
'SCALE 1 ' 2fl0' CON. INT. @ FE£T e••• £LEVATIOH DATUM= MEAN SEA LEVEL cewr*r urr 2�41

,I
MATCH SHEET 5I-01
t
Z,
,1
VL
N .% -
�0,
-; _i
l �o.
I I a
L
A .A
m` x
�1�
1 5
1j - � - �• � �! sa l +�� 3
iw
11 ' 1}
'All
40
=• _ -`���
N182,000 NIBS,OPA N l04,000 MATCH SHEFi 52.01 N 185AO0 �wasp00
■� ■��ir MAPPING LEGEND PREPARED BY PREPARED FOR
TOPOGRAPHIC 1611{P GATE OF Mdp @79 x w b b — u.rr o0. aa•ewarx 7�i ;Rwc LL •�cradr HEW NOVER
Q wiioila. r a` CHICAGO AERIAL Y
DATE OF REVISION Z!42- ! ___r•wr .v. +1 wwrr>I �� WALL SURVEY N G
2140 WOLF RO.
NEW HANOVER COUNTY N. C. --.rw�r w. 00 D
* DRTE tlF AERIAL PHOTO FEk 1475 xx� ® ■ea.rri�eiowrr+r•—,--.wwtrn uMr c r ea.[+ rxr
ppD PppFFEi wc'+ Y. n � 4 4 DESPLAINES ILL. MM
MAP NUMBER �1 —Q — ol�:.ara N.C. STATE PLANE COMB HATE SYSTEM 60018 N
SCALE I =200 CON.INT. 2 FEET ELEVATION OATUMA MEAN SEA LEVEL mwwn un

I 1~ "' .. -;i I
Q I
r
/
I
I
)
POGRAPHIC M
ANOVER COUN
AP NUMBER
/
/
/
/
X
"' w :..
"' T
0
N