WI0800018_GEO THERMAL_20160924

PAT MCCRORY
Gove rnor
DONALD R . VAN DER VAART
Sectl!lary Water R.-c @ S . JAY ZIMMERMAN _ I I I l ' QUALITY
Anthony and Deborah Alfano
115 Ricky Lane
Newport, NC 28570
August 24, 2016
Subject: Geothermal well sampling results
Permit Number WI0800018
Carteret County
Dear Mr. and Mrs. Alfano:
JJirecror
On June 15, 2016 staff from the Division of Water Resources sampled the influent and effluent from your geothermal heat pump system's wells. 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. A copy of the lab results are enclosed for your review.
Should you have any questions concerning this letter, please feel free to contact me at [phone] or by email at [e-mail].
RECE\VEOINCDEQ/DWR
AUG S 020\6
Water Quallty
Regional Operations Section
Enclosure: sample results
cc: Shristi Shrestha, DWR Central Office
DWR-WiRO files
Sincerely,
£;;::;;167
Water Quality Regional Operations Section
Wilmington Regional Office
Division of Water Resources, NCDENR
State of North Carolina I Department of Environmental Quality I Divisioo of Water Resources
127 Cardinal Drive Ext., Wilmington, NC 28405
919 796 7215
AC29815 North Carolina Division of Water Resources Water Sciences Section Laboratory Results
Lac, Descr.:
W108000481influent)
County:
Hew Nano"
Collector.
G KEGLEY WAID
Region:.
WIRO
Report To
MRO Location ID: WIRO NLC
River Basin
1JA,
Collect date:
-0 15120l6 Priority RQUTENS
Emergency
Collect Time:
11.00 Sample Matn7t: O OlttLNDWATER
COC Yes1No
Sample Depth
Lac. Type: Water Supp
Final Report
Sample 10:
AC29815
PO Number #
Dale Received:
0611812016
Time Received:
es:1s
Labworks LoglnlD
Slri WIF7
Delivery Method
NC Courier
Final Report Dale:
812H
Report Print Rafe:
0811212016
If this report Is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
Result/
Method
Analysis
Analvte Name
PQL
Qualifier
Units
Reference
Date
yalidstedAy
LAB
Sample temperature at receipt by lab
1-7
'�
6116)16
MSWIFT
MIC
COliform, MF Fecal in liquid
1
1 8201
CFUr100a
SM 9222 D-1997
6r16/16
ESTAFFORDI
Cvliform, MF Total in liquid
1
1 B2p1
UW100ml
SM 9222 8-1997
6116116
ESTAFFOR01
N UT
NO2+NO3 as N in liquid
0.02
0.31
m91L as N
EPA 353.2 REV 2
6121116
CGREEN
WET
Bromide
0.4
0.4 U
mgIL
EPA 300.0 rev2.1
6116116
CGREEN
Chloride
1.0
16
mg/L
EPA300.0 rev2.1
6116115
CGREEN
Fluoride
0.4
OA U
MOIL
EPA 900.0 rev2A
6116116
CGREEN
Sulfate
2.0
6.4
rnA
EPA 300.0 rev2.1
6116116
CGREEN
Total Dissolved Solids in liquid
12
347
mg/L
SM2540C-1997
6120116
CGREEN
MET
7440-22.4
Ag by ICPMS
1.0
1.0 U
ug1L
EPA 200.8 Rsv5.4
6122116
ESTAFFORD1
7429-9M
At by ICP
50
so u
ug1L
EPA 200.7 Rev4.4
6117156
ESTAFFORDI
7440-36-0
Antimony by ICPMS
10
10 U
u91L
EPA 200.8 Rev5A
W2206
ESTAFFORDI
744038.2
As by ICPMS
2.0
2.0 U
u91L
EPA 200.8 Rev5.4
612011E
ESTAFFORDI
7440-383
8a by ICP
10
10 U
u91L
EPA 2001 Rev4 4
6117115
ESTAFFORDI
7440-41-7
Be by ICP
5.0
5.0 U
uRIL
EPA 200.7 Rev4,4
6/17/16
ESTAFFORD1
7440-70-2
Ca by ICP
0.10
20
MOIL
EPA 200.7 Rev4.4
611-1/16
ESTAFFOR.D1
7440-43.9
Cd by ICPMS
0.50
0,50 U
ug1L
EPA 200,8 Rev5.4
6120116.
ESTAFFORDI
7440-48-4
Cobalt by ICP
50
50 U
ug1L
EPA 200.7 Rev4,4
6117116
ESTAFFORDI
7440-47-2
Cr by ICPMS
5.0
5.0 U
4L
EPA 200.8 RevS.4
6120116
ESTAFFORDI
7440-50-8
Cu by ICPMS
2.0
7.3
ug1L
EPA 200 Z Rev5.4
6120116
ESTAFFORDI
7439-89.6
Fe by ICP
50
50 U
ug1L
EPA 200.7 Rerv4,4
6117116
ESTAFFORDI
Hardness by Calculation
1.0
64
mg/L
S M 2340B EPA 20 0. 7
6117116
ESTAfFORD1
7440.09-7
K by ICP
0.10
2.4
mg/L
EPA 200.7 Rev4.4
6117116
ESTAFFORDI
7439-93-2
Ll ICP
25
75 U
ugIL
EPA 200.7 ReAA
6117116
ESTAFFORDI
7439.95-4
Mg by ICP
0.10
3A
mg/L
EPA ZOO- i Rev4.4
611.7116
ESTAFFORDI
7439.96-5
EVln by ICP
10
10 U
ugIL
EPA 200.7 R6v4.4
&17116
ESTAFFORD 1
7439.98.7
Mo by ICPMS
10
IOU
ugIL
EPA M.6 Rev5.4
0122116
ESTAFFOR01
7440-23-6
Na by ICP
0.10
100
mg/L
EPA200.7 Rav4.4
6117116
ESTAFFORDI
7440.02-0
Ni by ICPMS
2.0
2.0 U
ugIL
EPA 200:8 Rev5,41
WOMB
ESTAFFOR01
7439-92-1
Pb by ICPMS
2.0
2.0 U
ugtL
EPA 2018 Rev5A
6120116
ESTAFFORDI
WSS Chemistry Laboralary-a 1623 Mail Service Center, Ralstgh, NC 27699,1623 (919) 7333903
"Not Detected' or "U" does not indicate the sample is analyte free but that the analyte is not detected at or above the PQL.
Page 1 of 2

:NC <D~ La6oratory Section (RJsuits/Sa.mpfe Comments/QuaEi:fier (J)efinitians
Sample ID: AC29815
CAS# Analyte Name PQL Result/ Method Anal~sis
Qualifier Units Reference Date Validated b~
7782-49-2 Se by ICPMS 1.0 1.0 U ug/L EPA 200.8 Rev5.4 6/22/16 ESTAFFORD1
7440-28-0 Thallium (Tl} ICPMS 2.0 2.0 U ug/L EPA.200.8 Rev5.4 6/22/16 ESTAFFORD1
7440-62-2 V by ICP 10 10 U ug/L EPA200.7 Rev4.4 6/17/16 ESTAFFORD1
7440-66-6 Zn by ICPMS 10 10 U ug/L EPA 200.8 Rev5.4 6120/16 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699·1623 (919) 733•39Cl8
"Not Detected" or "U"· does not indicate the sample is analyte free but that the analyte is not detee!ed at or above the PQL.
Page 2 of 2
North Carolina Division of Water Resources
Laborata (Water sciences Sc�uaa
r3 )
Water Sample cotlectian & 8uhmii#al
Form1
N.—Sit tA
prranalj
VagI
7
r — —^ •__Central
i Q�29$ 5
I
Date Received: f � I
cation vescriptiol VV10800018
acaGorr Code _ : iL7 ' ,
County: r new hanover
Collector: G Kegley
Priority:
❑Amb,ent
0 Routine
❑ Compliance
❑ COC
[I Emergency
❑QA
Water Matrix
❑Surface
PIGround
1] Waste
❑ Blank
❑ Solution
Location Type:
❑RrverlStream
❑Estuary
❑ 5tomnwater
❑Monitoring Well
❑ Effluent
[]Field Blank
❑ Filter Blank
❑OIheI
[]Lake
❑Canal
RWater Supp
Ll lnfluenl
❑Trip Blank
Time Received:,, ()�j
DWR Region:- •
{Gasedoncayriry) WIRQ
rOWR QHice�
{wagencyname) C]iNF2-WQQROS
Received By: ' j • "'
River Basin:
Date: � � � �
State Courier
eiivery Method. ❑Hand Delivery
❑Other
Notes: Geothermal (plectron Wells
Tune:
❑ ChlvnnaYed ❑De-ehlonnafed m Field
Sarnplingr [y]Grab I .Composers
dfethod: ❑ tithe r
Temperature '
CQ
on Arrival : l
❑ Filtered in !Old Dissolved analysts Entermete "Dl5"
�n check -boxes for parameters
ample Depth..
p �
Cuilerlar's Cmnm�rrrs: �Cx..yrC e.
Hlr_'.`
Microbiology Parameters:
MBAS (surfactants)
mgIL
Metals Parameters:
Tin (Sri) pglL
Acidity, as CaCC3, to pH 4 518 3
mg/L
Oil and Grease, HEM, Tctiw Recoverat
rnglL
X
Aluminum (Al)
VgIL
Titanium (ri) pg1L
Alkalinity, as CaCO3, to pH 4 &a 3
mglL
Phenols, 'total Pecoverable
ogIL
X
Antimony (Sb)
pgIL
X
Vanadium (V) pglL
601) ewd:emical Oxygen Oeruand, 5-day
mglL
Residue Total (To#af SOO,,)
mglL
X
Arsenic (As)
jiglL
X
zinc (Zn) ti91L
cBOD Carbonaceous SOD, 5-day
mg1L
Residue VolatilefFixed, Total
mg)L
X
Barium (Ba)
V91
X
Coliform Fecal MF
1100tril
Residue Suspended (Suspended Solit
mglL
X
Berylbum (tie)
pglL
Boron (B), Total UgfL
X
Coliform Total MF
1160ml
Residue Volatile/Fixed, Suspended
mg)L
X
Cadmium (Cd)
pglL
Mercury 1631. low-level nglL
Coliform Tube Fecal
11 Como
X
T05 - Total Dissolved Solids
mglL
X
Calcium (Ca)
mglL
Cotiform Tribe Total
Aioami
Silica
mg&
X
Chromium (Cr), Total
pglL
Organics Parameters: -
Specrfc Conductance, at 25 OG
umhQVrM
SutFrde
mglL
X
Cobalt (Co)
pgIL
Acid Herbicides
TOC - Total Organic Carbon
mg/L
Tannin u Lignin
mg1L
X
Copper (Cu)
pglL
Organochionne Pesticide*
Turbidrty
NTU
X
lion (Fe)
pglL
Organarrrtragen Pesticides
Other Parameters:
Lead (Pb)
ilglL
Organophosphorus Pesticides
Wet Chemistry. parameters:
pH
s u
_2L
X
Lithium (Lr)
pgIL
PCBs (polychtormated biphenyls'
Bromide
mgIL
Hardness, Total as CaCO3 - by titratioi
mglL
X
Magrtesium (Mg)
mgIL
X
CMonde
mglL
X
Manganese (Mn)
U91L
Semi -Volatile Organics (BNAs)
Fluoride
mg1L
Mercury (Hg)
)rglL
TPH Diesel mange
x
Sulfate
mg1L
Nutrients Parameters: ".
?(
Molybdenum (Mo)
pglL
Chloroptryll a
pg1L
Ammonia as N (NH3-N)
mglL
X
Nickel (Ni)
UgIL
Volatile Organics (VOA)
Color ADMI
C u
X
Nitrate-Ndrlte as N (NO3+NO2-N)
mgIL
X
Potassium (K)
mgIL
Color Platinum Cobalt
c u
Total Kleldahl Nitrogen as N (TKN)
mg/L
X
Selenium (Se)
UgIL
TPH Gasoline Range
COD Chernical Oxygen Demand
mglL
Total Phosphorus as P (TP)
mgIL
X
Silver (Ag)
UgIL
Cyanide, Total
mglL
Nitrite as N (NO2-N)
mg( L
X
Sodium (Na)
mgIL
Biological: '
Formaldeh de
mgIL
Nitrate as N (NO3-N calculated)
mg1L
Strontium (Sr)
pglL
Phyloplankton 1 Algae
Hexavalent Chromium (Cr6•+)
mgIL
Orthophosphate as P (PO4)
mgI
X
Thallium (TI)
Uglt
LAB COMMENTS.
yield Parameters{eprronailj Water Temp CC) pH (s u.) I Dissolved Oxygen (ppm) I Conductivity (pmhos(crn) Salinity (p¢t)

�r*Lr 0 �I -C LA-.-OA
AM961E North Carolina .Division of Water Resources Water Sciences Section Laboratory Results
Loc. Descr.:
W10800018 Effiuen!
County:
New Hanover
Collector.
G KEGLEY visitlia
Region:
WIRO
Report To
WIRO Location ID:
WIRO NLC
River Basin
IA,
Collect Dale
0611512016 priority
RO_ UTINE
Emergency
Collect Time:
W1515 Sample MaWXx
GROUNDWATER
CDC Yes/No
Sample Depth
Loc. Type:
Water supply
Final Repot#
Sarriple ID:
AC29816
PO Number #
Date Received:
0611612016
Tune Received:
08�15
Labworks LoginlD
MS IET
Delivery Method
NC Courier
Final Report Dale:
811211a
Report Print Dale-,
0811212016
if this report is labeled preliminary report the results have not been validated Do nor use for Regulatory purposes.
Result) Units Method Analysis
CAS # Anal;-e Name � Qualifier Reference Date Validated_ by.
LAB
Sample temperature at recespt by lab 13 °C
MIC
6116115 MSWIFT-
Coliform, MF Fecal in liquid 1 15201 CFW IDOW SM 9222 D-1997 Sli6m6 ESTAFFOR01
C011form, MF Total In liquid 1 1 B201 CFU1100m1 SM 9222 6.1997 W16115 ESTAFFORDI
NUT
NO2+NO3 as N in liquid 0.02 0.31 MA as N EPA353.2 REV 2 6I24116 CGREEN
Bromide
0.4
0.4 U
mg1L
EPA 300.0 rev2A
6116116
CGREEN
Chloride
1.0
16
m21L
EPA 300.0 rev2.1
6116116
CGREEN
Fluoride
DA
0.4 U
mglL
EPA 300.0 rev2-1
6116116
CGREEN
Sulfate 2.0 6.6 mg1L EPA 300.0 rev2.1 6116/16 CGREEN
Total Dissolved Solids in liquid 12 346 rnglL Start 2540 C-1997 s120116 CGREEN
7440-22-4
Ag by ICPMS
1.0
MET
1.0 U
ug1L
EPA 200.6 Rev5A
6/22115
ESTAFFORD1
7429-90-5
AI by ICP
50
50 U
ug1L
EPA 200.7 Rev4.4
6117116
ESTAFFORDI
7440.3E-C
Antimony by ICPMS
10
IOU
uglL
EPA 200.8 RevS_d
W22116
ESTAFFORDI
74-40-38"2
As by ICPMS
2.0
2.0 U
uglL
EPA200.8 Rev5.4
6120116
ESTAFFORD1
744038-3
Ba by ICP
10
10 U
uglL
EPA2DO.7 R0v4,4
6117116
ESTAFFORDI
7440-41-7
Be by ICP
5.0
5.0 U
uglL
EPA200.7 ReAA
W17116
ESTAFFORDI
7440-70-2
Ca by ICP
010
20
mg/L
EPA 200.7 Rev4.4
6/17116
ESTAFFORDI
7440-43.9
Cd by ICPMS
0.50
a,50 U
uglL
EPA 209.8 Rev5.4
6120116
ESTAFFORDI
7440-48-4
Cobalt by ICP
50
50 U
ugIL
EPA 200.7 Rev4.4
611711$
ESTAFFORDI
7440-47-3
Cr liiy IGPMS
5.0
5.0 U
ug1L
EPA 200.8 Rey5A
6120115
ESTAFFORDI
7440.50-8
Cu by ICPMS
2.0
4.3
uglL
EPA 200;6 Rev5,4
6120116
ESTAFFORDI
74.39-8"
Fe by ICP
50
54 U
uglL
EPA 2D0,7 Rav4A
5117116
ESTAFFORDt
Hardness by Calculation
1.0
64
mglL
SM234DOEPA 200.7
6117116
ESTAFFOR01
7440-09-7
K by ICP
0A0
2.4
mg1L
EPA 200.7 ReAA
6117116
ESTAFFORDI
7439-93-2
Li ICP
25
25 U
ug1L
EPA 200.7 Rev4A
6117116
ESTAFFORDI
7439-95-4
Mg by ICP
0.10
3.4
rrtg/L
EPA 200.7 Rev4.4
6117116
ESTAFFORDI
7439-96-5
Mn by ICP
10
10 U
ug1L
EPA 200.7 Rev4.4
6/17116
ESTAFFORDI
7439-W-7
Mo by ICPMS
10
IOU
ug1L
EPA200.8 Rev5.4
t3d2F116
ESTAFFORDI
7440.23-5
Na by ICP
0.10
100
mg1L
EPA200.T Rev4-4
6117m6
ESTAFFORDI
7440-02-0
Ni by ICPMS
2.0
7.8
u91L
EPA 200.8 Rev5.4
6120116
ESTAFFORDI
7439-92-1
Pb by ICPMS
2.0
2.0 U
uglL
EPA 200.8 Rev5,4
6120116
ESTAFFORDI
WSS Chemistry Lab*ratorp;- 1623 Mail Service Center, Raleigh, NC 27699-1623 (0191733-3406
'Nat Detected" or "U" does not indpeale the sarnole is analyse free but that the analyte Is not dale cted at or above the POL.
Page 1 of 2

:NC 0'1¥1( Laboratory Section {J?Jsults/Samp{e Comme11ts/Quafifier '-Definitions
Sample ID: ~C29816
CAS# Anal yte Name PQL Result/ Method Analisis
Qualifier Units Reference Date Validated by
7782-49-2 Se by ICPMS 1.0 1.0 U ug/L EPA 200.8 Rev5.4 6/22116 ESTAFFORD1
7440-28-0 Thallil!m (Tl) ICPMS 2.0 2.0 U ugll EPA.200,8 Rev5.4 6/22/16 ESTAFFORD1
7440-62-2 V by ICP 10 10 U ugll EPA200.7 ReV4.4 6/1711.6 ESTAF'f'ORD1
7440-66-6 Zn by ICPMS 10 10 U ug/L EPA200.8 Rev5.4 6120116 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 (919)-733•391:iB
"Not Detected" or "U" ooes not indicate the sample is analyte free but that the analyte is not detected at or above the POL.
Page 2 of 2
North Carolina Division of Water Rcsourcrs
Central Laboratory (Water Soiencss Section)
Water Sample Collection & Subtaittal Form
Visit ID:
(aplinnatJ
Tag
ID
t.
AG29816
d T•
cation Descriptive W10800018
ocatlon Cade .c �
f 1
Data Received: �p
County: new hanover
Collector: G Kegley
Priority:
❑Ambient
❑r Routine
❑Compliance
❑ COC
❑Emergency
❑pA
Water Mafrix
- -
❑ surface
❑� Ground
[Iwaste
❑Blank
❑ SOIUtiOrl
Location Type:
❑RiverlStream
Estuary
❑Stormwater
❑Monitoring Well
�i filuent
[IF ield Blank
❑Filter Blank
❑Other
❑Lake
[]Canal
wwatersuppl
❑trtflueni
❑Trip Blank
j 21i i
II I
Time Received: Q d 1�
DWR Region: J wtR❑
(basedcincounfyJ
DWR ice: 17W� WQQf2G5
(or agencyrame;
ieceived 6y; (yl�
Riverflasin: 1
bate:
�
N1lT State Courier
slivery Method: ❑ Hand Delivery
❑Other
Notes: Geothermal Infection Wells
- Time: l 1"1S
Chlorinated
❑ ❑13e chlorinated in Field
Sampling ❑ Grab t—JComposite
Method: Other
Temperature ++
{oC� f
on Anfval :
❑ Filtered in Field Dissolved analysts Fitter' L]l5"
in check -limes for paramelers
ample Depth:
Colleuor's CalftntEr[LS: e��;�,r � Y` e.1 IR �[,`�-t a
Microbiology Parameters:
MBAS (su ctants)
mglL
Metals Parameters-
Tin (Sri) pglL
Acidity, as CaCO3, to pH G 5/8 3
mglL
Oil and Grease, HEM, Total Recoverat
mglL
X
Aluminum (AI)
laglL
Trtanium (Ti) pg&
A$kaltnity, as CaCO3, to pH d 51613
mglL
Phenols, Total Recoverable
pglL
)(
Antimony (Sb)
pq&
X
Vanadium (V) }tg/L
BOO Bnchernir:ai Oxygen Demand, 5-day
mglL
Residue Total (Total Solids)
mglt.
X
Arsenic (As)
pglL
X
Zinc (Zn) pglL
al300 Carbonaceous BCD. 5-day
mg/L
Residue Volatile/Fixed, Total
mg/L
X
8anum (Ba)
pg/L
X
Colifonn Fecai MF
1100mi
Residue Suspended (Suspended Sniti.
mg&
X
Beryllium (Be)
}igiL
Boron (B), Total uglL
X
Coliform Total MF
1100ml
Residue VolatilelFzxed, Suspended
mglL
X
Cadmium (Cd)
pglL
Mercury 1631, low -lever nglL
Cotrform Tube Feral
1100ml
X
TES - Totai Dissolved Solids
mglL
X
Calcium (Ca)
mg1L
Coliform Tube Total
1100MI
Silica
mglL
X
Chromium (Cr), Total
pg&
Organics Parameters' -
Specific Conductance, at 25 C
urn"Wem
Sulfide
mg&
X
Cobalt (Cc)
l.iglL
Acid Herbicides
TOC - Total Organic Carbon
mglL
Tannin & Lignin
mglL
X
Copper (Cu)
pglL
Organochlonne Pesticides
Turbidity
NTU
X
Iron (Fe)
pgIL
❑rganoni;rogen Pesticides
Other Parameters:
X
read (Pb)
pglL
Organephosphorus Pesticides
Wet Chemistry Parameters;
pH
s u
X
Lrthrum (Li)
pg1L
PCBs (palychlonnated biphenyis;
Bromide
mglL
Hardness, Total as CaCO3 - by titratioi
mglL
X
Magnesium (Mg)
mglL
X
Chloride
mglL
X
Manganese (Mn)
pg/L
Semi -Volatile Organics (BNAs)
Fiuonde
mg1L
Mercury (Hg)
liglL
TPH Diesel Range
x
Sulfate
m91L
Nutrients parameters:
X
Molybdenum (Mo)
pglL
Chlorophyll a
pglL
Ammonia as N (141-13-N)
mg1L
X
Nickel (Ni)
pg/L
Volatile Organics (VOA)
Color ADM]
c u
x
Nitrate -Nitrite as N (NO3+NO2-N)
mglt
X
Potassium (K)
rrg1L
Color Platinum Cobalt
c u
Total tt)eldahI Nitrogen as N JKN)
mg1L
X
seienium (Se)
pglL
IPH Gasoline Range
COD Chernical Oxygen demand
mglL
Total Phosphorus as P (TP)
rnglL
X
Silver (Ag)
pglL
Cyanide, Total
mglL
Nitnte as N (NO2-N)
mg1L
X
Sodium (Na)
mglL
81010gic& .
Formaldehyde
mg&
Nitrate as N (NO3-N calculated)
m IL
Strontium (Sr)
p91L
L
Phytoplankton ! Algae
Hexavalent Chromium (Cr6+)
mglL
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Revision 2108r2015

Permit Number WI0800018
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Faclllty Name
Anthony and Deborah Alfano SFR
Location Address
115 Ricky Ln
Newport
Owner
Owner Name
Anthony
Dates/Events
Orig Issue
8/14/2000
NC
App Received
5/9/2016
Regulated Activities
Heat Pump Injection
Outfal
Waterbody Name
28570
Alfano
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
6/30/2016
Permit Tracking Slip
Status
Active
Version
4.00
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
MajorfMinor
Minor
Region
Wilmington
County
Carteret
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Anthony Alfano
115 Ricky Ln
Newport
Issue
6/29/2016
Effective
6/29/2016
NC 28570
Expiration
5/31/2021
Requested /Received Events
RO staff report received .
RO staff report requested
Streamlndex Number Current Class
6/20/16
519/16
Subbasin
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Water Resources
ENVIRONMENTAL QUALITY
Anthony & Deborah Alfano
115 Ricky Lane
Newport NC 28570
Re: Issuance of Injection Well Permit
Permit No. WI0800018
June 29, 2016
Geothermal Heating/Cooling Water Return Well
Carteret County
Dear Mr. and Mrs. Alfano:
Secretary
S. JAY ZIMMERMAN
Director
In accordance with your permit renewal application received on May 9, 2016, I am forwarding Permit
No. WI0800018 for the continued operation of geothermal heating/cooling water return well(s) located
at the above referenced address. This permit shall be effective from date of issuance until May 31, 2021
. 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 June 15, 2016. 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,
Shristi Shrestha
Underground Injection Control (UIC)-Hydrogeologist
Division of Water Resources, NCDEQ
Water Quality Regional Operations Section
State of North Carolina I Environmental Quality I Water Resources
1611 Mail,;crvicc Ccutcr I Raleigh, North C...:oliua 27699-1611
919 707 9000
cc: Jim Gregson -Morella King Sanchez, Wilmington Regional Office
Central Office File, WI0800018
Carteret County Environmental Health Department
Page 2 of2
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143; and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Anthony & Deborah Alfano
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 115 Ricky Lane, Newport, Carteret
County, NC 28570 will be operated in accordance with the application submitted May 9, 2016, 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 bate of its issuance until May 31, 2021, and shall be
subject to the specified conditions and limitations set forth in this permit.
Permit issued this the 29d' day of June 2016.
Y
S. Jay Zimmerman, P.G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission.
Permit #WI0800018 UIC15A7 Page 1 of 5
ver, 11/15/2015

PART I -PERMIT GENERAL CONDITIONS
1. The P~rmittee 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 Il-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)].
Pernut#WI0800018 UIC/5A7
·ver. 11/15/2015
Page2 of5
7. A completed Well Construction Record (Form GW-1) shall be submitted as described in Part V.5 of this
permit.
PART ID -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 lG)].
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].
PARTIV-INSPECTIONS[15ANCAC 02C .0211(k)]
1. Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable time for the purpose of determining compliance with this permit, may
inspect or copy any records that must be maintained under the terms and conditions of this permit, and may
obtain samples of groundwater, surface water, or injection fluids.
2. DWR representatives shall have reasonable access for purposes of inspection, observation, and sampling
associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary samples of the injection facility's activities.
PART V -MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction, repair, or abandonment shall be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on-site and available for inspection [ 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 ISA 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 #WI0800018 UIC/5A7
ver. 11/15/2015
Page 3 of5
(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:
illC 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 Extension
Wilmington, NC 28405
PART VI-PERMIT RENEWAL [15ANCAC 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 purpose, then it should be permanently abandoned according to rule
15A NCAC 02C .0113(b) in order to prevent the well from deteriorating and acting as a source or conduit
of contamination, which is prohibited by General Statute 87-88( c ).
3. If a well is taken completely out of service temporarily, the Permittee shall install a water-tight cap or well
seal that cannot be removed without the use of hand or power tools.
4. When injection operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall 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).
Perm.it #WI0800018 UIC/5A7
ver. 11/15/2015
Page4 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 of abandonment.
5. The written documentation required in Part VII (4)(F) shall be submitted to the addresses specified in Part
V.5 above.
Permit #WI0800018 UIC/5A7
ver. 11/15/2015
Page5of5
vvro ~ooe>1&
Permit No. WI0899246
Date: 6/15/2016
To: Shristi Shrestha
Central Office Reviewer
County: New Hanover
Permittee/ Applicant: Anthony & Deborah Alfano
Facility Name:
L GENERAL INFORMATION
1. This application is (check all that apply): 0 New [gl Renewal
0 Minor Modification D Major Modification
a. Date of Inspection: 6/15/2016
b. Person contacted and contact information: Anthony Alfano aalfano l ec.rr.com . (252 ) 646-3958
c. Site visit condl,:lcted by: Geoff Kegley
d. Inspection Report Printed from BIMS attached: D Yes [gl No.
e. Physical Address of Site including zip code: 115 Rick Ln . New port. NC 28570
f. Driving Directions if rural site and/or no physical address:
g. Latitude: 34.7291 Longitude: -76.8680
Source of Lat/Long & Accuracy (i.e., Google Earth, GPS, etc.):_ Google Earth RECEl\fED/NCDEQIDWR
IL DESCRIPTION OF INJECTION WELL(S) AND FACILITY
1. Type of injection system:
[gl Geothermal Heating/Cooling Water Return
D In situ Groundwater Remediation
D Non-Discharge Groundwater Remediation
D Other (Specify: )
2. For Geothermal Water Return Well(s ) onl y
a. For existing geothermal system only:
JUN 2 0 2016
Water Quality
Regional operations Section
Were samples collected from Influent/Effluent sampling ports? [gl Yes D No.
Provide well construction information from well tag: No tag, owner does not have well construction
information.
b. Does existing or proposed system use same well for water source and injection? D Yes [gl 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? D Yes C8] 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 [gl Adequate D Poor
6. Flooding potential of site: [gl Low D Moderate D High
7, For Groundwater Rernediation Inieptinn Systems only, is the proposed and/or existing groundwater monitoring
program (number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ❑ Ycs ❑ No.
If No, attach map of existing monitoring well network if applicable and recommend any changes to the
groundwater -monitoring program.
8. Does the map included in the Application reasonably represent the actual site (property lines, wells, surface
drainage)? ❑ 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. IJ14
9. For Non-Discharue 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. E VAL UA TION AND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If Yes, explain.
2. List any items that you would like WQROS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item
Reason
3. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition
4. Recommendation
Reason
❑ Deny. If Deny, please state reasons:
❑ Hold pending receipt and review of additional information by Regional Office
❑ Issue upon receipt of needed additional information
® Issue
S. Signature of Report Preparer(s):
Signature of WQROS Regional St
Date: nb ►>Q1 a 016

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 Alfano residence. On June 15, 2016, staff visited the home to sample 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. Well construction information (GW-1 or
well tag} is not available. System operation has been normal.
WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW RE QUEST FORM
~: May 9, 2016
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: WI0800018
A. Applicant: Anthony & Deborah Alfano
B. Facilitv Name:
C . App lication:
Permit Type: Geothermal Heating/Cooling Water Return Welt
Project Type: Renewal
E. Comments/Other Information:
__ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 30 calendar days , please return a com pleted W OROS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy of
this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact person
listed above.
RO-W OROS Reviewer: __________________ Date: ____ _
COMMENTS:
NOTES: Please get a copy of GW-1
FORM: WQROS-AR.i.~ ver. 092614 Page 1 of 1
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secreta,y
Water Resources
ENVIRONMENTAL QUALITY S. JAY ZIMMERMAN
May 9, 2016
Anthony & Deborah Alfano
115 Ricky Lane
Newport NC 28570
RE: Acknowledgement of Application No. WI0800018
Geothermal Heating/Cooling Water Return Well
Carteret County
Dear Mr. & Mrs. Alfano:
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit application and supporting documentation received on May 9, 2016. 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].
cc: Wilmington Regional Office, WQROS
Permit File WI0800018
Sincerely,
~-
Debra J. Watts, Supervisor
Animal Feeding Operations & Groundwater
Protection Branch
Division of Water Resources
State ofNor,h C:;rol:na I Environmental Quality I Water Resources
1611 Mail s~rvice Center I Raleigh, North Carolina 27699-1611
919 707 9000
Director
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .Q224
GEOTHERMAL HEATING/COOLING WATER RETURN WELLS)
These well(s) inject groundwater directly into the subsurface as part of a geothennal heating and cooling system
CHECK ONE OF THE FOLLOWING:
New Application A Renewal* Modification Permit Rescission Request*
'For Permit Renewals or Rescission Request. complete Pages I and 4 (signature page) only
Prier or 7;ipe Ire, formation and Mail to the Address on the Last Page. IIlegible ApplicationT Will Be Returned As Incomplete-
DATE: 460A 1 50 ,20 PERMIT NO, 'V1 08 000 1 & (leave blank if New Application)
A. CURRENT WELL USE AND OWNERSHIP STATUS (leave Blank if New Application)
1. Current Use of Well
a. Continue to use as V Geothermal Well Drinking Water Supply Other Water
Supply
b. Terminate Use: If the well is no longer being used in ection well and you wish to
rescind the permit, check the box below. If abandon WO 11 Abandonment
Record (GW-34). MAY 4 9 2016
❑ Yes, I wish to rescind the permit Water Quality Reglona!
2. Current Ownership Status operations Section
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:
tale: Zip Code: County -
Day Tele No.: Email Address.:
B. STATUS OF APPLICANT (choose one)
Nan -Government: Individual Residence X Business/Organization
Government: State Municipal County Federal
C. WF.I.L OWNER(S)IPERMiT APPLICANT — For individual residences, list owner(s) on property deed. For
all others, list name of entity and name of Person delegated authority t sign:
Mailing Address: 1yq K&
Ci ty: t� -CW�2 Od—T State: +rIUip Code: o� ` S -7 0 County
Day Tele No.: Cell No.:
EMAU Address: 0 VIC i Y' CU - No.:
Geothermal Water Return Well Permit Application (Revised Jan 2015) Page 1

D. WELL OPERATOR (if different from well owner) - For individual residences, list owner(s) on property
deed, For all others, list name of entity and name of person delegated authority to sign on behalf of the business
or agency: b rdncrA b Ak,* G Irlb
Mailing Address:
City: t= ` d!> "T' state-, r� zip Co
Day Tele No.: a G Ea
E. LOCATION OF WELL SITE - Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: County:
(2) Physical Address (if different than mailing address): 1.0 A l L�- ,.j \ A y%e
City: [�_i F�?[�T - --- State: NC Zip Code: .'S ❑
)>' WELL DRILLER INFORMATION
Well Drilling Contractor's Name: 1 A
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. HVAC CONTRACTOR INFORMATION (if different than driller)
HVAC Contractor's Name: 1
NC HVAC Contractor License No.:
Company Naive:
Contact Person: EMAIL Address:
Address:
City:
Office Tele No.:
Zip Code: State:
Cell No.:
County:
Fax No,:
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation? YES NO
(2) Personal consumption? YES NO 9i
1. WELL CONSTRUCTION REQUIREMENTS - As specified in 13A NCAC 02C .0224&
(1) The water supply well shall be constructed in accordance with the water supply well requirements of
15A NCAC 02C .0107.
(2) If a separate well is used to inject the heat pump effluent, then the injection well shall be constructed
in accordance with the water supply well requirements of 15A NCAC 02C .0107, except that:
Geothermal Water Return Well Permit Application (Revised Jan 2015) Page 2
<-o"

(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 th~ collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
-~--*EXISTING WELLS ____ PROPOSED WELLS
*For existing wells, please attach a copy of the Well Construction Record (Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
( c) Casing depth below land surface
( d) Casing height "stickup" above land surface
(e) Grout material(s) surrounding casing and depth below land surface
Note: bentonite grouts are prohibited for sealing water-bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .0107(0(8 )
(f) Length of well screen or open borehole and depth below land surface
(g) Length of sand or gravel packing around well screen and depth below land surface
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) __ o F.
L. SITE MAP -As specified in ISA NCAC 02C .0224 (b )(4 }, attach a site-specific map that is scaled or otherwise
accurately indicates distances and orientations of the specified features from the injection well(s). The site map
shall include the following:
(1) All water supply wells, surface water bodies, and septic systems including drainfield, waste
application area, and repair area located within 250 feet of the injection well(s).
(2) Any other potential sources of contamination listed in 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 Permit Application (Revised Jan 2015) Page 3
NOTE. Inmost cases an aerial photograph of the property parcel shmping property lines and structures can be
obtained and downloaded from the applicable count/ GIS website. Typically, the property cur: be searched by
owner name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other
wells, etc. can then: be drawn in by band Also, a Yairer' can he 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 _0211i ei requires that all permit applications shall be signed as follows;
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer
or ranking publicly elected official;
4. for all others: by a] I the person(s) listed on the property deed.
If as 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. l 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 o Property OwnerlApplican
bc]norrAv, A
Print or sye Full Name
5i� ture of Property Ownt
PYAim)
Print or Type Full Nam
l�.P. "YJ0
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
Division of Water Resources
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Rcuim Well Permit Application {Revised tan 2015) Pagc.t

Postal
CERTIFIED MAILT. RECEIPT
ill ■
to
Ln
ru
.111 F I C J A 7U7S7E !I
-I- PastaQa
m
Certified Fee
r-3 Paeanefk
C3 Return Flaceipt Fee Hero
C3 {Endorsement Required}
Restricted Delivery Fse
(Endarssrnent Hequired)
0
ru Toial P
r.q Anthony and Deborah Alfano
sent v 115 Ricky Lane
�rrwafa Newport, North Carolina 28570
1:3 orPC]6.
CIly Sla
:rr -
• Complete item.. 1, 2, %-A 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailplece,
or on the front if space permits.
1. Arrticcle Addressed to:
Anthony and Deborah Alfano
115 Ricky Lane
Newport, North Carolina 28570
ffllfl�l� Illlll�ll�i�llllll f I �Il Ilf IlEllill ICI
9590 9403 0730 5196 3155 26
2. AMde Number (Thunfer ftM service kW
1201 0001 3432 6585
PS Form 3811, April 2015 PSN 7530-02-000-90W
A. abAre 0' 0ent
X t , t%?. ©A�cidrsseee
M Received �
by tinted NWWJ
i- a of Liv�ery
2
U. is delivery address dliferent from itm 12 ❑ Yes
K YES, enter delivery address below: ❑ No
3. Service Type
C] Priority Mal impress
❑ Adult Signature
Ll Reglstered MWITm
0 Adult Signature Restricted Delivery
❑ Registered Mail Restricted
E3 Certif✓ed Mail®
0 Certified Mali RwIrictad delivery
Delivery
❑ Return Receipt for
❑ Coltact on DOW"
Marchand se
R Collect on Ltalivery Rest>;cted Delivery
❑ Signature Confirmationrm
* Insured Mail
❑ SignatrxeCcrrfirmatign
:1 lnatued MO Ree:WMW Del"
ReStricW Dejlvery
'over $500;
Domestic Return Rea@ipt

.PAT MCCRORY
covemor
DONALD R. VAN DER VAART
Water Resources
ENIMONMENTAL OVALITY
March 29, 2016
CERTIFIED MAIL # 7014 1200 0001 3432 6585
RETURN RECEIPT REQUESTED
Anthony and Deborah Alfano
115 Ricky Ln
Newport, NC 28570
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No. WI0800018
Carteret County
Dear Mr. and Mrs. Alfano:
secreeaty
S. JAY ZIMMERMAN
Direcror
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 pem-lit for the
geothermal injection well system located on your property at the above referenced address was
issued on May 6, 2011, and expires on April 30, 2016, 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 Current1v Beim Used for Iniection:
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 Pcn-nit to Construct or Operate Injection Wells -- Geothermal
Heating/Cooling Water Return Wells). The form is also available on-line at our webslte
http://portal.ncdenr.org/web/wqlaps/gwpro/permit-applications.
If Your Geothermal Water Return Well is NO LONGER Being Used for Infection:
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.
State ofNordiCarolnia I rmnviranmentnlpaaiity,Wat9rResautvcs
1611 Mail scpA=Crater l Raleigh, North Carolina 27699-1611
919 707 9000

Page 2 6&2
If There has been a Change of Ownershiu of the Property -
If there has been a change of ownership of the property, an "Injection Well Permit
NamelOwnership 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 sbristi.shresthaLncdw r.Qov.
Regards, CVA
J'
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, WI0800018 w/o enclosures

UNDWATER FIELD/LAB FORM
n code
CaUllty
Quad No Serial No. —
Lai Long.
) J North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
SAMPLE TYPE SAMPLE PRIORITY I { r -� 030
' - N2
❑ Water ❑ Routine _ Lab umber ARD
❑ Soil ❑ Emergency pate Received4 Time: D - ! b
❑ Other Rec'd By: From:Bus, �e}urier, tiand Do.,
❑ Chain of Custody Other: ��
Report To: APO. FRO, MRO, RRO, WaRO, N� t - - - - - - Data Entry By: Ck:
WSRO, Kinston FO Fed. Trust, Central Oil., Other'. Date Reported:
Shipped by: Bus o ue , Hand Del., Other. Purpose:
Callector(s):_ is, _Ke-6 - ry Date - ( Time I A; OL3 Baseline, Complain(, Compliance, LUST, Pesticide Study, Federal Trust, Other;
tcucra Ina)
FIELD ANALYSES Owner A i A;, Skv-
pH 400 Spec. Cond.s4 at 250C Location or Site ►� _¢. �k-r L,A" r= _LJi U,,$ d-,t� .J�e- - —
Temp.jo IC Odor Description of sampling paint M'r4ur
Appearance Sampling Method _ l �. Sample lnterva4
Field Analysis By;_ Remarks umo. +a. ar- e .
LABORATORY ANALYSES (Pumping time, air temp, Mal —
BOO 310 mglL
COO High 340 mglL
COO Low 335 mglL
Califortn. MF Fecal 31a16 11f10m1
Colirorm- MF Total 31604 1100MI
TOC 680 mglL
Turbidity 76 NTl1
Residue, Tom Suspended 530 mglL
pH 403 units
Alkalinity to pH 4.5 410 mg/L
Alkalinity to pH 8.3 415 mglL
Carbonate 445 mglL
Br"rbonate 440 rng1L
Carbon dioxide 405 mg1L
Chloride 'M mg1L
Chromium: Hex 1032 trg/L
Color. True as *vu
Cyanide 720 m91L
Diss. 5oildS 70300 mg1L
Fluoride 951 mg1L
Hardness: Total 900 mg1L
Hardness (non-carb) 902 mg1L
Phenols 32730 U0
Specific Cond. 95 pmhordern
Sulrale 945 mglL
Sulfide 744 mg1L
Oil and Gr&ase mgli.
NH, as N 610
mglL
TKN as N 625
mg1L~
NO2 + NOJ as N 630
mg1L
P: Total as P 665
mg1L
Nitrate (NOsas N) 620
mg1L
Nitrite (NO2 as N) 615
mg1L
Ag-Silver 46566 ugh
Al -Aluminum 48557� _ ug1L
As•Amenic 46551 u
8a-Barium 45558 ugh
jf
Ca -Calcium 48552 mglL
Cd-Cadmium 46569 _ _ u IL
Cr-Chromium 46559 uglt
Cu-Copper 46562 ugiL
)c
Fe -Iron 46883 UgIL
Hg•Mercury 71900 u ti
K-Potessium 46555 mglL
aC
Mg -Magnesium 46554
Mn-Manganese 46565
Na-Sodium 46556
NI -Nickel
Pb-Lasd 465s4
Se -Selenium
Zn-Zinc 46587
Organochlonne Pesticides —
❑r ano hos horns Psshcldes
Nitrogen PeOcidas
Arid FlerbicWdg Y —
Sem}yeratile prssnfGs
TPH-Diesel Range
Volatile o_ rrnics LVOA bot11ai _T
TPH-Gasoline Ramie _
TPH-BTEX Gasorine Range
LAB USE ONLY ¢� j
Temperature on arrival (IC); 41 }
Lab Comments -- _ -
UN-54 REV. 4108 For Dissolved Analysis -submit SiSered sample and write'015' in block.

County:
CARTERET
+ River Basin
Report To
WiROAP
001tector
G KEGLEY
Region:
WIRC
Sa.-nple Matrix'
St1RFACEVNATER
Lou Type:
Emergency YeslNo
I CCC YeSINo
YES
Location IDW$RbAPNLC
CAS Analvte blame
LAS
Sample temperature at rat
YET
Ian Chromatography
Chloride
NUT
r-luorlde
Sulfate
Total Dissolved Solids in liquid
S
l - AW�
2 2.0 U mg1L
12 361 mg1L
Sample ID-
AB 70628
Pr] Number#
11GO310
Date Received:
0412012011
Tima Received'
08:10
Labworks LoginlD
DLEAViT
Report Generated-
5112111
Date Repoae&
0511712011
NEWPbRT.NC
7+
Time: 12:00
1 Sample Depth
Method Analvsis Velidaled b:
Reverence Date
4120/11 DLEAVITT
EPA 300.3
4126111
CGREEN!
EPA 300.0
4/26111
CGREEN
EPA 300.0
4125111
CGREEN
EPA 300.0
412E111
CGREEN
APHA2540C-18TH
4/25111
CGREEN
NO2+NO3 as N in Hauid 0.02 0.36 -ng/Las N LacW-107-04-1-c 4126111 CGREEN
MET
7429-90-5
Al by 1CP
5Q
50 t1
uglL
EPA 200.7
4/26111
ESTAFFORD1
7440-70-2
Ca by ICP
0,1
27
mg1L
EPA 200.7
4425111
ESTAFFORD1
744047.3
Cr by ICPMS
10
1❑ u
uglL
EFTA 200.8
4125111
ESTAFFQRDI
7440-50-5
CU by JOPMS
2
11
ug1L
EPA 200.8
4125111
ESTAFFORD1
7439-69-6
Pe by ICP
50
50 is
ug(l-
EPA 200.7
4P.6111
ESTAFFOR01
7440-09-7
K by ICP
0.1
2.1
mglL
EPA 200-7
4125111
ESTAFFORDi
7439-95.4
Mg by JCP
0.1
4.4
mg1L
EPA 200.7
41251i1
ESTAFFORD1
7439-25-5
Mn by ICP
10
10 u
uglL
EPA 2001
4126111
ESTAFFORDi
7440-23-5
Na by ICP
0.1
100
mglL
EPA 200.7
4125111
ESTAFFORD1
7440-02-0
Ni by ICPMS
2
27
uglL
EPA 200.8
4125111
ESTAFFORD1
7439-92-1
Pb by ICPMS
2
2.0 it
uglL
EPA 200J9
4r25r11
ESTAFFORD1
7440.56-6
Zn by ICPMS
10
2D
ug1L
EPA 200.8
4125111
ESTAFFORDI
1.d n •. �
r
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
iron of the qua Weir cvGes refer to nl7pj Ktai.roc[tan�ol�Nrg +� wzl lslanwnnecrrauig3Qa�-@- q:ia� er�1 e5 thtir •fir, arpi n=?nr-n;•ikreb7w_ acfglYnnrolrha:si$;r
pw-sp 1 of 1 t

U1VDIWATER FIELD/LAB FORM
lIon code
linty ,� f Icr r
4uad Nn Serial No.
Lai Long.
Norm uarouna
Department of Environment and Natural Resources I
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
SAMPLE 7YF'E SAMPLE PRIORI TY } I V � 030
® N:Z)
�_,Water 0 Routine Lab Number
❑ soil
❑ ❑ EmergencyDale Received
Other
F2ec'd By: Fro n:BLts curie , lfa�_VrRW„
1 Chain of Custody Other: I %-
Repurt To. ARO, FRO. MRO, RRO, WBRO, 1�
�
Data Entry By: � Ck:
—
- - —
WSRO, Kinston FO Fed. Trust, Central Off., Other:
Date Reported:
Shipped by: Bus Cratj _ , Hand Del., Other:
Purpose:
y
Callector(s): G7, K65jLL/ Date T`t-[9t if Time
t 2 =+S Baseline, Complaint, Compliance,
LAST, Pesticide Study, Federat Trust, Other:
FIELD ANALYSES
Owner
[carGa me)
PH 400 Spec. Cond.ga at 25°C
Location or Site _ t_t
_; t x �r _ G A" G �Jf'j,y1dyf- , OJ-(—
Temp.,a °C Odor
Description of sampling
Appearance
Sampling Method
Sample Interval
Field Analysis By:
Remarks`
LABORATORY ANALYSES
(pumping time, air temp., etr,)
ROD 3W mgli.
)<
,Diss- Saids 7D300
mg&
Ag-Silver 4a556
u IL
Or anochlorine Peslirides
COD High 340 MA
Fluoride 951
mg&
1[
Al -Aluminum 46557 u !f
Cr env has horns Pesticides
COD Low 335 mglL
Hardness: Total 900
mglL
As -Arsenic 46551
L
N11r en Pe5tiCide5 _
Conform' MF Fecal31616 1100m1
Hardness (non-car11) 902
mglL
Ba-Barium 46559
u IL
Acid Herbicides
Colif°rm: MF Total 31504 1108ml
Phenols 32730
ugll
r1(
Ca -Calcium 46552
M2A
PC85
TOC 680 mg1L
Specific Cend. 95
pk1hos1cm
Cd-Cadmium 46559
1
Turbidity 76 NTU
Residue, Total Suspended 630 mg1L
pH 403 units
Alkalinity to pH 4.6 410 mg1L
Alkalinity (a pH 8.3 415 mglL
Carbonate 445 mg1L
Bicarbonate 440 mglL
Garbnn dlvx[de 405 mglL
is
Chtaride 940 mglL
T
Chromium: Hex 1032 ug&
Color: True 80 C[J
Cyanide 720 mgll
Lab Comments
Sulfate 945 mgJL
Sulfide 745
Oil and Grease mglL
NH-s as N 610'
mg1L
TKN as N 625
mg/L
N% f NO, as'N 630 _
mglL
P: Total as P 865
mglL
Nitrate (NO3 a5 N) 620
mgfL
Nitrite (NO2 es N) 615
mg1L
GIN-54 REV. 4105 For Dissolved Anatysis-suhmit filtered %am pie and write'DI5' in biock-
i
Cr-Chromium 48559
u11-
Cu-Copper 465B2
u
Fe -Iron 46562
Hg-Mercury 71900
u
IL
K-Polassium 46555
mL
Mg•Magneslum 46554
y m IL
•Mn-Manganese 46565
U L
Na-Sodlum 46556
N!-Ntckel
ugry
Pb-Lead 46564
ugfL
Selenium
u9!L
Zn•Zinc 46567
„ 11
TPH-Diesel Ranr
Volatlie.QrganicssvOA bottte)
TPH-Gas_ollna Ran.3e
TPH-BTE% Gasoline Range
LAB US ONLY r
Temperature on arrival (°C): I l

County:
CARTERET
Sample ID:
A1370629
R{verBasin
bF WR���
&&LUL
PO Number#
11G0311
Report To
WIROAP
Z
Date Received:
04/20/2011
Time Received:
OB:20
Collector
G KEGLEY
,s
Labworks LoginlD
DLEAVITT
Region:
WIRQ
Report Generated:
5112111
Sample Matrix:
SURFACEWATER
Date Reported:
05/12/2011
Loc.Type;
Emergency Yes/No
COG YeslNo
YES
ViOHD
'
116 ��
Loc. Descr.: ALFANO RESIDENCE 115 RiCKY
LANE NEWPORT. NC F
l
�LLarafic APNLC
��llert19f2011
CaliectTime: 12F15
5ampfe Depth I
CAS #
t_AS
`
Anal�,te Name
Sample temperature at receipt by lab
PQL
ResuV Units
Qualifier
0.1 ac
Method
Reference
Ana!sis
(Date
4=111
Validated b-,
DLEAVM
WET
Ion Chromatography
_TITLE_ mglL
EPA 300.0
4126111
CGREEN
Chloride
15 mg1L
EPA 300.0
4126111
CGREEN
Fluoride
0.4
0.4 U mg/L
EPA 300.0
4/26111
CGREEN
Suffate
2
2.0 U mglL
EPA 300.0
4126111
CGREEN
Total Dissolved Solids in liquid
12
366 mg1L
APHA254OC-18TH
4/25111
CGREEN
NUT
NO2+NO3 as N in liquid
0,02
0.32 mg1L as N
LacIO-107-04.1-c
4128111
CGREEN
MET
7429-94-5
Al by ICP
50
sou u91L
EPA 200.7
4126111
ESTAFFORDI
7440-70-2
Ca by 1CP
CA
28 rnglL
EPA 2D0.7
4/25111
ESTAFFORDI
7440-47-3
Cr by ICPMS
10
IOU ug1L
EPA 200.8
4/25111
ESTAFFORDI
7440-50-8
CU by ICPMS
2
3.0 uglL
EPA 200.8
4/25111
ESTAFFORGi
7439-89.8
Fe by ICP
50
52 Lig&
EPA 200.7
4126/11
ESTAFFORDI
7440-09-7
K by ICP
0.1
2,2 MgIL
EPA 200.7
4125111
ESTAFFORDI
7439-95-4
Mg by ICP
0.1
4.6 mg/L
EPA 200,7
4/25111
ESTAFFORD1
7439-96-5
Mn by 1CP
10
IOU uglL
EPA 200.7
4/26111
ESTAFFORDI
7440.23-5
Na by ICP
0.1
100 mglL
EPA 200.7
4125/11
ESTAFFORDI
7440-02-0
Ni by ICPMS
2
2,0 U uglL
EPA 200.8
4/25111
ESTAFFORC71
7439-92-1
Pb by ICPMS
2
2.0 U uglL
EPA 200.8
4125111
ESTAFFORDI
7440-66-6
Zn by ICPMS
10
to U ug1L
EPA 200.8
4125H 1
ESTAFFORD1
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 (919) 73.3-3908
Ia,ailed desanplim of the GuaArer cedes fafsr w hlla�l. fowj1U w"L4I] nr' � N'�W cni t#6ata_�;UEIVGe,: odes �f^t� :N;1t@r r�CgaJsr c3mnvpJ�,rw�ll�rJsla�infnnech3seis:•
Page 1 of 1

Environmental Chemists, Inc.
6602 Wimdmill_ Wa}z • • Wilmington, NC 28405
(9I0) 3924223 CLzb] -(91C) 3924424 (Fax)
71a•BOwsertown Road ■ Manteo, NC 27954
(252) ,473-5702
ANALYTICAL & CONSULTIAIC,
CHEMISTS NCDENR- DWQ CEFMICATE #94. DIS CERTIRCATE #37729E.
_
NCDENR-DWC #14y Date of Report: May 11. 2011
'127 N. Cardinal Drive Ext. - Customer Pa #:
Wilmington NC 28405 071 Report#: 2011-03779
Attention: Geoff Kegley Report to: Geoff Kegley
Project ID: Alfano VIC
Lab ID sample ID. I Collect DatelTime ...Matrix Sampled by
11-09838 Site: 4/19/2011 12.00 PM DW Geoff Kegley
Test Method Results Date Analyzed
SM 9223B_ _w_- ._ .. w .. - -Absent 04/19/2011
Total Coliform SM 9223B Absent 04119/2011
Lab 10 Sample ID: E Collect Date/Time Matrix Sampled by
11-09839 Site: 411912011 .12:15 PM DW Geoff Kegley
Test Method Results Date Analyzed
E, Coli SM 9223B Absent 04/19/2011
Total Coliform SM 92238 Absent D411912011
Comment:
Reviewed by-
4
�: 2011-a3779 Page 1 of 1

County:
Rider Basin
Report %
CARTERET
W IROAP
Collector. G KEGLEY
Reg ion: W IRO
Sample Matrix' St1RFACEWATER
Loc, Type:
Emergency YeslNo
COC Yes/No YES
Sample 10--AB70629
O*rWATR¢
PO Nurnber#
IIG0311
P
Date Received'
Time Received.
04120/2011
011:20
a
Labworks LoginlD
DLEAVITr
Report Generated:
5112111
Date Reported:
05/12/2011
Visitld
�
Lac. descr,; AI.FANO RESIDENCE 115 KICKY
LANE NEWPflRT NC
Location ID: WIROAPNLC Collect Date: 0411912011 Collect Time: i2:15 Sample Depth
CAS # Anal-Ae Name PQL Result) Units Method AnSIYSis Vardated b.:
Qualifier Reference Date
LIB
Sample temperature at receipt by lab
0,1
°c
4120111
DLEAVITT
WET
Ion Chromatography
_TITLE_
mg/L
EPA 300.0
4126111
CGREEN
-`Chloride
_
15
mglL
EPA 300.0
4126111
CGREEN
Fluoride
g.4
0.4 U
mg1L
EPA 300.0
4/26111
CGREEN
Sulfate
2
2.0 U
mglL
EPA 300.D
4126/11
CGREEN
Total Dissolved Solids in liquid
12
366
mg1L
APHA254OC-18TH
4125111
CGREEN
NUT
NO2+NC3 as N in liquid 0.02 0.32 mg/L as N Lac1O-107-04-1-c 4126/11 CGREEN
MET
7429-90-5
At by ICP
50
50 U
ug1L
EPA 200,7
-
4/25/11
ESTAFFORD1
7440-70-2
Ca by ICP
0.1
28
mg1L
EPA 200.7
4/25111
ESTAFFORD1
7440-47-3
Cr by ICPMS
10
'IOU
uglL
EPA 200.8
4125111
ESTAFFORDI
7440-50.8
Cu by ICPMS
2
3.0
uglL
EPA 200.8
4/25111
ESTAFFORD1
7439.M6
Fe by ICP
50
52
ug1L
EPA 200.7
4126/11
ESTAFFORD1
7440-09-7
K by ICP
0.1
2,2
mg1L
EPA 200.7
4/25/11
ESTAFFORDI
7439-25-4
Mg by ICP
0A
4.6
mg1L
EPA 200.7
4125111
ESTAFFORDI
7439-96-5
Mn by ICP
10
IOU
uglL
EPA 200.7
4126/11
ESTAFFORDI
7440-23.5
Na by ICP
0A
10.0
mglL
EPA 200.7
412501
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2
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4125111
ESTAFFORD1
7440-66-6
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10
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4/25/11
ESTAFFORDI
h�1 fit' 201,
Laboratory Section>a 1523 Mall Service Center, Raleigh, NG 27699.1623 [phone]
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Page 1 of 1

gton, NC 2W5
ENVIRONMENTAL CHEMISTS, INC 6602
OFFICE: RID-3 2-023FAX[phone]
Analytical 8 Consulting Chemists NCDENR: DWO CERTIFICATION # 94 NCDHHS: OLS CERTIFICATION # 3TT29
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REPORT TO: PHONEWAX:
COPY TO: E-MAIL:
aampien toy: SAMPLE
TYPE:
I = Influent,
E = Effluent, W = Well, ST = Stream, SID = Soil, SL = Ziu[}ge, umer:
Sample Identification
Collection
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tDTICE . DECHI.aRINATION: Samples for Ammonia, TKN,
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—Received By:_ �-,
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Date: -Time: %S� ` s c ,-

NWEN
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Govemor Director
May 24, 2011
Anthony and Deborah Alfano
115 Ricky Lane
Newport, NC 28570
Subject' U I C sampling results
Permit Number WI0800018
Carteret County
Dear Mr. and Mrs. Alfano:
Dee Freeman
Secretary
On April 19, 2011, staff from the Wilmington Regional Office of the Aquifer Protection Section sampled
the influent and effluent lines of your geothermal underground injection well heat pump system. The
samples were analyzed by the ❑ivision of Water Quality lab for rneta Is, nitrates and other inorganic
constituents. A copy of the lab results is enclosed for your review.
These results have been forwarded to the central office in Raleigh along with a recommendation for
renewal of your permit WI0800018. Should you have any questions concerning this letter, please feel
free to contact me at [phone] or by email at Geoff. Kegleygncdenr.gou.
Enclosure: 4/19/2011 sample results
cc: Michael Rogers, APS Central Office
Wilmington Regional Office
127 Cardinal ode Extension Wilmington, NC 28405
Phone: 9 ] 0.796-7215 / FAX. 9 ] 0-350-2004
inlernet: www.QCWpterClRJakly—q
An Equal Opportunity/Affirmative Action Employer
50% Recyc led/ ] 0% Post Consumer Paper
Very Truly Yours,
Geoff Kegley
Hydrogeologist
L=
NorthCarolina
;Vatim171111
Customer Service 1-677-623-6748

NC DIVISION OF WATER QUALITY
LABORATORY ANALYTICAL RESULTS
5A7 GEOTHERMAL UNDERGROUND INJECTION CONTROL (UIC) WELL
PERMIT NO.: W10800018
PERMITTEE: Anthony Aifano
SAMPLE COLLECTION DATE: 4/1912011
Parameter
Fecal Coliforrn I
Total Coliform
pH (field) I
Chloride, Cl
Hardness
Total Dissolved Solids
units
CFU1100m1
CFU1100m1
units
mgfL
mg1L
mgfL
NC MCL andlor EPA Standard
NC MCL= i
NC MCL - 1
NC MCL = 6.54.6
NC MCL =260
NS
NC MCL= 500
EPA SAWS = 6.S to 8.6
EPA SOWS - 250
EPA SOWS = 500
Influent Sample Results
0
0
not sampled for
i5
not sampled for
361
Effluent Sample Results
0
0
not sampled for
15
not sampled for
3e6
Parameter
Nitrate
Nitrite
Aluminum, Al
Arsenic, As
Calelurn, Ca
Chromium, Cr
units
mg1L
mglL
pgtL
pglL
mgfL
pglL
NC MCL andlor EPA Standard
NC MCL =10
NC MCL-1
NC MCL = 50
NS
NC MCL - 50
EPA PDWS -10
EPA POWS =1
EPA SOWS = 50 to 200
EPA POWS =10
EPA POWS =100
influent Sam la Results
0.36
not Wnpjed for
C60
not sampled for
27
<10
Effluent Sample Results
0.32
not sampled for
a50
not sampled for
28
<10
Parameter
Copper, Cu
Iron, Fe
Potassium, K
Magnesium, Mg
Manganese, Mn
Sodium, Na
units
pgfL
pglL
mg&
mglL
pglL
mgfL
NC MCL andlor EPA Standard
INC MCL = 1000
NC MCL = 300
NS
NS
_
NC MCL = 50
NS
EPA SOWS -1000; PAWS =1300
EPA SOWS= 300
EPA SOWS � 5o
influent Sample Results
11
50
2.1
4.2
a10
inn
Effluent Sample Resuft5
3
52
2.2
4.6
� i o
500
Parameter
NieW, NI
Lead, Pb
Zinc, Zn
units
µg1L
pgfL
pgfL
NC MCL andlor EPA Standard
NC MCL = 100
NC MCL=15
NC MCL=1050
EPA PDWS z 15
EPA SOWS - 5000
Influent Sample Results
27
<2
20
Effluent Sample Results
<2
-C10
NC MCL = North Carolina Maximum Contaminadon Limits per r SA NC AC 2L .0200
EPA PDWS = Environmantal Pro1achon Agency Primary drinking Water Standards
EPA SDW S = Environmental Pfdteaq(t Agency Secondary Drinking Water Standards
NS = No Standard

Permit Number WI0800018
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well (SA?)
Primary Reviewer
thomas.slusser
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
Anthony and Deborah Alfano SFR
Location Address
115 Ricky Ln
Newport
Owner
Owner Name
Anthony
Dates/Events
Orig Issue
08/14/00
NC 28570
Alfano
App Received Draft Initiated
08/05/05 07/13/06
Scheduled
Issuance
Central Files : APS_ SWP_
05/05/11
Permit Tracking Slip
Status
Active
Version
2.00
Project Type
Renewal
Permit Classification
Individual
Permit Contact Afflllatlon
Major/Minor
Minor
Region
Wilmington
County
Carteret
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Anthony Alfano
115 Ricky Ln
Newport NC 28570
Public Notice Issue
07/19/06
Effective
07/19/06
Expiration
07/31/11
_R_e~g~u_la_t_e_d_A_c_t_iv_i_ti_e_s ________________ ""R=e=a=u=e=s-'-'te=d=/-=--R=e=c=e-=--iv,_,e=-=dc:....=E'-'-v=e"""n=ts=--------------
Heat Pump Inj ection Additional information received
RO staff report received
Additional information requested
Additional information received
Additional information requested
Additional information received
Additional information received
Additional information requested
Additional information received
Additional information requested
09/30/05
10/07/05
11/08/05
11/17/05
12/08/05
01/09/06
03/20/06
05/30/06
07/19/06
Outfall l·J~Ji .I
Waterbody Name Stream Index Number Current Class
Central Files: APS_ SWP_
05/05/11
Subbasin
NCDENR
North Carolina department of Environment and Natural Resources
Division of Water Cluallty
Beverly Eaves Perdue Coleert H. Sullins
Governor Director
May 6, 2011
Anthony and Deborah Alfano
115 Ri cicy Ln.
Newport, NC 28570
Re: Issuance of Injection Well Permit
Permit No. W10800018
Issued to Anthony and Deborah Alfano
Carteret County
Dee Freeman
Secretary
In accordance with your application received March 15, 2011,1 am forwarding Permit No. W10800018 for the
operation of a 5A7 geothermal underground in}ection control (UIC) well heat pump system located at the above
referenced address. This permit shall be effective from the date of issuance until April 30, 2016, and shall be
subject to the conditions and limitations stated therein.
The Wilmington Regional Office collected groundwater samples from your geothermal system on April 19,
2011. 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 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
Quality. If you have any questions regarding your permit or the Underground Injection Control Program please
call ine at [phone].
Best Regards,
Michael Rogers, P.G. (NC & F1')
Environmental Specialist
cc: Charles Stehman, Wilmington Regional Office
Central. Office File W10800018
Carteret County Environmental Health. Dept.
AQUIFER PROTECTION SECTION
1636 Mall Service Center, Raleigh, North Camiina 276Wi636
Lmatbit. 2728 Capital kulevard. Rale in. Noll f nrolirka 277W
0hone, .918-733-"a2"1 l FAX [phone]d M6: FAX 2i 919-71Ba43 %Customer 5arvican: 1-677-623.6748
Intemet: www.nuxaiercualhv,nr
One
Nortb Cat olm- a
to Ovporwni:{ � Affirmaiive Amm) Employer

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
Anthony and Deborah Alfano
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 115 Ricky Ln., Newport, Carteret County, NC 28570, and will be constructed and
operated in accordance with the application received March 15, 2011, and in conformity with the specifications
and supporting data, all of which are filed with the Department of Environment and Natural Resources and are
considered a part of this pennit.
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 effective, unless revoked, from the date of its issuance until April 30, 2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through VUI hereof.
Permit issued this the 6th day of May, 2011.
~0 )<O
_)~6.1~~!~
~leen H. Sullins , Director
Division of Water Quality
By Authority of the Environmental Management Commission.
WI080001 8
PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be permanently labeled with a warning that it is for injection purposes and the entrance to each well
must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.0213(g).
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to:
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Wilmington Regional Office
127 Cardinal Dr. Extension
Wilmington, NC 28405
[phone]
GW-ls must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
PART II-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.
WI0800018 2
3. The issuance of this pennit shall not relieve the Pennittee 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 perm.it 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 Ill-PERFORMANCE STANDARDS
1. 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
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Pennittee 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 Pennittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART IV -OPERATIONS 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 perm.it, 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.
WI08000l g 3
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 [phone], any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4 . In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART 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 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)
(B)
(C)
WI0800018
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.
The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
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.
4
(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)(I) within 30 days of completion of abandonment.
3. The written documentation required in Part VIII (1) and (2) (G) shall be submitted to:
WI080001 ~
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
5
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 4/20/11 County: Carteret
To: Auuifer Protection Section Central Office Permittee: Deborah and Anthony Alfano
Central Office Reviewer: Michael Rogers Project Name: AIfano Residence
Regional Login No: Geoff Ketacy Application No.: WtOO8000118
I. GENERAL INFORMATION
1. This application is (check all that apply): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Remediation ®(?then Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ❑ Yes or ❑ No.
a. Date of site visit: 4/19/11
b, Person contacted and contact information: Deborah Alfano
c. Site visit conducted by: Geoff Kep-lev
d. Inspection Report Attached: ® Yes or ❑ No.
2. Is the following information entered into the B1MS 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 I Type of Wastes (e.g., subdivision, food processing, municipal wastewater):
For Disposal and Infection Sites:
[If multiple sites either indicate which sites the informarion ap Ip ies to. copy and paste a new section into the
document for each site, or attach additional paces for each site
a. Locations):
b. Driving Directions: Hwy 24 towards Morehead City, turn right on Brook Lane, left on to Ricky Lame.
c_ USGS Quadrangle Map name and number:
d. Latitude: Longitude:
11. NE WAND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or minor
n+odrfcutions, skip 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: Alfano Residence Staff' report April 2011 1

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
IV INJECTION WELL PERMITAPPLICATIONS (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.)
Descri ftion Of Well S And Facilities —New, Renewal And Modification
1. Type of injection system:
® Heating/cooling water return flow (SA7)
❑ Closed -loop heat pump system (5QMI5QW)
❑ In situ remediation (51)
❑ Closed -loop groundwater remediation effluent injection (5U Non -Discharge")
❑ Other (specify:
2. Does system use same well for water source and injection? ® Yes ❑ No
3. Are there any potential pollution sources that may affect injection? ❑ Yes ® No
What is/are the pollution source(s)? _What is the distance of the inioction_weil(s) from the pollution
source{ s ? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? 13 ft.
5. Quality of drainage at site: ® Good ❑ Adequate ❑ Poor
d. Flooding potential of site: ❑ LOW ® Moderate ❑ High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ❑ Yes ❑ No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring pro};ram-
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? ® Yes or ❑ 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 QAl}•:
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)?
❑ Yes ® No. If ves. Ax ain_
2. For closed -loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? ❑ Yes ❑ No. if yes, explain:
3. For renewal or modification of groundwater remediation permits (of any type). will
continued/additional/modified ieetions have an adverse impact on mi6ption of the lume or manage -went of
the contamination incident? ❑ Yes ❑ No. if ves. ex Wn-
4. Drilling contractor: Name: Unknown
FORM: Aifono Residence Staff report April 20 l 1 4

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.: This review was conducted for a
permit renewal for an open loop geothermal well (5A7). A site visit was performed on April 19, 2011. The
influent and effluent sampling spigots are not labeled, but according to the owners, the hose bib on the side of
the house is representative of the influent as it is located after the well and before it enters the system. The
effluent tap is located inside the garage, near the pump & bladder tank. The remaining appurtenances are
inaccessible in the house's crawl space. The onsite septic system is greater than 120 feet away from the well,
and the neighbor's septic system is approximately 100 feet away, no other potential pollution sources were
identified. The sample results from the last permit renewal inspection indicated Lead at a level above 2L
Standards. The Central Office may want to wait for the sample results before issuing the permit to see if any
corrective action requirements need to be included in the permit.
2. Attach Well Construction Data Sheet-if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? D Yes [8:] 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
FORM: Alfono Residence Staff report April 2011 6
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
8. Signature of report preparers):
Signature ofAPS regional supervisor: _
Date: D :z I I
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: Alfono Residence Staff report April 2011 7

Compliance Inspection Report
Permit: WI0800018
SOC:
County: Carteret
Region: Wilmington
Effective: 07/19/06 Expiration: 07/31/11
Effective: Expiration:
Contact Person: Anthony Alfano
Directions to Facility:
Title:
System Classifications:
Primary ORC: Certification:
Secondary ORC{s):
On-Site Representative(s):
Related Permits:
Owner: Anthony Alfano
Facility: Deborah & Anthony Alfano -SFR
115 Ricky Ln
Newport NC 28570
Phone:
Phone:
Inspection Date: 04/19/2011
Primary Inspector: Geoff Kegley
Secondary lnspector(s):
Entry Time: 11 :00 AM Exit Time: 01 :00 PM
Phone:
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Heating/Cooling Water Return Well (5A7)
Facility Status: 0 Compliant O Not Compliant
Question Areas:
■Wells ■ System Operations
(See attachment summary)
Page: 1
Permit: VVI0800018 Owner - Facility: Anthony Alfano
Inspection Date: 0411912011 Inspection Type: Compliance Evaluation
Inspection Summary:
Reason for Visit: Routine
This review was conducted for a permit renewal for an open loop geothermal well (W). A site visit & sampling was
performed on April 19, 2011. The influent and effluent sampling spigots are not labeled, but according to the owners, the
hose bib on the side of the house is representative of the influent as it is located after the well and before it enters the
system. The effluent tap is located inside the garage, near the pump &'bladder tank. The remaining appurtenances are
inaccessible in the house's crawl space. The orisite septic system is greater than 120 feet away from the well, and the
neighbor's septic system is approximately 100 feet away, no other potential pollution sources were identified. The sample
results from the last permit renewal inspection indicated Lead at a level above 2L Standards, Samples were taken and
results are pending.
System Operation
Yes
No
NA
NE
Is same well used as source well and injection well?
■
❑
❑
❑
Is injection well capable of assimilating injected fluid?
■
❑
❑
❑
In}ectian flow rate at time of inspection (gpm)
Was system ownerloperator noticed any abnormalities (turbidity, air in system, poor heating/cooling, etc) in
❑
■
❑
❑
system operation?
Comment an system operation
❑
❑
■
❑
Is system operation and construction consistent with that described in application?
■
❑
❑
❑
Describe inconsistencies between application and observed operation/construction
Comment'
Page: 2

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North Carolina
GROUNDWATER FIELD/LAB FORM Department of Environment and Natural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
Location code SAMPLE TYPE SAMPLE PRIORITY
County ❑ Water ❑ Routine Lab Number
Quad. No Serial No. ❑ soil ElEmergency Date Received Time:
Lat. Long. El Other Rec'd By: From -.Bus, Courier, Hand Del.,
❑ Chain of Custody Other:
Report To: ARO, FRO, MRO, RRO, WaRO Data Entry By: Ck:
WSRO, Kinston FO Fed. Trust, Central Off., Other:. Date Reported:
Shipped by: Bus , Hand Del., Other: Purpose:
Collector(S): Date -tt Time 19. vo Baseline, Complaint, Compliance, LUST, Pesticide Study, Federal Trust, Other:
FIELD ANALYSES+ Owner i��rio - ld O1e}- LXc-
pH doo Spec. Cond.94 at 250C Location or Site t s tw 7 L. q*-' cs• N e-
Temp.lo °C Odor Description of sampling point
Appearance Sampling Method a, u, Sample Interval
Field Analysis By: Remarks md.tlalwe=I - --
LABORATORY ANALYSES (Pumping 9MR. air ww.• RtO
BOA 310 mg1L
COD High 340 n4L
COD Low 335 mglL
Colifvrm: MF Fecal 31616 1100m1
Coiiform: MF Total 31504 71 ooml
TOC 680 rrigA-
Turb�dity 76 NTU
Residue, Total Suspended 530 mgrL
PH 403 units
AWaltnity to pH 4.5 410 mg1L
Alkallnity to pH 8.3 415 mg1L
Carbonate 445 mg&
Bicarbonate 440 mgUL
Carbon dioxide 405 mg1L
Chloride 940 mg1L
Chromium: Hex 1032 ug1L
Color. True 80 Cu
I Cyanide 720 mg/i_
Diss, Solids 70300 mg/L
Fluoride 951 m91L
Hardness: Total 900 mg1L
Hardness (non -card) 902 mglL
Phenols 32730 ugA
Specific Cond. 95 pMhosldm
Sulfate 945 mg1L
Suifide 745 mg1L
Olt and Grease mg1L
NH3 as N 810 mg1L
TKN as N 625 mg1L
N%+ NO3 as N 630 mglL•
R Total as P 665 mg1L
Nitrate (NO3asN) a 2 0 mg/L
Nitrite (NOx as N) 616 rw1L
Lab Comments
GW-64 REV, 4100 For Dissolved Analysis -submit filtered sample and write "DIS` In block.
Ag-Sllver 46566
u L
AJ-Aluminum 46557
ugIL
As -Arsenic 46551
ugIL
Ba-Barium 46558
uq1L
j[
Ca -Calcium 46552
m 1L
Cd-Cadmium 46569
u IL
Cr-Chromium 40559
u L
Cu-Capper 46562
u L
jc
Fe -Iron 46563
ug1L
Hg-Mercury 71900
uqjL
X
K-Potassium 48555
m sil
Mg -Magnesium 45564
m
y[
Mn-Manganese 48565
u L
�[
Na-Sodiurn 45556
m IL
Ni-Nickel
u
�[
Pb-Lead 46564
ugIL
Se -Selenium
Wk.
Zn-Zinc 46587
u L
Pesticides
Pesticides
PCBs
Temperature on arrival (°C):

I GROUNDWATER FIELD/LAB FORM
Location code _______________ _
County _--1,,c-=-'"·o.=f....._.:{e.tr-=--_._(/.,_k:.._ ______ _
Quad No ______ Serial No., _______ _
Lat.________ Long .. ________ _
Report To: ARO, FRO, MRO, RRO, WaRO,~
SAMPLE TY P E
fSI Water
0 Soil
D Other
C! Chain of Custody
WSRO, Kinston ~ Trust, Central Off., Other: _________ _
SAMPLE PRIORITY
129 Routine
0 Emergency
North Carolina
Department of Environment and Natural Resources
DIVISION OF WATER QUALITY-GROUNDWATER SECTION
0 Lab Number ______________ _
Date Received. ______ Time: _____ _
Rec'd By: From :Bus, Courier, Hand Del.,
Other:, _________ _;_ ______ _
Data Entry By : ______ _ Ck : ____ _
Date Reported: _____________ _
Shipped by: Bus~ Hand Del ., Other: Purpose:
Collector(s): G,, ¥-/5 6 L<?:-/ Date "f-/J-11 Time 1.:z.: ,s-Baseline, Complaint, Compliance, LUST, Pesticide Study, Federal Trust, Other:, ____ _
N A' ,. o·_ • (circle one) ( ,, FIELD A AL YSES Owner tt" .... o F-e'S.c:~.-e1,tt e--U <--
Location or Site I\ S::: jl ,, ~y (,.A I-Jr; Nii->f<fYt-" , ,N-<.....
Description of sampling point. __ ___.,e."---({,f:t:..f.l-'-«l!..!,e,a'14~1--------,,----:------,---------
Sampling Method ?"..., 7 IPumo . baner. etc.I Sample Interval. _______ _ Remarks _______________________________________ _
(Pumping time, air temp., etc.)
pH 400 Spec. Cond.94, ______ at 25°C
Temp.10, __ --'--_____ °C Odor ____________ _
Appearance ______________________ _
Field Analysis By:. __________________ _
LABORATORY ANALYSES
BOD 310 m9/L )( Diss. Solids 70300 mg/L Ag-Silver 46566 ua/L Orci anochlorine Pesticides
COO High 340 mg/L Fluoride 951 mg/L )( Ai-Aluminum 46557 ua/L Oraano ohosohorus Pesticides
COO Low 335 mg/L Hardness: Total 900 mg/L As-Arsenic 46551 uo/L Nitroo:i en Pesticides
Coliform: MF Fecal 31616 1100ml Hardness (non-carb) 902 mg/L Ba-Barium 46558 uo/L Acid Herbicides
Coliform : MF Total 31504 1100ml Phenols 32730 ug/I X Ca-Calcium 46552 ma/L PCBs
TOC 680 mg/L Specific Cond . 95 µMhoslcm Cd-Cadmium 46559 uo/L
Turbidity 76 NTU Sulfate 945 mg/L X Cr-Chromium 46559 ua/L
Residue, Total Suspended 530 m9/L Sulfide 745 mg/L )( Cu-Copper 46562 ua/L
')< Fe-Iron 46563 ua/L Semivolati le Oraanics
Oil and Grease mg/L Hg,Mercury 71900 ua/L TPH-Oiesel Ran ge
pH 403 units X K-Potassium 46555 mQ/L
Alkalinity to pH 4.5 410 mg/L X Mg-Magnesium 46554 mall
Alkalinity to pH 8 .3 415 mg/L X Mn-Manganese 46565 ua/L Volatile Orcanics 0/OA bottle)
Carbonate 445 mg/L NH3 as N 610 mg/L X Na-Sodium 46556 mo/L TPH-Gasoiine Ranae
Bicarbonate 440 mg/L TKN as N 625 mg/L 'f., Ni-Nickel ua/L TPH-BTEX Gasoline Ran ae
Carbon dioxide 405 mg/L X NO2 + NO3 as N 630 mg/L 'X Pb-Lead 46564 ua/L
X. Chloride 940 mg/L P: Total as P 665 mg/L Se-Selenium ua/L
Chromium: Hex 1032 ug/L Nitrate (NO3 as N) 620 mg/L X Zn-Zinc 46567 ua/L
Color: True BO cu
Cyanide 720 mg/L
Nitrite (NO 2 as N) 615 mg/L LAB USE ONLY
Temperature on arrival (°C):
Lab Comments _____________________________________________________ _
GW-54 REV. 4/06 For Dissolved Analysis-submit filtered sample and write "DIS" in block.
Report to: GROUNDWATER SECTION Page ( of /
CHAIN OF CUSTODY (COC) RECORD
NC DENR/DWQ LABORATORY (check one): [O{J CENTRAL (□)ARO (O)WaRO
..
For Investigation of: A:l..fa.i.t~ ~~~d.e.t,\('.~ U\c._ Incident No. -
Sample collector (print name) ~ ~-~"!/:-~ and GW-54 forms completed by: Sample collector's signature:
Field storage conditions and location (when applicable):
Lab Use Only NUMBER
DATE TIME OF
LABNO. SAMPLE ID QUAD.NO. LOCATION SAMPLED SAMPLED CONTAINERS
1-I I S" ~',.~ l,.>A e. N~.~ --I -1'1-1\ J '2:c,D tJ
I e \ l CS' 12-t_ G;{c...v I ,.,, .D dJ~t»r t-c..t-11-t I /2 : ,~ <-f
I I
R %hed~y ~gnz~e~/4-._ Date Time Received by (signature): Date Time
'l-11 --tt 1-6:~
R e linquished by (signature):V Date Time Received by (signature): Date Time
Relinquished by (signature): Date Time Received by (signature): Date Time
Method of Shipment (check one): State Courier):8' Hand-delivered□ Federal Express□ UPS □ Other:
Sealed by: I Broken by:
Security Type and Conditions: £ / -7 /f ~ h , /1-..,., /_,, -
, --' ,
INTRALABORATORY CHAIN OF CUSTODY -a se n v L bU O I
LAB NUMBERS NUMBER ANALYSES RELINQUISHED RECEIVED DATE TIME
FROM THROUGH BOTTLES REQUESTED BY: BY:
cW,
Analytical & Consulting Chemm
ENVIRONMENTAL C HEMISTS, INC
NCDINR: DWQ CERTIRCATION 'I M NCDHHS: DLS CERTIRCATION I 37721
COLLECTION AND CHAIN oF:cusTODY
6I02 Wlndmlll W., Wllmlngton, NC 2l40I
OFFICE: 918-392~223 FAX 918-392~
CLENT: ___ ~_C-_-=-P_tv---....Q _____ PROJECT NAIIE: A\~ o V \ (,_ REPORT NO: _________ _
ADDRESS. ____________ CONTACT NAME: &off ilej \-ey PO NO: __________ _
________________ REPORTTO: ____________ PHONEIFAX: ______ --"-----
COPY TO: E-MAIL: ---------------------------
Sampled By; ( __:_.,f'E O r:: c::-_, L c-r-? C. <c:. 7 SAMPLE TYPE: I • Influent. E • Effluent, W • Well, ST • Strum, SO • Soil, SL • Sludge, Other:
Collection ,I .. , rf :1 PRESERVATION
la. 1-I 1s I -C, Sample ldentlficatton 1: i Ill I I a: ANALYSIS REQUESTED 1~ i i i 2 Ill I e 2 ~i jE 6 ..
J)ate Time Temp u u :z;
.l 4114 111 I )~e:>D vJ C (,t)
--rb~ l fec4 ,1 c0 ftf;vv1-1, . \ ((!J G I
€ '-t\ I °i\l \ 12:i~ w C @
{c)~ ( fecrAI/ co/tfo ✓vn I I tfi G ..
C p
G G
f C p
G G
C p
G G
C p
G G
C p
G G
C p
G G
C p
G G -C p
G G
NOTICE-DECHL.ORINATION: ...... for Ammonia, 110t, Cyallllll.,.__. and Bac:ar1I muat be dachlortnmd (0.2 ppm or IIN) In tlle tllld •a. am. ofcalldlon. SN ...... for llalruc1lola
Tra.,.,., Rel l . By; DaWTime ReceMKI Bv: Data/Time
1.
z. ·-
T ,
RKelved: 7: .,, ~= ---~ Resample Requested: -r f Dollv_By,'"'c;eo ff (ej .;_'i -By:__:__~~ 0.: L(IJ'i,l(t Time: l5;3c,
Commenta:. ________________ ___,b.......,_~z=r:--=_..,:;..----_______ TU RNAROUND:--------
Rogers, Michael
From:
Sent: )
To:
Subject:
Stehman, Charles
Friday , April 29, 2011 10:36 AM
Rogers, Michael
RE: Alfano 5A7 WI0800018
Sorry about that. Our intent was that the permit should be renewed . We left you the option of waiting until the
chemistry comes or issuing prior to that report ..
Charles F. Stehman, Ph.D.,P.G.
Environmental Program Supervisor III
NC Division of Water Quality, Aquifer Protection Section
Wilmington Regional Office, 127 Cardinal Drive Extension
Wilmington,North Carolina 28405
phone: [phone], fax: [phone]
DISCLAIMER: Per Executive Order No. 150, all e-mails sent to and from this account are subject to the North Carolina
Public Records Law and may be disclosed to third parties.
From: Rogers, Michael
Sent: Friday, April 29, 2011 9:58 AM
To: Stehman, Charles
Cc: Kegley, Geoff
Subject: Alfano 5A7 WI0800018
Charlie-
Good morning sir. I was looking at the staff report for the above site. Item V.7 was missing on the form. Probably what
happened was when the form was printed out, this line was left off page. This item is where you recommend permit
issuance or not. I just want to confirm that you recommend that we renew the permit. If so, I'll just attach your e-mail
to the form.
Thanks
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
http ://porta l.ncdenr.org/web/wq/aps/gwpro/permit-applications#geot hermApps
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
1
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: March 21. 2011
To: ❑ Landon Davidson, ARO-APS ❑ David May, WaRO-APS
❑ Art Barnhardt, FRO-APS Charlie Stehman, WiRO-APS
❑ Andrew Pitner, MRO-APS 9Sherri Knight, W-SRO-APS
, R it❑ APS
From: Michael Rosiers Groundwater Protection Unit
Telephone: t919L 715-5166
E Mail: Michael.Rogers p ncmail.net
A. Permit Number: IN1 0800018
B. Owner: Alfano
O. Facility/Operation:
❑ Proposed ® Existing
D. Application:
Fax: 1919) 71 S-0588
❑ Facility ❑ Operation
1. Permit Type: ❑ Animal ❑ SFR-Surface Irrigation[] Reuse ❑ H-R Infiltration
❑ Recycle ❑ I/E Lagoon ❑ GW Remediation (ND)
® UIC —5'l'7 Well
For Residuals, ❑ Land App, ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
1. Project Type: ❑ New ❑ Major Mad. ❑ Minor Mod. 0 Renewal ❑ Renewal w/ Mad.
E. Comments/Other Information: ❑
NOTE:
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within, please take the following actions:
® Return a Completed APSARR Form and attach laboratory analytical results, if applicable.
❑ 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 R❑-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 07106 Page 1 of 1

HCDE R
North Carolina department of Environment and
Division of Wale; Quality
Beverly Eaves Perdue Ulcer, H. Sullins
Governor Director
March 18, 2011
Anthony Alfano
Deborah Alfano
115 Sticky Lane
Newport. NC 28570
Subject: Acknowledgement of Application No. W10800018
Dr,borah & Anthony Alfano - 5FR
Injection HeatinglCoohng Water Return Well (5A7)
Carteret
Dear Mr. & Mrs. Alfano:
Natural Resources
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on March 15, 2011. 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, trust 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 at 919-715-6166, or via e-mail at michael.rogers@ncdenr-gov. If the
reviewer is unavailable, you may leave a message, and they will respond promptly.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUUUES ON THIS PROJECT
Sincerely,
t
for Debra J. Watts �—
Supervisor
cc: Wilmington Regional Office, Aquifer Protection Section
Permit Application File W10800018
AOU!FER PRO ACTION SECTION
1936 Mail Servlre Gantef, P,OIeoh. NMh Carolina 27688-163u
Location: 2728 Capital8uolavard. Ra6gh. No.1h GarOna 276%
Prione' 9 i8-733-3221 1 FAQ t: 919=715-0588; FAXi: 915-7 15-60491 GustamerS?svrrx_ 1-8-n23.674
Internet, www.ncwa1emua1y-off
An Fq kA Clpanur, r}' Cmplo;i':
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All��sF�`1����

R CE1VED. or -AA jt-VC)
►O rr, aq , - 4 Ta
NORTH CAROLINA MAR 2011
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR INJECTION
WITH A GEOTHERMAL HEAT PUMP SYSTEM
TYPE 5A7 "OPEN LOOP" INJECTION WELDS)
(check one) New Permit Application Renewal Modification
r, h
DATE: — _ 20�_
PERMIT NO.: WI U bs 0 ' _ (leave blank if NEW permit application)
A. PROPERTY OWNERIPERMIT APPLICANT
Name of each owner listed on property deed. For a business or government agency, state name of entity and
name of person delegated authority to sign application on behalf of the business/agency:
0�w.11 � l . f1b
(1)
(2)
Mailing Address: j i l!1—
M1
City: State: VJ6 zip Cade: � 4; S 7 [� county: {
Home/Office Tole No.:
Fax No.
Email
Physical Address of Well Site (if different than above):
City:
State: Zip Code:
Home/Office Tole No.: Cell No.:
Fax No.
Email Address:
B. PROPERTY OWNERSHIP DOCUMENTATION
County:
Lr
Provide legal documentation of property ownership, such as a contract, deed, article of incorporation, etc. and
a PLAT map showing the property. This information may be obtained from county Register of Deeds or GIS
website.
C, AUTHORIZED AGENT, IF ANY
If the property owner/permit applicant wants to authorize someone else to sign the permit on their behalf, then
attach a signed letter from the property owner/permit applicant specifying and authorizing their agent (well
driller, heat pump contractor, or other type of contractor/agent) to sign this application on their behalf_
Company Name:
Contact Person: Email. Address:
Address:
City: State: Zip Code: County:
Office Tele No.. Fax No. Cell No..
Website Address of Company, if any -
Type 5A7 Injection Well Permit Application (Rev. August 20091 Page 1 of 4

D. WELL DRILLER INFORMATION
E.
F.
G.
Company Name: ________________________________ _
Well Drilling Contractor's Name: __________________________ _
NC Contractor Certification No.: -----------°'C'""°'o'""'n""ta=c'-"--t -"'--P=er=s=o=n ,__: ___________ _
Company Website,!..: _W:_:_,:_W..:....W..:..:....:.. ______________ -=E=m=a=i,,__l =A=d=dr=e=s=s,__: ________ _
Address:------------------------------------
City: __________ State: __ Zip Code: _______ County: ________ _
Office Tele No.: Fax No.: Cell No.: ---------
HEAT PUMP CONTRACTOR INFORMATION (if different than Driller)
Company Name: L k:":M c\ l , ~SL(\ Contact Person: f¼ 5,;,-/ 1 V/ 11 A // L /
Company Website,.,_: __,_WW-'----'---'---'W'--'----'---. ---------------=E=m=ai"'-l =A=d=dr=e=s=s,__: ________ _
Address: !) ';;}o £>.Ll-~ ~
City: N WJ~l){\.__A State:~Zip Code: ).. ~ $") 0 County: CIA Y \-<-Vl,~ 1
Office Tele No.: q\q 1' )) ~ J(,} 5 Fax No. ______ Cell No., _______ _
INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
$~ lP~ \-o ,d ~u-4 6)~
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 ----
H. WELL CONSTRUCTION DATA
(1)
____ PROPOSED Well(s) to be constructed for use as an injection well. Provide the data in (1) through
(7) below as PROPOSED construction specifications. Submit Form GW-1 after construction.
--~~·· __ EXISTING Well(s) being proposed for use as an injection well. Provide the data in (1) through (7)
below to the best of your knowledge. Attach a copy of the Well Construction Record (Form
GW-1) if available.
Well Construction Date: ________ Number of borings: ___ _
Depth of each boring (feet): ________ _
(2) Well casing. Is the well(s) cased?
(a) YES ✓ If yes, then provide the casing information below.
Type: Galvanized steel / Black steel __ Plastic __ Other (specify) _______ _
Casing thickness: __ diameter (inches): ___ depth: from ___ to I :;t'J feet (relative to land surface)
Casing extends above ground ____ inches
(b) NO
(3) Grout material surrounding well casing:
(a) Grout type: Cement__ Bentonite* Other (specify) ______ _
*By selecting bentonite grout, a variance is hereby requested to ISA NCAC 2C .0213(d)(l)(A). which requires a cement type grout
(b) Depth of grout around well casing (relative to land surface): from ___ to ___ feet
Type 5A7 Injection Well Permit Application (Rev. August 2009) Page 2 of4
(4) Well Screen or Open Borehole depth (relative to land surface): from ____ to ____ feet
(5) N.C. State Regulations (Title 15A NCAC 2C .0200) require the Permittee to make prov1s1ons for
monitoring wellhead processes. A faucet on both Influent (groundwater entering heat pump) and Effluent
(water being injected back into the well) lines is required. Will there be a faucet on:
(a) Influent line? Yes V No (b) Effluent line? Yes ,/ No
(6) Source Well Construction Information. If the water source well is a different well than the injection
well, attach a copy of the well construction record (Form GW-1 ). If Form GW-1 is not available, provide
the following data:
From what depth, formation, and type of rock/sediment units will the groundwater be withdrawn? (e.g.
granite; limestone, sand, etc.)
Depth: \ ~0 Formation: ______ Rock/sediment unit: _______ _
NOTE: THE WELL DRILLING OR HEAT PUMP CONTRACTOR CAN HELi' SUPPLY THE DATA IF THIS
INFORMATION IS OTHERWISE UNAVAILABLE.
I. OPERATINGDATA
(1)
(2)
(3)
(4)
Injection Rate:
Injection Volume:
Injection Pressure:
Injection Temperature:
J. INJECTION-RELATED EQUIPMENT
Average ( daily) ] gallons per minute (gpm).
Average (daily)7DD gallons per day (gpd).
Average (daily) ~ pounds/square inch (psi).
Average (January) 5 D ° F, Averagi:; (July) __ ° F.
Attach a schematic diagram or cross-section of the well construction that shows the total depth, length of casing,
extent of grout, stickup, location of influent/effluent sampling ports, etc. If. this is a modification, show the
engineering layout or proposed modification of the injection equipment and exterior piping/tubing associated with
the injection operation. The manufacturer's brochure may provide supplementary information if needed.
K. LOCATION OF WELL(S)
(1) Attach a site map (can be drawn) showing: houses and other structures, property lines, surface water bodies,
potential sources of groundwater contamination, and the orientation of and distances between· the proposed
injection well(s) and any other existing well(s) or waste disposal facilities such as septic tanks or drain fields
located within 1000 feet of the geothermal heat pump well system. Label all features clearly and include a
north arrow.
(2) Attach a scaled topographic map of the area extending 1/4 mile from the property boundary that indicates
the facility's location, a north arrow, and the map name.
NOTE: In most cases, an aerial photograph of the property parcel showing property lines and structures can be
obtained and downloaded from the applicable county GIS website. Typically, the property can be searched by owner
name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other wells, etc.
can then be drawn in by hand. Also, a 'layer' can be selected showing topographic contours or elevation data.
Type SA 7 Injection Well Permit Application (Rev. August 2009) Page 3 of4
RECEIVED) OENN ujvQ
AWFr;R PPnTrrrrnt, ^ov Tfil,.
L. CERTIFICATION (to be signed as required below or by that person's authorized agent) MAR 15 2011
NCAC 15A 2C .0211 (b) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4, for all others: by the well owner,
If an authorized agent is signing on behalf of the applicant, then submit a letter signed by the
applicant that names and authorizes their agent as specified in Part C of this permit application.
"I hereby certify, under penalty of law, that l 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. 1 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 iniection well and all related appurten in accordance with the approved
specifications and conditions of the Permit." _ �+
f - `�, _
Signature of Property Owner/Applicant
Print or Type Full Name
�> ci
Signature of Property OwnerlApMicant
Print or Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Summit TWO signed copies of the completed application package and all attachments to:
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Type 5A7 Injection wcl! Pcnnit Application (Rcv. August 2009) Page'4 of

State of North Carolina
Department of Environment and Natural Resources 'MFJ) l DENR J UWU
Division of Water Quality -WPWrXr MN SFCTM
STATUS OF INJECTION WELL SYSTEM IrlAiz 15 2011
Permit Number: W-r D s b 001 K
Perm ittee Name:
Address:
Please check the selection which most closely describes the current status of your injection well system:
1) [)%We]l(s) still used for injection activities, or may be in the future.
2) ❑ Well(s) not used for injection but is/are used for water supply or other purposes.
3) D Injection discontinued and: a) ❑ Well(s) temporarily abandoned
b) ❑ Well(s) permanently abandoned
c) IJ Well(s) not abandoned
4) ❑ Injection well(s) never constructed
Current Use of Well
If you checked (2), describe the well use (potable water supply, irrigation, monitoring, etc), including pumping rate and other
relevant information.
Well Abandonment
If you checked (3)(a) or (3)(b), describe the method used to abandon the injection well- (Include a description of how the well
was sealed and the type of material used to fill the well f permanend)) abandoned):
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?
❑ Yes ❑ No
Certification:
"I hereby certify, under penal law, that I have personally examined and am familiar with the information submitted
in this document, and that to the befit' of y knowledge the inft1mation is true, accurate, and complete."
r`
gnature Date
Revised 5105 GWIUIC-68

r
MCDENR
North Carolina department of Environment and Natural Resources
Dmsiw of Water Qualify
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
March 1, 2011
Anthony Alfano
115 Ricky Lane
Newport, NC 28570
Subject: Notice of Expiration (NOE)
5A7 Geothermal Injection Well
Permit No. W10800018
Carteret County
Dee Freeman
Secretary
The Underground Injection Control ([71C 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, which was issued to you on July 19, 2006, and expires on
July 31, 2011, 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.
our Iniection Well 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 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 httv:llnortal.ncdenr.orV_lweblwcrlansir-x• nrolr:_portin�_-fanns-
If Your Injection Well is CurrentlN 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 April 2. 2011.
A01J]HR PROTECTION SECTION
1636 Mail Service Center, Rare gtr. North Carolina 27699-1631,
Lo;m�n 2728 Capital Boulevard. Raleigh. Norm L'ararna 27604
Phow 919 733,32211 FAX [phone]. FAX 2: 919-715-6U46 1 CusW of Service:1-677-623-674C
InteMai: WWW.nahrdpeMUali'_.'W1
An Equa+ OpDoriuniig I AM ma5ae AcOnn Employe?
❑n;
Noi th (—_arohn

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 S_ystemfor 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
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 th.e DWQ website at
htto://h2o.enr.stat e.nc.us/ap s/gp n/forms .hhn.
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.smith @ncdenr.!!ov.
Sincerely,
~ . .!) }ruJJ
Eric G. Smith, P.G.
Hydrogeologist
Enclosures
cc: Wilmington Regional Office -APS w/o enclosures
APS Central Files - P erm it No. WI0800 01 8 w/o enclo sures
2
Michael F. Easley, Govemor
William G. Ross Jr., Secretary
North Carolina Deparmtent of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
July 20, 2006
Anthony & Deborah Alfano
115 Ricky Lane
Newport, NC 28570
Subject: Transmittal Letter
Injection Heating/Cooling Water Return Well (5A7)
Permit No. WI08000I S
Deborah & Anthony Alfano - SFR
Carteret County
Dear Mr. R Mrs. Alfano;
In accordance with your application submitted on August 5, 2005, the Division of Water Quality's
Underground Injection Control (UIC) Program is forwarding Permit No. WI0800018 for the construction
and operation of a geothermal heat pump injection system at 115 Ricky Lane in Newport, North Carolina.
This pert -nit shall be effective froth the date of issuance until July 31, 2011, and shall be subject to the
conditions and limitations stated therein. Please read your permit carefully to snake sure you thoroughly
understand its requirements and your responsibilities.
F'or your records; we have included the recent groundwater sampling results for your injection system.
Additionally, please pay particular attention to the permit requirements listed in Part IX of your permit
issuance letter.
Please contact Qu Qi at [phone] if you have any questions regarding your permit, the UIC
Program, or injection rules and regulations -
Sincerely,
Jesse Wiseman
Aquifer Protection Section
Enclosures
cc: wilmington Regional Office
APS Central riles
Aquifer Protection SCctlon 1636 Mail Service Center Raleigh, NC 27699.1636
Internet, w"yw.racwalerqu lk'ti org Location: 2729 Capital Boulevard Raleigh, NC 27604
An Equal Op portunilylAffirmaliveAdon Employer-50%Recyckmill0%Post ConsumerPaper
t4�tthCarolina
AltUrll*lf
Telephone: [phone]
Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAND 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
DEBORAH and ANTHONY ALFANO
FOR THE OPERATION OF A TYPE 5A 7 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 115 Ricky Lane in Newport, Carteret County, North Carolina, and
will be operated in accordance with the application submitted August 5, 2005 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 1 SAN orth 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 July 31, 2011 and
shall be subject to the specified conditions and limitations set forth in Parts I through IX hereof.
~
Permit issued this the l~ day of __ ~--r"r=---' 2006.
~~
~ Alan W. Klimek, Director Q Division of Water Quality
By Authority of the Environmental Management Commission.
Pennit No. WI0800018
GW/UIC-5 ver. 7/05
PAGE 1 OF 6
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 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.
PennitNo. WI0800018
GW/UIC-5 ver. 7/05
PAGE2 OF 6
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 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 qr 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. WI0800018
GW/UIC-5 ver. 7/05
PAGE3 OF6
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 [phone], 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 15A NCAC 2C .0213(h)(l), Well Construction
Standards.
Permit No. WI0800018
GW/UIC-5 ver. 7/05
PAGE4 OF 6
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)
(E)
(F)
(G)
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.
In the case of gravel-packed wells in which the casing and screens have
not been r~moved, the casing shall be perforated opposite the gravel pack,
at intervals not exceeding 10 feet, and grout injected through the
perforations.
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.
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:
Permit No. WI0800018
GW/UIC-5
Aquifer Protection Section-UIC Staff
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
ver. 7/05
PAGE 5 OF6
PART IX -OPERATION AND USE SPECIAL CONDITIONS
Results of water sample testing associated with renewal of this permit indicate that the heat pump
effluent being injected into the groundwater via the injection well exceeds the groundwater
quality standards for Lead. The following special conditions pertain to this exceedance:
1. The permittee shall take all necessarv action to sto p this discharge violation and to
correct the source(s) of this violation as specified in NCAC 15A 2C .0206 and other
parts of this permit.
2. The permittee shall submit a written record of all corrective action taken, including
modifications, repairs, and confirmation sampling, within 60 dav s of the date of
issuance of this permit.
3. Documentation is to be submitted to the address listed above in Part VIII, Item #3.
PermitNo. WI0800018
GW/UIC-5 ver. 7/05
PAGE60F 6
DIVISION OF WATER QUALITY
AQUIFER PROTECTION SECTION
July 12, 2006
MEMORANDUM
TO: Debra Watts S J v-:>@
THROUGH: Qu Qi, UIC Program Manager Q V
FROM:
RE:
Thomas Slusser~
Issuance of Injection Permit WI0800018
Deborah and Anthony Alfano
~&~ _L
~
'f/,vx..~~
Su--~ iS~oJ'-t.. ~~
l"l.. o-a u\c..~ ~
~~~
~c.r--~ fC>~
~v):tis.
I recommend that permit WI0800018 be issued to Mr. and Mrs. Alfano for the operation of an
injection well associated with their geothermal heating and cooling system. Having the Alfanos bound
by this permit will provide a strong basis from which to bring their injection well into compliance.
On April 17, 2006 Geoff Kegley of the Wilmington Regional Office made a second inspection to
collect influent and effluent water samples as part of the permit renewal process. Laboratory test
results indicate no problems with the influent samples but indicate effluent 2L exceedances for the
following parameters: Lead, Iron, and Manganese; the Iron and Manganese exceedances are
comparable to samples collected in 1998. Samples were not collected during Mr. Kegley's initial
inspection on September 22, 2005 because the injection well was constructed below grade under the
previous permitee.
In the past the UIC Program has taken two different approaches to address the situa~ion of water
quality or well construction problems:
1. conduct a confirmatory resampling of the suspect parameters;
2. issue the permit with the condition that the permitee address the problem.
I am recommending the second approach in order to be consistent with the practice of other APS
permitting units and to provide the permitees with a tangible regulatory framework within which
they must operate their injection well system; currently they are operating without a permit.
Evan Kane, former UIC Program Manager, found this to be an agreeable position. WIRO staff did
not foresee any problems with permit issuance as noted in the September 22, 2005 staff report.
r
Memorandum
To:
Through:
From:
Subject:
Thomas Slusser
Charlie Stehman GO
Geoff Kegleyi�j)11
Alfano Residence
W100800018
May 23, 2006
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water [duality
Attached are the April 17, 2006 sampling results for the 5A7 geothermal 'injection well located at
the Alfano residence.
Total and Fecal coliform were not present in either the influent or the effluent. Nitrates, TDS,
and Chlorides were similar in both the influent and effluent and at levels below 2L standards,
however elevated levels of iron, Manganese, Lead and Zinc are present in the heat pump effluent
near or above 2L standards. See attached.
If you have questions, please call me at [phone].
cc; WiRO-APS Files
S:IGWSIGeofllPermttin&lC1A[fan o memo may06
1 Carolina
Natimily
North Carolina Division of Water Quality 127 Cardinal Drive Ext. Wilmington, NC 28405-3845 Customer service
tntemet: h2o.encstate.nc.us Phone [phone] FAX [phone].67-3-6748
An Equal OpportunitylAffm §ve Action Employer — 50% Recyeled110% Post Consumer Paper

envirochem
ANALYTICAL & CONSULTING
CHEMISTS
Customer:
NCDENR-DWQ
127 N. Cardinal Drive Ext.
Wilmington, NC 28405
Attn: G. Kegley
Date Sampled: 04/17/06
Sampled By: G. Kegley
A 4a,, o
WELL: JMIWgResidence _
F— -
Sample ID Lab ID
I # 6933
E # 6934
Comments:
Reviewed by: ,
Environmental '%emists, Inc.
6602 Windmill Way ■ Wilmington, NC 28405
[phone] (Lab) ■ [phone] {Fax)
710 Sowsertown Road ■ Manteo, NC 27954
[phone]
NCDEitiR: DWQ CER'rIPICNI'E #94. DLS CERTIFICATE #37729
qol
6S
REPORT OF ANALYSIS
Fecal Coliform,
colonies1100 mL
C ]
C 1
��C:t • �j C-� �-C. S �fl 1•.0
Date of Report: April 19, 2006
Purchase Order #:
Report Number: 6-2789
Report To: G. Kegley
Total Coliform, Date
Colonliesl100 mL Analyzed
Cl
<1
04/19/06
04/18/06

ENVIRONMENTAL CHEMISTS, INC 6602 Windmill Way
' Wilmington, NC 28405
Sample Collection and Chain of CustodN? Phone: [phone]
Fax [phone]
r.
Client: _ 5t K F �� tI EMAIL: ECHEMWna?eol.com
Collected By. c�T�' I — - - - . Reuart No: is Z. - 9
yam Ie i I pe- i = inuuen[ r- = zntuent w =wen. ai =Stream. 3V =aou.
ii� amuge
uTner•
Identification
Calieciion
a
F
o
` ^
c
'a'Sample
u
PRESERVATION
D a ANALYSIS REQUESTED
r
DATE
TIME
TEMP
0- 33
'31
LL
C
P
G
711
i
C
P
C
P
G
G
C
P
G
G
C
P
G
G
C
P
G
G
C
P
G
G
C
P
G
G
C
P
G
G
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P
G
G
NOTICE — DECHLORINATION : Samples for Ammonia, TKN, Cyanide, Phenol, and Bacteria most be dechlorinated
1I.2 ppm or less in the field at the time of collection. See reverse side for instructions.
Transfer
Relinquished By:
DatelTime
Received By:
Date/Time
1.
2.
Temperature whe!,Received: Accepted: Rejected: Resample Reques -
Delivered By: • ��;7 : ` ' Received By: Date: 'z r� l Time:
Comments:

NC Division of Water Quality Laboratory Section Results
Loe. De!:.~r.: NO LOCATION CODE
L,::>cation ID: WIROAPNLC
County: CARTERET
River Basin
Report To WIROAP
Region: WiRO
Collector: G KEGLEY
Sample Matrix: Groundwater
Loe. Type: Influent
Sample Depth
Collect Date: 04/17/2006
Collect Time:: 13:30
nalyte Name
LAB
3ample temperature at receipt by lab
MET
6-lbylCP
:;a by ICP
::;rby ICPMS
::;u by ICPMS
=e by ICP
< by ICP
v1g by ICP
v1n by ICPMS
\Ja by ICP
\Ji by ICPMS
:>b by ICPMS
Z:n by ICP
NUT
Sample ID :
PO Number#
VisitlD
Date Received:
Time Received:
L~bworks LoginlD
Date Reported:
PQL Result Qualifier Units
1.0 ·c
50 50 u ug/L
0.10 48 mg/L
25 25 u ug/L
2.0 5.4 ug/L
50 62 ug/L
0.10 3 .4 mg/L
0.10 5.0 mg/L
10 10 u ug/L
0.10 60 mg/L
10 10 u ug/L
10 10 u ug/L
10 10 u ug/L
AB03036
6G0677
04/18/2006
10:25 ,· -,c.__ '·---1 . .
MMA sl1g(o<c 05/17/2006
Approved By
JGOODWIN
EST AFFORD
EST AFFORD
EST AFFORD
EST AFFORD
EST AFFORD
ESTAFFORD
EST AFFORD
EST AFFORD
EST AFFORD
ESTAFFORD
EST AFFORD
EST AFFORD
\JO2+NO3 as N in liquid 0.02 0.37 mg/Las N CGREEN
WET
:hloride in liquid 5 18
Total Dissolved Solids in liquid 10 330
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 (919} 733-3908
Page 1 of 1
mg/L MOVERMAN
mg/L MOVERMAN
COUNTY : CARTERET
QUAIL NU:
REPORT TO . WIRO Regional O(1'ree
CRLLFCTOR{S) ' G KECLEY
DATE: 7I
TIME: :
DIVISION OF WATER QUALITY
Chemistry laboratory Report 1 Ground Water Quality
SAMPLE PRlORJTY
]ROUTINE EMERGENCY
CHAIN OF CUSTODY ❑
W❑ SAMPLE'rYPE
PURPOSE- Owner: _ ALPONO RESIoijK�UtC
Location or Site:
Deseriptinn of sampling point
Sampling Method:
Remarks:
LABORATORY ANALYSIS
BOD 310 mglL.
COD High 340 m
COD l.aw 335 m
Colifttrm: MF Fecal 31616 1100m1
Cohfarm: MF Total 3tN9 1100m1
TOC m 1
rarbidiry NTU
Residue., Suspended 53D mg1L
Total sands rgfl-
PH units
Alkalinity to eH 4.5 mglL
A lkaliniry to eH 93 mBIL
Carbonate FnIVL
Bicarbonate m
Carbon d iotide m
X. +ride 18 m
�ramium: Hex 1032 ILDn-
pt,
lor True 80 C.u,
Cyanide 720 mglL
COMMENTS:
X
Diss. Solids 70300 330 MFLI-
Fluoride 951 m
Httrdrtess: total 9M
Hardness' (non-carb) 902 mZ1L
Phenols 32730 u el
.Specific
Cond. 95 umhoslam2
Sulfate rn
Sul fide 745 ma&
MBAS mgjL
Oil and Grease. to
Silica mvJL
Boron
Formaldehyde m811.
NH3 asN610 mjyL
TKN as N 625 MgA-
X
NO2 +NO3 as n 630 OL37 m
P. Total AS P 665 mvL
PO4 m&(L
Nitrate (NOS as N) 620 mpjL
Nicnic (NO, as N)615 mg/L
Ag-S itvrr 46566
X
AI-Alunnnum46557
SOU uWL
As -Arsenic 46551
u
Ba-Banum 46558
u
X
Ca -Calcium 46552
4q__TtfL
Cd-Cadmium 4G559
u gtLL
X
Cs -Chromium 46560
25U u
Cu- Capper I042
5,4 u
H
Fe- Iron ID45
fit u
Hp, Mercury 71900
ug/L
IX
•
K-Patassium 46555
3A m
X
M -Ma nesium927
5.0 m
X
Mn-Man anew 1055
IOU ugfL
X
Na- Sodium 929
60 m
X
K-Mickel
IOU u
X
Pb-Lcad 46564
IOU u
Sc-SHCOlam
4
X
Zn-Zinc 46567
1OU u L
Lab Number AB03036
Date Received 4118f2006
Time Received 10:25 AM
Received By OS
i 1-7)kQeEa`sed BY
Dale reported : Sl16f2006
Otgnnochlofinc Pesticides
Or o tas horns Pesticides
Nivoaen Peslieides
Acid
I IVolatile Organs (V,;.A bonle) l
I ITPH-BTEX Gasoline Ranfie I
4EMOY,

fJanll Catalina
GROUNDWATER FIELD/LAB FARM Department of >=nvlranrnanr and Natural Resources
DIVISION OF WATER QUALITY -GROUNDWATER SECTION
SAMPLE TYPE S�A/MPLE PRIORITY
County G: waxer L'�J Roullne Q
LabNumher 5oil ❑ EmergencyQuad No Serial No. Date Roca d Tlma: b
Lot. Long. ❑ Other Rec'd by: rom:Bu Courier and Del..
® CYialrs of Custody Other:
Report To: ARO, FRO, MRO, RRO, WaRO,PjR Data Entry By: Ck:
WSRO, Kinston FO Fed. Trust, Central Off., Date Reported:
Shipped by: Bus our er Hand Del , Other: Purpose:
Collector{sj: Data Time 1 Baseline Complaint, Compliance, LUST, Pesticide Study, Federal Trust, Other:
FIELD ANALYSES Owner wn
l_-
PH One Spec, Cond.a4 at 25eC Location or Site 4 x 4rAWEa
Temp.w °C Odor Description of sampling point
Appearance Sampling Method wt Sample Interval
Field Analvsis By: Remarks
LABORATORY ANALYSES
000310 mgRL
COD High 340 moll-
COI] Low 335 mglL
Colllorm: MF Fatal 31616 IWO"
COIItOM MF Total 31604 1100ml
TOC 680 mglL
Tufbldity 78 NTU
Residue, Suspended 530 mglL
pli 403 units
Alkalinity to pH 4.5 410 (nolL
Alkalinity to pH 8.3 415 mglL
Carbonate 445 mglL
Blcarbonale 440 nIgIL
Cannon dfoxlde 405 sngil.
Chloride 940 mglL
Chromium: IIax 1032 ug1L
Ulm Tine 80 CU
Cyanide 720 mg1L
I -oh Comments
Dlsa. solids 70300 moll-
Fluoride 951 mq&
Hardness: Total 000 mgA.
Hardness (non-cerb) 902 rrWL
Phenols 32730 ugll
SpedlIc Cond. 95 uMhoalcm
Sulfate 945 moll-
Suirlde 746 mglL
011 and Grease mg1L
NHs as N 610 mg1L
TKN as N 625 mglL
P40, 4 NO, no N 630 mall
P: Total as P 665 mglL
Nltrala {NOj as N) 620 mg&
Nil dle (N07 as N) 615 MgIL
OW-54 REV. TI03 For Dissolved Analysts-auhmlt filtered sample and write "DIS' In block.
!Pumping time, ah lernp., etc,)
Ag-Silva r 48566
u IL
AI -Aluminum 46557
u Ig L
As Arsentc 46561
u IL
13a-13arlum 4655E
u 1L
�[
Ca-Catdunl 46552
,fti, IL
Cd-Cadmium 46659
u,1t
X
Cr-Chromium 46559
to IL
Cu-Capper 46562
u L
Fe -Iron 46563
u IL
Hg-Marcury 71000
u L
K-Polesslum 46555
MOIL
Mg -Magnesium 46554
melt.
X
Mn-Mangan esa 46565
u IL
Na-Sodium 46556
mglL
NI•NlFkel
u 1L
Pb-Lesd 40564
u IL
Se -Selenium _ - _ —
u01L
Zn-ZInC46567
un/L
Oc nOchlarine Pe5tlCides
.Orj?an2Li.hosjjhorus Paslicldes
Nitrogen Pesticides
Acid Her5lc1dae
PCBs
Semivotatila Of anics
TPI-Clasal Ran e
Volattle Oiflanlcs tVOA botile) _
TPI-1-Gasollna Range
TPI i-RTEX Gasoline Ranc e
LAI3 USr= 07 11_Y
Temperaltire on arrival:

NC Division of Water ?·-•ality Laboratory Section Result~
( Loe. Descr.: NO LOCATION CODE
Location ID: WIROAPNLC
County: CARTERET
River Basin
Report To WIROAP
Region: WiRO
Collector: G KEGLEY
Sample Matrix : Groundwater
Loe. Type : Effluent
Sample Depth
Collect Date: 04/17/2006
Co llect Time:: 13:40
nalyte Name
LAB
3ample temperature at receipt by lab
MET
II.I by ICP
::a by ICP
:::r by ICPMS
Cu by ICPMS
Fe by ICP
K by ICP
Mg by ICP
Mn by ICPMS
Na by ICP
Ni by ICPMS
?b by ICPMS
Zn by ICP
NUT
PQL
50
0.10
25
2.0
50
0 .10
0.10
10 .
0.10
10
10
10
Result
Sample ID :
PO Number#
VisitlD
Date Received :
Time Received:
Labworks LoginlD
1.0
52
88
Date Reported:
Qualifier
25 U
8.0
2000
1.6
3.9
88
11
10 U
2.-4
97
Units
·c
ug/L
mg/L
ug/L
ug/L
ug/L
mg/L
mg/L
ug/L
mg/L
ug/L
ug/L
ug/L
AB03037
6G0678
04/18/2006
10:25
MMA
05/17/2006
Approved By
JGOODWIN
EST AFFORD
EST AFFORD
EST AFFORD
EST AFFORD
EST AFFORD
EST AFFORD
EST AFFORD
EST AFFORD
EST AFFORD
ESTAFFORD
ESTAFFORD
ESTAFFORD
NO2+NO3 as N in liquid 0.02 0 .02 U mg/Las N CGREEN
WET
Chloride in liquid
Total Dissolved Solids in liquid
5
10
17
321
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
Paqe 1 of 1
mg/L MOYERMAN
mg/L MOYERMAN
ll !~ .
~/tg(oea
Owner:
L.ocauou of Site:
Description ofsampling pains
Sampling Method:
Remarks:
ALFONO RESIDENCE UIC
X
Diss. Solids 7030u
321
mWL
Fluoride 951
mg/L
Hardness: total 900
` '
m
Hardness:(non-mrb)902
Pttenels 32730
pecift Cond. 95
umhoskrn2
Sulfate
m
Sulfide 745
mg/L
MOAS
mg1L
Oil and Grease
m
Silica
RIFIL
Roma
Formaldehyde
mglL
NH3 as N 6LO
mg/L.
TKN as N 625
mg1L
NO2 +NO3 as n 630
&02U
mgfL
P: Total as P 665
mg&
PO4
-AfL
X
Nitrate (NOS as N)620
mg/L
Nitrite (NO, as N) 615
mg1L
COUNTY :
CARTERET
QUAD NO:
REPORT TO :
WIRO
COLLECTOR(S)
_ G KEGLEY
DATE:
411'1P2006
TIME:
PURPOSE:
LABORATORY ANALYSIS
DIVISION OF WATER QUA IATV
Chemistry Labaralery Report 1 Cronnd Wager Quality
SAMPLE PR1OR11 N
X]ROUTINE E]FMERGENCY
Regional Office CHAIN OF CUSTODY
W❑ SAMPLE TYPE
BOD 310 L
COD High 340 —111VL
COD Low 335 m&fL
Coliform: MF Fcca131616 Iloomt
Cali Wro. MFTotal 31504 A00mi
TOC m I
Turbidiry NTU
Residue„ Su ended $30 m
Total Suspended solids mg/L
I-fi units
Alkalinity m pH 4-5 m
Alkalinity to EH 8.3 mglL
Carbonate MEA.
Bicarbonate mglL
Carbon dimidc m
>t vide 17 In
- vromium: Hex 1032 ug/L
Cokr; True 8o C.U.
Cyanide 720 mglL
Lab Number A003037
Date Received 41IM2006
Time Rcccivcd - 10:25 AM
Received By : DS
lieleaud E y : I IMM
Date reported _ 5/16/2606
Orgingochlorine Prs[icides
OrpmjAwsphorus Pesticides
NiLragen Pesticides
Acid Herbicides
Semivolatiks
TPH Mwel Range
VolegilcD anics(VOA Lon le)
TPH-Gmline Range
l PH-OTEX Gasoline (Art ge
COMMENTS -
,
r
C 1,
A8=17

GROUNDWATER FIELD/LAB FORM
County _ CcAl -- - -- -
Quad No Serial
Lat.— Long.
Water
❑ Soil
❑ other
JIL 0 Chain of Custody
Report To: ARO, FRO, MRO, RRO, WaRO,�OD
WSRO, Kinston FO, Fed. Trust, Central Off., Other
Shipped by: Bu Co r, Hand Del., Other: Purp se:
Collector=sy: �. �� Date Time
FIELD ANALYSES T Owner
of Environment and Natural Resources
SAMPLE PRIORITY ^ �� f'f
Routine Lab Number (�
❑ Emergency Date Received Time: 10
Rec'd By: From:Bus, o r, Hand Del.,
Other:
Data Entry By: Ck:
Date Reported;
nce, LUST, Pesticide Study, Federal Trust, Other.
.-.014rcl loom — r N C
?H 400 Spec. Cond.g4 at 25°C Location or Site j� tr tv
Temp.,n °C Odor Description of sampling pain r 1ve.%7r
Appearance__ Sampling Method Sample Interval
Field Analysis By: _ R Remarks uma ar. r,
LABORATORY ANALYSES {Pumping dma, elr lamp., etc.}
BOD 310 mg1L
_
COO Nigh 340 mglL
COD Low 335 mgl
Colitorm: MF Fecal 31618 110(Iml
Conform: MF Total 31504 flooml
TOG 660 mg1L
Turbidity 76 NTu
Residue, Suspended 530 mgtL
pH 403 untla
Alkalinity to pH 4,5 410 mgt-
Alkaltnily to pH 8.3 415 mgrL
Carbonate 446 mgR
atcarbonale 440 mglL
Carbon dioxide 405 mglL
Chloride 940 mgtL
Chromium: Hex 1032 uglL
Color: True 80 Cu
Cyanide 720 rngtL
Lab
Diss. Solids 70300 mg1L
piucrkie 951 mg)L
Hardness: Total 900 rrQfL
Hardness (non-carb) sot mg1L
Phenols 32730 ugA
Specific coed_ 95 uMhostcm
Sulfate 945 mglL
Sulfide 745 rrtglL
Oil and Grease mglL
NH3 as N 610 mgA.
TKN as N 625 rn9&
NO2 + NO3 as N 630 mglL
P: Total as P 665 mglL
Nitrate (NO3 as N) 620 mg1L
Nitrite (NOg as N) 615 mglL
GW-54 REV. 7103 For Dissolved Analysis -submit fltared sample and write'DIS' In block.
Ag-Sllvar46566 u IL
}Q
At -Aluminum 46557 u &
As -Arsenic 46551 u A.
Ba-Barium 46558 u &
2<
Ca-Calclum 46552 m L
CO -Cadmium 46559 WIL
Cr-Chromium 46559 u 1L
Cu-Copper46592 ur
j�
Fa -iron 46563 u !L
Hg-Mercury 71900 u IL
K-Potassfum 46655 m A.
Mg-Magnaslum 46554 mr�L
Mn-Menganeae 46565 u lL
N"odlum 46556 m
NI -Nickel u IL
Pb-Lead 46554 u IL
S"alentum u
X
Zn-Zinc 46507 us IL
on arrival: l

Rcport to; W"Mo GROT-`NDWATER SECTION
CHAIN OF CUSTODY (COC) RECORD
Page I of I
NC DENRIDWQ LABORATORY (cheek one): (® 1 CENTRAL f [J I AR❑ 1%3 1 Wafto
For Investigation of. Ali'ono Residence, UIC
Sample collector (print name)
and GW-54 forms completed by: G. Kegley Sample collector's signature: r
Field storage. conditions and location (when applicable):
Lob Use Only
LAB NO. SAMPLE TD QUAD, NO. LOCATION
DATE
SAMPLED
Incident No.
NUMBER
TIME OF
SAMPLED CONTAINERS
* r%�
I
115 Ricky Lane
7
4
36
E
l 15 Ricky Lane
_ ,,.r
!
4
4 f-'&
L�
1
Reiinq d by (signature -
D e C
Time
v d by {sign u
IC
Relinquished by (. gnature):
la a
Time
Received by (signature):
!fEki
Time
Relinquished by (signature):
Method of Shipment (check one): State Courier®
Date Time Received by (signature):
Hand -delivered❑ Federal Express[] UPS❑ Other,
Date Time
Security Type and Conditions: I
Sealed
��7���
�
by:
�
— —
� p
INTRALABORATORY CHAIN OF CUSTODY
Lab Use On1v
LAB NUMBERS
FROM •r
BOTTLES REQUES►
r
�
Ili
_

Michael R Easley, Governor
William G. Ross Jr.. Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
March 20,. 2006
Deborah and Anthony Alfano
115 Ricky bane
Newport, NC 28570
Ref: Notice of Regulatory Requirement
Injection Well Sampling and Inspection
Dear Mr. and Mrs. Alfano:
The Underground Injection Control (UIC) Program received notification from you on January 9,
2006 that the required sampling spigots were installed on your injection well and that the -
injection well system was ready for re -inspection and sampling. Inspection and sampling of your
injection well is an integral part of the permitting process, which you initiated with your permit
application dated July 29, 2005. North Carolina -Administrative Code Title 15A, Subchapter 2C,
Section .0211(d)(1)(E) requires injection permit applications to include the chemical, physical,
biological, and radiological characteristics of injected fluids. Currently the Division of Water
Quality provides this service for applicants at no cost.
Geoff Kegley of the Wilmington Regional Office has made several attempts to- contact you and
to sample your injection well system. North Carolina General Statute § 87-90 provides the legal
authority to conduct this inspection and precludes refusal of entry, access, or other modes of
obstruction of duties while in the process of carrying out this inspection.
You are hereby instructed to call Mr. Ke_�Jey+ at 910-796_7215 within one week of receiving this
letter in order to schedule an inspection and sampling date. This date shall be scheduled within
30 days of receipt of this letter. Please note that it is necessary that you be present at the time of
the inspection in order to allow access to the system and ensure that the system is running at the
time the samples are collected.
A permit to inject heat pump effluent will not be issued without the collection of water quality
samples. Please note that it is a violation of NCAC 15A 2C .0211(a) to operate or use any well
for injection without a permit.
�°'x lural?y Carola a
aa
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636
Intemet: ht32Jlwww-ncwateroualily.prg 2728 Capital Boulevard Raleigh, NC 27604
An Equal oppodunitylAif rma&e Action Employer- 5M4 Recydedlt D% Post Consumer Paper
Telephone:
[phone]
Fax 1:
[phone]
Fax 2:
(919) 715-M48
Customer Service:
[phone]

Mr. and Mrs. Alfano
Notice of Regulatory Requirement
March 20, 2006
Page 2 of 2.
Failure to comply with this Notice of Regulatory Requirement will result in the issuance of a
Notice of Violation for unlawfully operating an injection well without a permit, which may be
accompanied by a recommendation for the assessment of civil penalties or other enforcement
actions available to the State. ·
Please contact Thomas Slusser at 919-715-6166 or me at 919-715-6182 if you have any
questions regarding this letter, injection well rules and regulations, or the UIC Program.
cc: Geoff Kegley, Wilmington Regional Office
UIC-CO Files
UIC Enforcement Files
APS Read Files
Evan 0. Kane, L.G.
UIC Program Manager
.,..
Re: Alfano (WI0800018) update]
1 of 1
Subject: Re: Alfano (WI0800018) update]
From: Thomas Slusser <[e-mail]>
Date: Wed, 15 Feb 2006 11 :08:58 -0500
To: Geoff Kegley <[e-mail]>, Evan Kane <[e-mail]>
Hey Geoff, thanks for trying. I'll talk with Evan and see what we can
do, then let you know. Thanks again ,
-Thomas.
--------Original Message --------
Sub ject:Re: Alfano (WI0800018) update
Date:Wed, 15 Feb 2006 11:02:24 -0500
From: Geoff Kegley <Geoff.Ke!!.ley0 ncmail.net>
To:Thomas Slusser <Thomas.Slusser(a ncmail.net>
References:<43F34 736.1050809(a ncmail.net>
Thomas,
I haven't forgotten about you! I have left several (unreturned) phone messages with the Alfano's and
stopped by and tried to sample twice now, with no luck.
How do you want to proceed?
-Geoff
Thomas Slusser wrote:
Greetings Geoff,
Have you been able to arrange resampling with the Alfanos yet?
-Thomas.
Thomas Slusser <Thomas.Slusser(a ncmail.net>
Hydrogeological Technician II
Aquifer Protection Section, UIC Program
NCDENR,DWQ
3/14/2006 2:09 PM
Re: Alfano NOV
1 of 1
Subject: Re: Alfano NOV
From: Thomas Slusser <[e-mail]>
Date: Wed, 11 Jan 2006 16:37:24 -0500
To: Geoff Kegley <[e-mail]>
Greetings Geoff,
Thanks a lot! Evan said that he spoke with Mrs. Alfano this week and
learned that the sampling spigots were install.ed during some unrelated
plumbing repairs. So, let them know when you can check it out and
collect some samples. Thanks again for all of your help!
-Thomas.
Geoff Kegley wrote:
Hey Thomas,
The Alfano UIC NOV was hand delivered on 1/9/2006. Unfortunately, no one was home to get a
signature.
Thanks,
Geoff
Thomas Slusser <Thomas.Slusser(fo ncmail.net>
Hydrogeological Technician II
NCDENR,DWQ
Aquifer Protection Section, UIC Program
1/11/2006 4:38 PM
DIVISION OF WATER QUALITY
AQUIFER PROTECTION SECTION
December 21, 2005
MEMORANDUM
TO: Geoff Kegley
FROM: -----Thomas Slusser ·7 J:,5 _
RE: Delivery of Notice Of Violation
In accordance with our conversation on December 21, 2005 I am sending you the NOV that was issued
to Deborah and Anthony Alfano. This NOV was sent twice and was returned unclaimed both times.
The UIC Program is very grateful for one of the WIRO staff to deliver this to the intended recipients.
Please have the homeowners sign the green card if they are home and return it to me. The date and
time should also be noted. Thank you, again, for your help!
cc: CO-UIC File
Attachment
VCUNITED-VTAxES
7-POSTAL SERViGE
Home 1 H" 1 Sign In
Track & Confirm
Search Results
LabellReceipt Number: 7002 2410 0003 0274 1087
Detailed Results:
■ Unclaimed, December 06, 2005, 12:05 pm, NEWPORT, NC
• Notice Left, November 18, 2005, 2A2 {gym, NEWPORT, NC 28570
Sauk Renjen to USPS.r.Ow Wilif• k
E I
jMr.k_&-Confirm FAQT,
1: Ca .firm
Enter Label/Receipt number.
Track & Confirm by email
Get current event information or updates for your item sent to you or others by email. Go s
Gv >
® -TORS Si. m ct u tion Prerni r Ar- is
r 'na Trus copyri i , d r d. Terms or Priva cy PolScv PF

Forth Carolina Department of
Environment and Natural Resources
Division of Water Quality
Aquifer Protection Section
1636 Mail Service Center
Raleigh, Mr, 27699-1536 nLED1DENR
AQUIFER PRCTECTrjt4 5 CWN
DEC 0 S 20ffi
i URN RECEIPTRE UEMD
02 2410 0003 0274 1087
OA El ATTEMPTED NNOT KNOWN ❑ OTHER
� 0 NO SUCH NUMBER/ STREET
❑ -UNABLE TO FORWARDDDRE55ED
CERTIFIED
MAIL,
2410 0003 0274 1087
HASLER $4.42
1'1F •I
Nov 17 zoos
r
US POSTAGE
CERTIFT£D
z,
r N51�� t
MAILED FROM
011 A0413QU — S
A ❑ tNSUFFXIENT ADDRESS
O❑ ATTEMPTED NOT KNOWN OTHER
C ❑ NO SUCH NUMBK STREET
S 0 NOT DELIVERABLE AS ADDRESSED
- UNABLE TO FORWARD '
4-
_ ,'�r.i W «. .. flllilIlfII�I11rFlFI �I I11 iF lilliil S13111f 11f }j7f 1111 i11I lilt

DIVISION OF WATER QUALITY
AQUIFER PROTECTION SECTION
November 10, 2005
MEMORANDUM
TO:
FROM:
RE:
t
Debra Watts & '~ ~
Thomas Slusser~
Re-Issuance of Notice of Violation
Violation of Well Construction Standards
The attached Notice of Violation is in need ofre-issuance because the original NOV was not claimed
by the permit applicants to whom it was addressed. The original NOV was issued on October 7, 2005
and the local post office tried to deliver it on October 19 and 26, 2005, leaving a notice each time.
Finally, the NOV was returned as unclaimed on November 3, 2005.
Ed Hardee said that in this situation he simply re-issues the NOV or other item being sent by certified
mail because it is not known if the recipient was not able to receive the NOV at the times delivered or
if they simply refused to accept it. If it is returned again then Ed said the next step is to have the local
Sheriffs office deliver it to the recipient.
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department or Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
November 14, 2005
CERTIFIER MAEL
RETURN RECEIPT REQUESTED
7002 2410 0003 0274 1087
Deborah and Anthony AIfano
115 Ricky Lane
Newport, NC 28570
Ref: Notice of Violation
Well Construction Standards
Dear Mr. and Mrs. Alfano:
The Underground Injection Control (UIC) Program of the Division of Water Quality is responsible for the
regulation of injection well construction and operation activities within the state of North Carolina. On
September 22, 2005 Geoff Kegley of the Wilmington Regional Office conducted an inspection of your
injection well system as part of the injection permit application process. Mr. Kegley's inspection revealed
the following violation:
VIOLATION
Your injection well system does not have any means for sampling the heat pump effluent. North Carolina
Administrative Code Title 15A, Subchapter 2C, Section .0213(c)(4) requires that a hose bibb, sampling
tap, or other approved equipment, be installed on the line entering the injection well such that a sample of
the injectant can he obtained immediately prior to its entering the injection well,
REQIIMD CORRECTIVE ACTION
You must install the required sample collection equipment required in NCAC 15A 2C .0213(c)(4) within
60 days of receipt of this Notice of Violation, and submit documentation of this corrective action within
15 days of completion.
ASSESSMENT OF CIVIL PENALTIES
Assessment of civil penalties may be recommended for violations described within this Notice of
Violation. Your prompt attention to the items described herein is required. Failure to comply with the
States rules in the manner and time specified may result in the assessment of civil penalties and/or the use
of other enforcement mechanisms available to the State. Each day that a violation continues may be
considered a separate violation. R
tavt
Carolina
ffm!!y
Aquifer Protection Section 1636 Mai service Center Raleigh, NC 27699-1636 Phone [phone] Customer Service
Internet: b":/1h2o.enr.sta1e_nc.us 2728 Capital Boulevard Raleigh, NC 276M Fax [phone]I3.6748
Fax [phone]
An Equal OpportunitylAifimra0ve Action Employer — 50% Re*$edilD% Post Consumer Paper

Mr. and Mrs. Alfano
Notice of Violation
November 14, 2005
Page 2 of 2.
Please contact Thomas Slusser at [phone] or Evan Kane at [phone] if you have any
questions about this correspondence, the UIC Program, or injection well rules and regulations.
cc: Charlie Stehman, Wilmington Regional Office
CO-UIC Permit File
CO-Enforcement File
CO-Read File
Sincerely,
~_\_~
Debra J. Watts, Supervisor
Groundwater Protection Unit
October 7, 2005
Deborah and Anthony Alfano
115 Ricky Lane
Newport, NC 28570
Ref: Notice of Violation
Well Construction Standards
Dear Mr. and Mrs. A]fano:
Michael F. Earley, Governor
William G. Ross Jr., Secretary
Narth Carolina Department of Environmcntand Natural Resources
Alan W. Klimek, P,E. director
Division of water Quality
CERTIFIED MAU,
RETURN RECEIPT REQUESTED
7002 2410 0003 0274 6150
The Underground Injection Control ([]IC) Program of the Division of Water Quality is responsible for
regulating injection well construction and operation activities in North Carolina. On 22 September 2005
Geoff Kegley of the Wilmington Regional Office conducted an inspection of your injection well system
as part of the injection permit application process. Mr. Kegley's inspection revealed the following
violation:
VIOLATION:
Your injection well system does not have any means for sampling the beat pump effluent. North Carolina
Administrative Code Title 15A, Subchapter 2C, Section-213(c)(4) requires that a hose bibb, sampling tap,
or other approved equipment be installed on the line entering the injection well such that a sample of the
injectant can be obtained immediately prior to its entering the injection well,
REQUIRED CORRECTIVE ACTION:
You must install the required sample collection equipment required in NCAC 15A 2C .213(c)(4) within
60 days of receipt of this letter, and submit documentation of this corrective action within 15 days of
completion.
ASSESSMENT OF CIVIL PENALTIES
Assessment of civil penalties may be recommended for violations described within this Notice of
Violation- Your prompt attention to the items described herein is required. Failure to comply with the
State's miles in the manner and time specified may result in the assessment of civil penalties and/or the
use of other enforcement mechanisms available to the State. Each day that a violation continues may be
considered a separate violation.
NDr Carolina
Yirrra 1!1
Aquifer Protection Section 1636 Mail Semice Center Raleigh, NC 27d99-1636 Phone [phone] Customer Service
Intrmel: http-1/h2o.enr.s1ate.nc.us 2729 Capital Boulevard Raleigh, NC 27604 Fax [phone]
Fax [phone]
An Equal 0pportunitylAllirmative Action Employer — 50% Recycledll0% Post Consumer Paper

Mr. & Mrs. Alfano
Notice of Violation
October 7, 2005
Page 2 of 2.
Please contact Thomas Slusser at [phone] or Evan Kane at [phone] if you have any
questions regarding this correspondence or injection well rules and regulations.
CC: Charlie Stehrnan, Wilmington Regional Office
CO-UIC Files
Sincerely,
~J. l}J)t3
Debra J. Watts, Supervisor
Groundwater Protection Unit
7002 2410 0003 02
North Carolina Department of
Environment and Natural Resources P17'05
����
vision of Water Quality
Aquifer Protection Section nn
1636 Mail Service Center �. 0.4
Raleigh, NC 27699-1636 578 W C H MCTER 717ors
AWIFE R Mtj�(' GIlog
NOV 68mm;
1st NOTICE ] p
2nd NOTICE
RfItlRltit�� _ _ 11.Y� ��
/OTHER
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Pr-
oA ❑ IN5UFFlCIENT ADDRESS
C ❑ATTEMPTED NOT KNOWN
❑ NO SUCH NUMBER/ STREET
� ❑ NOT DELIVERABLE A5 ADDRESSED
• UNABLE TO FORWARD
9
a

n
R
SENDER,.MPLETE THIS SECTION COMPLETE. ON DELIVERY
■ Complete items 1, 2, and 3. Also complete A. Received by {Please Print Clearly) B. Date of Delivery
Item 4 If Restricted delivery is desired.
r a Print your name and address on the reverse Signature
so that we can return the card to you. Agent
■ Attach this card to the back of the mailplece, X 0 Addressee
or on the front if space permYts.
1. Article Addressed to: p• Is delivery address different from item 17 ❑ Yes
if YES, enter delivery address below: ❑ No
Deborah and Anthoziy Alfano
115 Ricky Lane
Newport NC 28570 3. Service Type
❑ certified Maio ❑ Express Mall
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mall ❑ C.D.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number (Copy from -' -7 0 02 2 41-0 0 a 0 3 Q 2 7 4 6 ]a 5 �! —
PS Form 3811, July 1999 Domestic Return Receipt 102595-00-M-0952
y

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O�Q� WA rFMichael F. Easley, Governor
William G. Ross Jr., Secretary
rNorth Carolina D"rtment of Environment and Natural Resources
7 r„i
Alan W_ Klimck, P.E. Director
Division of Water Quality
October 7, 2005
Deborah and Anthony Alfano
115 Ricky Lane
Newport, NC 28570
Ref: Notice of Violation
Well Construction Standards
Dear Mr, and Mrs. Alfano:
CERTIFIED MAIL
7002 2410 0003 0274 6150
The Underground Injection Control (U1C) Program of the Division of Water Quality is responsible for
regulating injection well construction and operation activities in North Carolina. On 22 September 2005
Geoff Kegley of the'Wilmington Regional Office conducted an inspection of your injection well system
as part of the injection permit application process. Mr. Kegley's inspection revealed the following
violation:
V10LATIDN:
Your injection well system does not have any means for sampling the heat pump effluent. North Carolina
Administrative Code Title 15A, Subchapter 2C, Section .213(c)(4) requires that a hose Bibb, sampling tap,
or other approved equipment be installed on the line entering the injection well such that a sample of the
injectant can be obtained immediately prior to its entering the injection well.
RE UMED CORRECTIVE ACTION:
You must install the required sample collection equipment required in NCAC 15A 2C .213(c)(4) within
60 days of receipt of this letter, and submit documentation of this corrective action within 15 days of
completion.
ASSESSMENT OF CIVIL PENALTIES
Assessment of civil penalties may be recommended for violations described within this Notice of
Violation. Your prompt attention to the items described herein is required. Failure to comply with the
State's rules in the manner and time specified may result in the assessment of civil penalties and/or the
use of other enforcement mechanisms available to the State. Each day -that a violation continues m!iy be
considered a se Orate violation.
t
Cam�'na
Aquifer Protection section 1636 Mail Service Center Raleigh, NC 27699-1636 Phone [phone] Customer service
Internet: http:ffh2o.enr.sta1e.nc.us 2728 Capital Boulevard Raleigh, NC 27604 Fax (919) 71"588 1-877-623-6748
Fax [phone]
An Equal OpportuallylA fiirmanve Action Employer — 50% Rec) dled110°Ae Post Consumer Paper

Mr. & Mrs. Alfano
Notice of Violation
October 7, 2005
Page 2 of 2.
Please contact Thomas Slusser at [phone] or Evan Kane at [phone] if you have any
questions regarding this correspondence or injection well rules and regulations.
CC: Charlie Stehman, Wilmington Regional Office
CO-UIC Files
Sincerely,
~J,w;tts
Debra J. Watts, Supervisor
Groundwater Protection Unit
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 9/23/05
To: A quifer Protection Section Central Office
Central Office Reviewer: Thomas Slusser
Regional Login No: __ _
L GENERAL INFORMATION
County: Carteret
Permittee: Deborah and Anthon y Alfano
Project Name: Alfano Residence
Application No.: WI00800018
1. This application is (check all that apply): D New [8J 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
D Attachment B included
D Surface Disposal
D 503 regulated D 503 exempt
D Closed-loop Groundwater Remediation [8J Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? D Yes or D No.
a. Date of site visit: 9/22/05
b. Person contacted and contact information: Deborah Alfano
c. Site visit conducted by: G. Kegley
d. Inspection Report Attached: [8J Yes or D No.
2. Is the following information entered into the BIMS record for this application correct?
D Yes or [8J 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 Disposal and Injection Sites:
{I f multi ple sites either indicate which sites the information a pplies 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: H wy 24 towards Morehead Ci ty. tum ri ght on Brook Lane. left on to Ricky Lane.
c. USGS Quadrangle Map name and number: __
d. Latitude: Longitude: __
C) ;.~.,-
C.Jl r:.: i .
IL NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or5@nor ;~~:~_:·
modifications, skip to next section ) ~ ~2j
0 c:~
Descri ption OfWaste(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: Alfono Residence Staff report Sept05 1
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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 OfWell(S) And Facilities-New, Renewal, And Modification
1. Type of injection system:
IZI Heating/cooling water return flow (SA 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? IZI Yes D No
3. Are there any potential pollution sources that may ~ffect injection? D Yes IZI No
What is/are the pollution source(s)? . W hat 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? 13 ft.
5. Quality of drainage at site: IZI Good D Adequate D Poor
6. Flooding potential of site: D Low IZI 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)? IZI Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
Injection Well Permit Renewal And Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation ( e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes IZI No. If yes, explain:
2. For closed-loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? D Yes D No. If yes, explain:
3. For renewal or modification of groundwater remediation permits ( of any type), will
continued/additional/modified injections have an adverse impact on migration of the plume or management of
the contamination incident? D Yes D No. If ves, explain:
4. Drilling contractor: Name: Unknown
FORM: Alfono Residence Staff report Sept05 4
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.: This review was conducted for a
permit renewal for a open loop geothermal well (SA 7). The property owner has changed since the original
permit was issued. A site visit was performed on September 22, 2005. It appears that the wellhead and
associated plumbing was completed below grade, presumably with a pitless adapter. The pump and pressure
tank are located inside the garage, but no influent or effluent sampling spigots appeared available, therefore no
)
samples were collected. The remaining appurtenances are inaccessible in the house's crawl space. The onsite
septic system was greater than 120 feet away from the well, the neighbor's newly installed septic system was
approximately 100 feet away, no other potential pollution sources were identified. The new owner has not had
any abnormalities in system operation since purchasing the property approximately four years ago. The
proposed renewal application appears acceptable.
2. Attach Well Construction Data Sheet -if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? D Yes l2J 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
FORM: Alfono Residence Staff report Sept05 6
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
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 super
Date: r 2-'Z -5
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: Alfono Residence Staff report Sept05

Permit: WI0800018
SOC:
County: Carteret
Region: Wilmington
Compliance Inspection Report
Effective: 08/14/00 Expiration: 08/31/05 Owner: John Morrill
Effective: Expiration: Facility: Morrill, John -SFR
115 Ricky Ln
Newport NC 28570
Contact Person: John Morrill
Directions to Facility:
Phone: [phone] Ext.
Primary ORC:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 09/22/2005
Primary Inspector: Geoff Kegley
Secondary lnspector(s)
Tara MacPherson
Entry Time: 01 :00 PM
Certification: Phone:
Exit Time: 02:00 PM
Phone:
Phone:
Phone:
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Injection Heating/Cooling Water Return Well (5A7)
Facility Status: D Compliant D Not Compliant
Question Areas:
■Wells
Inspection Summary:
■ System Operations
This inspection was conducted for a permit renewal request. The property owner has changed since the original permit was issued. It
appears that the wellhead and associated plumbing was completed below grade, possibly with a pitless adapter. The pump and
pressure tank are located inside the garage, but no influent or effluent sampling spigots appeared available, therefore no samples
were collected. The remaining appurtenances are inaccessible in the house's crawl space . The onsite septic system was greater
than 120 feet away from the well, the nieghbor's new septic system is approx. 100 feet away. The new owner has nothad any
abnormalities in system operation since purchasing the property approximately four years ago.
Page: 1
Pennit: WI0800018
Inspection Date: 09/22/2005
Owner• Facility: John ·Morrill
Inspection Type: Compliance Evaluation Reason for Visit: Routine
I ocatjon
CONV001287
Distance from septic tank & drainfield (feet)
Distance from other waste disposal/collection
Comment.
Distance from other pollution source (feet)
Comment.
Is well location subject to flooding?
Minimum distance to property boundary (ft)
Comment:.
IP Plate
CONV001287
ID Plate present & properly completed?
Well Contractor indicated on ID Plate?
Comment: No ID plate
Wellhead Completjon
CONV001287
Access port present?
Spigot present?
Suction Line meets standards?
(feet)
Comment: Unable to find sampling spigot (if available?)
Tee ijet) meets standards?
If naturally flowing well, is flow valved?
Vent meets standards?
Watertight pipe entry meets standards?
Well Entry meets standards?
Pitless adaptor (if used) meets standards?
Well enclosure meets standards?
lnfuent (water source) sampling port present and labeled?
Effluent (injected fluid) sampling port present and labeled?
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
120
100
□■□□
13
Ves No NA NE
□■□□
□■□□
Yes No NA NE
□■□□
□■□□
□□□■
□□□■
□□■□
□□□■
□□□■
■□□□
□□□■
•□□□
□■□□
□■□□
Ves No NA NE
■□□□
•□□□
□■□□
□□■□
•□□□
Page: 2
O�D� ,�J A7'FR��
O
� r
August 5, 2005
Deborah and Anthony Alfano
115 Ricky Lane
Newport, NC 28570
RE: Receipt of Injection Well Permit Application
Dear Mr. and Mrs. Alfano:
Miclwei f.-as ley. Governor
WiIlium G. Ross Ir- Sec rcl&ry
Noah Camiina Department ter Envimnriienl and Nalival Resources
Alan W. Klimek, P.E. Director
Division ol'Water Quality
Your renewal application for a permit to use a well for the injection of geothermal heat pump effluent has
been peceived and is under review. A member of the Aquifer Protection 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.
Please contact me at 919-7I5-6166 or Evan Kane at 919-715-61 S2 if you have any questions regarding the
Underground Injection Control Program or injection we]I rules and regulations.
Best Regards,
,�
Thomas Slusser
Hydrogeological Technician I1
UIC Program
Cc: Charlie Stehmatr, Wilmington Regional Office
C-O-UIC riles
X°C Kim) Ilia
rlrrrrr.)lY
Aquifer Proleclion Section 1636 Mail Scrvice Center Raleigh, NC 27699-1636 Plaie �219) 733-3221 Customer service
Internet: http: lh2u.enr.state.m-.us 2728 Capital Boulevard Raleigh. NC 27604 Fax [phone]
Fax [phone]
An Equal Opportunity/Affirmative Aalinrt Empleyer- 50% Recyrcfedll D% Post Consumer Paper

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
RENEWAL APPLICATION FOR PERMIT TO USE WELL(S) FOR INJECTION WITH A
HEAT PUMP SYSTEM
Type 5A7 and 5QM Wells
In accordance with the provisions of NCAC Title 15A: 02C.0200
complete application and mail to address on the back page.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: k .20
A. PERMIT'APPLICAN'T
Permit Number:' 1 {{ (WIO##A# , listed at the bottom of each page of your perm
Name: I i5� L- T G 1�L7 1Vt f
Address:�p�-�.` tiA�'1 A
City: iV i� ti �!►r ew PC) jZj' State: Zip code � r�
County: W V� "'i,4 TeIephone: � � � � G It> 5
B. PROPERTY OWNER (if different from applicant)
Name: �Y1�i �'1 !� P. 1 A t�i- f,�C�Y�� Ali
Address:
City: NEW Pok f State: Zip code: 3 T 51 0
County: �,; 71 Y4 tyf, Telephone: r� -� t 0 C 0 4 5
C. STATUS OF APPLICANT
Private: �_ Federal:
Native American Lands:
Conuncrcial: State: Public:
D. FACILITY (SITE) DATA [Fill out ONLY if the Status of Owner is Federal, State, Public or Commercial).
e
Name of Business or
Address:
City:
County:
Contact Person:
State:
Telephone:
Standard Industrial Code(s) which desenbe commerbi~al facility -
Zip code: — -- --
Revised 5/05 GW/U1C-57 HPR Page I of 3

E.
F.
G.
H.
INJECTION PROCEDURE (specify any modifications to the injection procedure since the issuance of the
previous injection permit)
WELL USE Is(are) the injection well(s) also used as the supply well(s) for either of the following?
(1) The injection operation? YES ~ NO __
(2) Your personal consumption? YES__ No___x_
CONSTRUCTION DATA
(1)
(2)
Specify any and all modifications to the well casing, grout or screens since the issuance of the previous
injection permit.
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. Is there a faucet on:
(a) the influent line? YES_L NO __
(b) on the effluent line? YESl NO __
CURRENT OPERATING DATA
(1) Injection rate: Average ( daily) la gallons per minute (gpm)
(2) Injection volume: Average (daily) gallons per day (gpd)
(3) Injection pressure: Average ( daily) pounds per square inch (psi)
(4) Injection temperature: Annual Average degrees Fahrenheit (°F)
I. 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).
J. 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 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.
K. 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
L. 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.
Revised 5/05 GW/UIC-57 HPR Page 2 of3
M. 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 imprisornnent, for
submitting false 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 Permit."
{Signature of Well Owner or Authorized Age"t)
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner
authorizing the above agent.
N. 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 Well Construction Standards (Title 15A NCAC
Subchapter 2C .0200)
h =t.lb411y �f L I�Zj
(Signature of Property Owner iffferent From Applicant)
Please return the completed Application package to.
UTC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Revised 5105 GWAAC-57 TiPR Page 3 of 3

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY, AQUIFER PROTECTION SECTION
STATUS OF 1N4ECTIQN WELL SYSTEM
Permit Number.
Permittee Name: I YW V\.
s
Address: 1rA LL L I 3- *--)'_' i ►.SL 1
Please check the selection which most closely describes the current status of your injection well.
In addition, please provide the requested information.
Well is still used for injection activities.
2) Well is not used for injection but is used for water si inniv r,r Mc,— _ -
3) _ Injection discontinued and: a} Well temporarily abandoned
b} Well permanently abandoned
G} Well not abandoned
4) — injection well never constructed
If you checked (2), describe the weii use (pctabte water supply, irrigation, etc), including pumping rate and other
relevant information.
If you checked (3)(a) or (3)(b), describe the method used to abandon the injection well. (Include a description of
how the well was Sealed and the type of material used to fill the well if permanently abandoned):
Certification: (For well abandonment)
"i hereby certify, under penalty of law, that I am personally responsible for the proper abandonment of any
injection well as required in Title 15A NCAC 2C .0214 Criteria and Standards Applicable to Infection Wells."
1'i►f� �-r�wMa��w � •
Certification: (For information verification)
"I hereby certify, under penalty of law, that I have personally examined and am familiarwith the information
submitted in this document, and that to the best of my knowledge the information is trice, accurate, and ccmplete."
aw�
Signature
-1-�- IT --o�;,
Date
Revised 5l05 GWIUIC-E8

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Michael F. Easley, Govemor
William G. Boss Jr., Secrelary
North Carolina Depmtment of Environment and Natural Resources
AIun W. Klimek, P.E. Director
Division of WawQuality
July 12, 2005
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
7002 2410 0003 0274 4804
Anthony Alfano
115 Ricky Lane
Newport, NC 28570
Ref: Notice of Regulatory Requirement
North Carolina Well Construction Standards
Applicable to Injection Wells - Subchapter 2C
UIC Permit No. W10800018 Issued to John Morrill
Bear Mr. A Kano:
The Underground Injection Control (UIC) Program of the Division of Water Quality is responsible for the
regulation of injection well construction and operation activities within the state of North Carolina. The
purpose of this letter is to inform you, as the current property owner. of your responsibilities pertaining to
injection well rules.
The permit referenced above for the construction and operation of an injection well will expire on August 31,
2005. This office attempted to bring your injection well into compliance by sending you a notification of
expiration, a blank application for permit renewal, and an injection well status form in May of 2005. To date the
UIC Program has not received either the renewal application or the status form.
In order to comply with the regulatory requirements listed under North Carolina Administrative Code (NCAC)
Title 15A, Subchapter 2C, Section .0211, you must take one of the following actions:
1. Submit the form RENEWAL APPLICATION FOR PERMIT TO USE WELL(S) FOR INJECTION WITH A HEAT
PLjw SYSTEM (form GWIUIC-57 HPR) if the injection well on your property is still active;
2. Submit the form STATUS OF INFECTION WELL SYSTEM (form GWIUIC-68) if the injection well is
inactive or has been temporarily or permanently abandoned.
If the well 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. If the injection well is to
be permanently abandoned, a well abandonment record must be submitted to our office to certify that the
abandonment was properly conducted.
I�rrl7Cari7 Ina
Aquifer Proteetian 5eetion 1636 Mail Service Center Raleigh, NC 27699-1636 Phone [phone] Customer Service
Internet: http:1J12o.enr.state.nc.us 2728 Capital Boulevard Raleigh, NC 27604 Fax (919) 7I5-0589 1-877-623-6748
Fax [phone]
An Equal QpportunitylAf rmaEve Action Employer— 50% Recyclad110% Post Consumer Paper

Mr. Anthony Alfano
July 11, 2005
Page 2 of2
Again, we have provided you with the appropriate materials to update your UIC permit. You must respond
within 15 days of the receipt of this notice, or a Notice of Violation will be issued to you, which carries the
possibility for an assessment of fines or cessation of operation of the injection well system. Please contact
Thomas Slusser at [phone] or myself at [phone] if you have any questions about this
correspondence, the UIC Program, or the enclosed forms.
cc: DWQ -Wilmington Regional Office
CO-illC Files
Enclosures
Sincerely,
~()~~
Evan 0. Kane, L.G.
UIC Program Manager
■ Complete items 1, 2, G a. Also complete
item 4 if Restrictad Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mailpiece,
or on the front if space permits.
I. Article Addressed to:
Anthony Alfano
115 Ricky Lanz;
Newport, NC 28570
A. Signature
❑Rent
x ��'`;if�`I �J'{' l3' �l� �u b Addressee
B. Received By (Printed Name{) C. pate of Deliverer
D. is delivery address differonl from Item 17 ❑ Yes
if YES, enter delivery address below: 01140
3. Service Type —
Certified Mail ❑ Express Mail
Registered ❑ Retum Receipt for Merchandise
I3 Insured Mail ❑ C,O.D.
4. Restricted Delivery? (Extra Fee) © Yes
2- 7002 21410 0OD3 0274 4804
PS Form 3811, August 2OO1 Domestic Return Receipt
■ Complete Items 1, 2 13. Also complete
Item 4 If Restricted ❑envery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Anthony Affano
1 S 5 Ricky Large
Newport NC 20570
2ACFRT-M-Z-0985
A. ignalure
X I� Addr
Addressee
ressed
B. AeceWd by (Printed Nar" Cr Date of Delivery
1 /
D, is delivery address different from Stem t? ❑ Yes
If YES, enter defivery address below: ❑ No
3. Service Type
❑ Cerfified Mall ❑ Express Mall
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7002 2410 0033 0373 ri824
(Transfer from service label)
PS Form 3611, August 20O1 Domestic Return Receipt 2ACPRi-03-2-0985

Michael F. Easley, Governor
Will iarn G. Ross Jr., Secretary
North Cara IinaDepartment of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
June 8, 2005
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
7002 2410 0003 0273 9824
Mr. Anthony Alfano
115 Ricky Lane
Newport, NC 28570
Ref: Notification of Expiration
North Carolina Well Construction Standards
Applicable to Injection Wells - Subchapter 2C
UIC Permit No. W10800018 Issued to John Morrill
Dear Mr. Alfano:
The Underground Injection Control ([1IC) Program of the Division of Water Quality is responsible for the
regulation of injection well construction and operation activities within the state of North Carolina. Our records
show that the operating permit referenced above for the injection well on your property will expire on August
31, 2005. In addition, our records do not indicate that the well has been abandoned.
In order to comply with the regulatory requirements listed under North Carolina Administrative Code (NCAC)
Title 15A, Subchapter 2C, Section .0211, you must take one of the following actions:
I. Submit the forty RENEWAL APPLICATION FOR PERMIT TO USE WELL(S) FOR INJECTION WITH A HEAT
PUMP SYSTEM (form GW/`UIC-57 HPR) if the injection well on your property is still active;
2. Submit the form STATUS OF INJECTION WELL SYSTEM (form GWIUIC-68) if the injection well is
inactive or has been temporarily or permanently abandoned.
If the well 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, If the injection well is to
be permanently abandoned, a well abandonment record must be submitted to our office to certify that the
abandonment was properly conducted. The appropriate form(s) should be forwarded to us within 30 days of the
receipt of this notice, to allow adequate time for well water sampling and analysis.
.ant
pl-111Catnlinu
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Phone [phone] Customer Service
Internet: ht1pJ/h2o.enr.state.nc.us 2728 Capital Boulevard Raleigh, NC 27604 Fax [phone]
Far (919) 7I5.6048
An Equal OpportunitylAffirmattva Action Employer — 50% Recycled110% Post Corisumer Paper

Mr. Anthony Alfano
June 8, 2005
Page 2 of2
Please submit the appropriate form within 30 days of the date of this letter. If you have any questions regarding
the permit and injection well rules or would like assistance completing these forms please contact Thomas
Slusser at [phone] or myself at [phone].
cc: WIRO-UIC Files
CO-UIC Files
Enclosures
Sincerely, ....
~W~
Jesse Wiseman
Processing Assistant
UICProgram
GROUNDWATER SECTION
August 14, 2000
MEMORANDUM
To:
From:
Re:
Charlie Stehman
Groundwater Section
Wilmington Regional Office
AmyAxo~-
UIC Group
Groundwater Section
Issuance of injection well permit
Permit No. WI0800018 has been issued for the injection of water from an open loop geothermal heat
pump. The permit is issued to John Morrill, 115 Ricky Lane, Newport, Carteret County, North
Carolina. A copy of this permit is enclosed for your files. The Underground Injection Control
Group appreciates your staffs assistance with injection well inspection and sampling tasks. If you
have any questions regarding this permit or the UIC program, please contact me at [phone].
Enclosures
cc: UIC Files
AN"tA
NCDENR
JAMES 13. HUNT JR,
GOVERNOR
BILL HOLMAN
SECRETARY
KERR T STEVENS
DIRECTOR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
August 14, 2000
Mr. John Morrell
115 Ricky Lane
Newport, NC, 28570
Bear Mr- Morrell:
In accordance with your application dated January 26, 1998, we are forwarding Permit
No. W10800018 for the operation of a geothermal heat pomp injection well at 115 Ricky
Lane, in Newport, NC, in Carteret County. A copy of the laboratory test results of water
samples collected on May 27, 1998 is also enclosed.
This permit shall be effective from the date of issuance until August 31, 2005, 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 [phone].
Sincerely,
Array Axon
Underground Injection Control Program
CC: UIC Files �
WiRO Files ■3i
Enclosures
GROUNDWATER SECTION
1636 MAIL SIERV ICE CENTER, RALE$G H, NC 27 69 9-1 636 - 2728 CAPITAL, BLVD., RA LEI GH, INC 27604
PHONE [phone] PAX 919-715-0588
AN EQUAL OPPORTUNITY I APpIRMATfVE ACTION EMPLOYER - 50% 11ECYCLGD160% POST -CONSUMER PAPER

.. ..
MEMORANDUM August 14, 2000
To: Mr. John Morrell
From: Mark Pritzl tel. [phone]
Re: Groundwater Sampling Results from May 27, 1998
Influent Water Sam ple Effluent Water Sam ple
Coliform, total <1/l00ml Coliform, total <1/lO0ml
Coliform, fecal <1/l00ml Coliform, fecal <1/lO0ml
pH ns pH ns
Chloride 14 mg/L Chloride 12 mg/L
Total Dissolved Solids 330 mg/L Total Dissolved Solids 330 mg/L
Total Hardness 240 mg/L Total Hardness 250 mg/L
NO2-+ NO3-as N ns NO2-+ NO3-as N ns
TKN ns TKN ns
NH3 ns NH3 ns
Aluminum, Al ns Aluminum, Al ns
Calcium, Ca ns Calcium, Ca ns
Silver, Ag ns Silver, Ag ns
Chromium, Cr <25 ug/L Chromium, Cr <25 ug/L
Copper, Cu <2 ug/L Copper, Cu 3.9 ug/L
Iron, Fe 1500 ug/L Iron,Fe 1300 ug/L
Potassium, K ns Potassium, K ns
Magnesium, Mg 3.5 mg/L Magnesium, Mg 3.6 mg/L
Manganese, Mn 77 ug/L Manganese, Mn 80 ug/L
Sodium, Na ns Sodium, Na ns
Nickel, Ni <10 ug/L Nickel, Ni <10 ug/L
Lead, Pb <10 ug/L Lead, Pb <10 ug/L
Zinc, Zn 63 ug/L Zinc, Zn 71 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
Coliform, fecal <1/100 ml
Chloride <250 mg/L
Total Dissolved Solids <500 mg/L
NO2-+ NO3-as N <10 mg/L
Cadium < 5.0ug/L
Chromium, Cr <50 ug/L
Copper, Cu <1,000 ug/L
Iron, Fe <300 ug/L
Manganese,Mn <50 ug/L
Nickel, Ni <100 ug/L
Lead, Pb <15 ug/L
Zinc, Zn <2,100 ug/L
1 Liter of water= 1,000 grams at 20° C
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
( 1 gram/1, 000, 00Ograms )/ 1,000 grams
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
John Morrill
FOR THE CONSTRUCTION AND OPERATION OF AN INJECTION WELL for the purpose
of operating an open loop geothermal heat pump. This well will be is located at 115 Ricky Lane,
Newport, North Carolina, in Carteret County, and will be constructed and operated in accordance
with the application dated January 16, 1998, The well will be constructed and operated 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 Construction and 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 he effective, unless revoked, from the date of its issuance until August 31,
2005, and shall be subject to the specified conditions and limitations set forth in Parts I through
X hereof.
Permit issued this the � day of August, 2000.
Ted L. Bush, Jr., Assistant Chief
Groundwater Section
Division of Water Quality
By Authority of the Environmental Management Commission.
Permit No. W10800019 PAGE 1 OF 6

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 NCAC2C
.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.
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 II -WELL CONSTRUCTION SPECIAL CONDITIONS
At least forty-eight (48) hours prior to constructing each injection well, the Permittee shall
notify the Groundwater Section -Underground Injection Control (UIC), Central Office
staff, telephone number [phone].
PART III-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of
injection, as described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the
Division of Water Quality (Director). In the event there is a desire for the facility to
Permit No. WI0800018 PAGE20F 6
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
Pennittee 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.
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
Permit No . WI0800018 PAGE30F6
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.
PART VIII -PERMIT RENEW AL
The Permittee shall, at least three (3) months prior to the expiration of this permit,
request an extension.
Permit No. WI0800018 PAGE40F 6
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 ofdrinking water and in accordance with the terms and conditions
of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30)
as specified in 15A NCAC 2C .0213(h)(l) within 30 days of completion of
abandonment.
Permit No. WI0800018 PAGE 5 OF 6
3. The written documentation required in Part IX (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 X-OPERATION AND USE SPECIAL CONDITIONS
NONE
Permit No. WI0800018 PAGE60F6
Name Date T yp e of Permit/Comments
Heat Pump Remediation Other
Mark Pritz}
~
8l, J ,u ,geatPu~ Remediation Other
Amy Axon fo~
Ted Bush
9
COUNTY:
CARTERET
QUAD NO:
_T
REPORT TO :
1YI RO
COLLECTORS]
: Cfl[PSIA14 f
DATE'
SR71911
TIME:
PURPOSE:
LABORATORY ANALYSIS
COMMENTS,
Rcsional Office
Owner:
Location or Site:
➢escriplion of sampling point
Smnpiirlg Method:
Remarks:
DIVISION OF WATER QUALITY
Cbrinhiry Lnbornlary 14partI Grnnnd Water Qualily
SAMPLE PRIORITY
g]ROL717NE EMERGENCY
CHAIN OP CUSTODY
2A
El SAMPLETYPE
RICKY LANE
X 1
Din. Solids 70300 330 mg1L
Fluoride 95 E mg1L
X
Hardness: Ivtal900 260 mglL
Hudnass: (non -cub) 902 mglL
Phenvls32730 ug/L
Specific cent 95 limhaalctn2
Sulfide inWL
Sulfide 745 mg1L
MBAS nqA
➢il and Grease mglL.
_
Silica mg(L
anion
Fonnatdahyde mWL.
NIi3 as N 6i0 mg1L.
T K14 as N 625 mg/L
NO2+NO) as n 630 mg1L.
P: Tolal u P 66S rnwq.
PO4 tnglL
mn jug. 161999
AS -Silver 46566
AI -Aluminum 46557
ulyL
ug1L
As -Arsenic 46551
ug/L
Re-8ariurn 46558
ug/L
Ca-Culei urn46552
mglL
Cd-Cadium 46559
URIL.
1L
Cr-Chromitvn 46560
<25 ugll.
X
Co. Copper 1042
3.9 ug1L
X
Fa. Iron E045
1300 ug1L
Hp,- Mercury 71900
uglL
KGPotasslum 465SS
mglL
_
X
h1g-Magnesium927
3.6 mg&.
X
Mn-Mvigolsese 1055
Na- Sodium 929
60 ug/L
mglL
X
Ni-Nickel
clo 051L
X
Pb-Lead 46564,,
<10 uWL
Se -Selenium
UA
71
Zn Zinc 46567
71 Mg L.
Lab Nnmbcr RG 1293
Dale Received ; 511aft
Time Received 9:00 AM
Received By IG
Released By : l7S
Dale rcporica! : 7JM98
Organochlorine Pesticides
Organophosphurus Pesticides
Nitrogen Pesticides
Acid Ijerbieides
Selrtivolabics
_ITFH-Diesei Range
Voiatlle Organics (VOA bottle)
TPEE-Gasafine Range
TPII-BTFX 40wolinr Ranrte
ari 1293 hLM1Y

G! C:.... WATER FIELD/LAB FORM
Count
Quad tin f�I Serial No.
Lal.7�'° ze'P- Loma, ?CJ7'1 a r
NarIli Carot Ilia -- - -
Daparlment of Erlvlronlnenl, I1ea11Ir, nnri Na m i nesnrircas
DIVISION OF WATEfI QUALITY - GROUNDWATER SECTION
SAMPLESAMPLETY24 SAMPLE PRIORITY Lab Number C f"? ::;
04ater O'Routlne
El 5011 ❑ Emergency❑ate Racf:Ivetl� � Yaime � ! ��
❑ other R>ro'd by:� From: Colrrl anti Dal.,
Olher:
Reporl To: AAA, FRO, MRO, RRO; WaRO�j El Chain of Custody Data Entry By: Ck:
WSRO, }Clnslon FO, Fed. Trost, Central Oil., Other: Date Reported:
Shipped by, Bus trier i-Nnd Dal., Other
Purpose; ��
Collector�sj �s' � f]a1e r :' "' Time �d Basellne, Corrtplalrt(Cnm liance{�, ST, Pesllcide Study, federal Trust, 01her:
F i EI D_A JUALYS E5E5 Owner �r
pH Spec. Cand. at 250 C Location or site400
Tpm�i.10 oC Odor Description of samplin .peint
Pearance Sampling Method tft_ Sample Inlerval
Field Analysis By: Remarks m�, Uap.I
LABORATORY ANALYSES rWUWIN+v»Olime. arlamp. pie.1
BOQ 310 me d
T
COD I-Ilgh 340 mglt
COD Low 335 m;111
Colilorm: MF Fecu1 31616 1t00ml
_
C I❑ Ilnrrn: Mr- Total 31604 11001111
680 -mg/l
_
_TOG
Turbidity 76 NTU
Resldue., Suspended 530 mg11
p1-1403 unil.
Alkalinily to pl-1 4.5 410 mgll
Alkalinity to pH 8.3 416 mgli
Carbonate 445 mgll
T
Bicorbonals 440 msll
/Carbon dioxide 405 mg/1
Clllorlde 940 mg/I
Chromlum: Ilex 1032 U911
_
color: True 80 GU
T
cyanide 720 rrfrdll
Lab Comments:
✓
f]Iss_ _Sots 70300 moll
AA - Silver 465fi6 ugll
rlourlde 051 m[]N
Al - Aluminum 46557 brill
HardflessJoIal 000 _r rLL
As - Arsgpja 46551 us1H
Hardness loon-cafbi if02 mrLll
Ba - Barium 46550 - _ vqLl
_
Phenols 3273 u
Ca - Caidurn 46552 rnn/f
jj"Citla Cond. 95 1!N910e1Cmt
Cd - Cadmium 46559 !call
. Cr - Chramluln 46560 f q)LI
Sulfate 945 nr ll
`�
Sulfide 745 rnnh
I/
Cu - Coppar 46562 UE /l
^Fa
- troll 46563 UR/l
Oil and Grease m Lll
Hq - MercurL 71900 ug/l
`9-.Pola551um46555 mg/1
M, q - Mac nesiurn 46554 m9/1
Mn - Manr-1 anew 46565 u211
NH, as N 610 MCL/I
Na - Sodium_ 46556 mall
110
T
-JEtta.; N 25 mgIL
as N 630 mall
_Pb - Lead 46564 uf,Lll
P: Total as P 665 mull
Ae - Selenium Ugilil
Zn - Zinc 46567 ugll
GW-54 nEV. 7141 For plssolvsd Analysis - submit lillered sample and wrile "D1S4 In Wock
llnrine
❑rganophosphorus Pesticides
Nl- Irnsden Pesticides
Acid_ Herbicides
PCl3's
Serrll.volatlle Organics
TPH - Diesel Range
Volatile Organics (VOA boille)
TPH - Gasoline Range
TPH - HTEX Gasolir» Range

}
DIVISION Or WATER QUALITY
Chemistry Labe ra lory Report 1 Gronud %V Oer Qna lily
COUNTY: CARTERET SAMPLE PRIORITY
QUAD NO: _ _ ID ROUTI[NE 11EMERGF.NCY
REPORTTO : WIRO Regional Office 1fl CHAIN OF CUSTODY
COLLECTOR(S) : CUIPMAN 1A
BATE: 5/27198 0 SAMPLE TYPE
TIME:
PURPOSE: Owner. RICKY LAME
LABORATORY ANALYSIS
1800310 M94,
COD }sigh 340 mIVL
COI] Low 135 mgoL
•
Culiform- MP Feted 31616 r1 1100MI
X
Coliform: MFToW 31504 41 hDorni
TOC mgll
Tu WIi y NfU
Residue., Suspended 530 mgoL
TOW Suspended solids nwx
pki units
Allurlinhy to pit 4_S mWL
Atkdinily to pit t.3 rnglL
Carbanote mgll.
--tubonale -A
". diaxide mo,
X
Chiaride 14 mglL
Chmmium: Ilex 1032 idyl.
Color . True E0 c.u.
Cyanide 720 m6el.
COMPIENTS:
Location or Site: _......�4�
Bcscriplian ofsampling point
Sampling Mclhad:
Rcmarks:
Disc Snlids 70300 330 mgA.
Ag-Silva 46566
F[rrvride 951 mgoL
Al -Aluminum 46557
Hardness: total 9W 240 nrglL
_
As -Arsenic 46551
Hardness: (nort-wh) 902 mglL
Ba-Barium 46559
Phena1s32730 ugoL.
CwCalcium46552
Specific Cond. 95 umhoslem2
C&Cadiurn 46559
Sulreu mgoL
X
Cr-Chromium46560
Sulfide 745 mgoL
X
Cu-Copper 1042
WAS MWL
X
Fe -Iron 1045
Oil Fad Clresse MSIL
Hg- Mercury 7 t900
Silica m vL
K-Foinsxium 46555
<25
42.0
1500
acres X Mg- Magocsiura 927 3,5
Formaldehyde MIX X_ Mn-Monganesc 1055 77
NN3 FAN 610 rnglL Na- Sodium 929
TKN as N 625 mF)L X Ni-Nickct '410
NOd +NOS as a 630 ingot X Pb-Lead 46564 .410
P: Toud as P 665 mWL v So -Selenium
PO4 mWL X in 2ina46567 63
Ls6 Nemher :
8C 1292
Bak Received ;
SaIM8
Time Received :
9,00 AM
Reuived By
3O
Released by :
OS
Date repartcd :
71ISMS
Organochlorine Pesticides
Organophosphoras Pesticides
Nitrogen Peslicides
Acid F[eclAcides
Semival lIn
TPH•Biesel Range
V uladle Organics (YQA bwlte)
TP1 [-Oewl ine Rangy
TP li-BT EX Gasoline Range
crt -*I"
W o
_cap
C7
tT't
� z
fr'
_ C'r
G?
lal"2wy

GITO-UN1DWATER FIELD/LAB FORM
Count
at ad I a_ 7 `" Serlal No. _
Lal.2e 'e� Long. 7C-�% ��
SAMPLE TYPE
04aler
❑ soil
❑ Other
SAMPLE PMOfiITY
13"noutino
❑ rtmergency
IJurlh [)}aroI111th
DepalIInerrl of Environment, Hoof Ih, find Nolural 11esourcas
01VISION OF WATEn fa13ALITY - GROUNDWATEn SECTION
Lab Number ��I I
Dale Flecelved�_-�- 1/--2 I-Ir
• Reed by:1=ram: 13u(
f Qillar:
Report To: ARU, FRO, MRO, RRO, WaRO�O,� III
ElChaino! Custody f� Data !;Wiry By: Cl[:
WSRO, ICfnston FO, Fed. Trust, Central Oil., Other: hale Reported:
Shipped by: Bus Juri+:r,-1-hand Del., Other
�-- Purpose: ��
Col€ector(sj �� �' Date �' T€rne -� f 8aseflne, Carlrplalrll Co111Ranc6.' I)U3 i, Pesliddo Simly, 1-ederal Trust, Other:
HELD ANALYSES Owner-
PH..o Spec. Cond.s4 at 250 C Location or slle h-
r.10 °C Cdor __ Descr€pllon of samplin )e€I31 /ve
Appearance Sampling Malhod Sample Interval
Field Analysis By: Remarks I� °`' °r
LABMRAT00Y -Af�i ALYSE r �umpinpinie, ak l°mr. qlc.�
BOD, 310 nIL
COD Fllgh 340 mg/l
T
GOD Low 335 Ingll
Coiilornt: MF Fecal31616 11001111
_
'Coll orrn: MF Total a 1604 1100r111
TOO 680 n1111
Turbldlly 76 NTU
_^
Residue., Suspendad 53o 111g11
pl-I 403 DIMS
Alkalkdly to p1.14.5 410 Ingn
_
AlkallnHy to pl-1 B.3 415 mrall
Calb011218 445 Ing_1l:
Bicarbonate 440 (nail
.Carbon dioxide 405 rngll
Cl11DIlda 940 1101
Chromium, Ilex 1032 uglf
Colors True 60 CLI
Cyanide 720 rural!
Lab Cornnlenls:
DISs, Solids 703110
-mull— -
As - Sliver 46566
u /l
•Fiaurlde 951
In_gll
AI - Allrrrllnur11413551
u11I
flardg@ss: Total pan
_runs
As - Arsenic 46551
U(M
Hardness anon -carp) 902
m_gll
13a - Barlum 46550
urL
711--f. 7774[R
11n11
1 .q - r..R1rh tin Ars59
rnnh
stllale 945 -- - - - Fyn[ If
Sulfide 745 nlral_I
1 Oil and Grease rur3/l
NH. as N s10 19r 1
TICK asJ�? � _ 1ng1L
❑ + NO, as N Dan Infill
-Cd - CadmlUr 1 46659 urL
. Cr- Cllfnnliunl 46560 lJcfll
Cu - Calm ar 46562 - u1L
J
Fe - lron 46563 uV
)•1g- Mercury 71000 Uglt
Al( - Potassium 46555 rngA
LMrr - megnsslurr146554 Fin
MIT - Malloanese 48565 u01
;No - Sodium 46558 m A
GW-54 (IEV. 719 For Dissolved Analysls - rubmll 111lared sample and wide "DIS" In block,.
Pit - Lead 46564
t n
,Se - Selenium
ufllr
211- ZInG 46567
unll
Del.,
Or onochlorine Pesticides _
Drganopflaspflorus Pesticides
Nllra;fen Pesllddes
Acid I-lerUGdes
PCB's
Selulvolallla OiganIcs
TPH - Diesel ]range
Volallla Organics (VOA botlla)
TPH - Gasollne Raring
TPH - GTEX Gosollno Range

:MEMORANDUM
DMSION OF WATER QUALITY
GROUNDWATER SECTION
January 29, 1998
To: Charles Stehrnan
Groundwater Section
Wilmington Regional Office
From: Marcus Geist -"'t~
UIC Group ·
Groundwater Section
Raleigh Central Office
Re: Request for review of an injection well permit application and routine sampling/inspection
of Mr. John Morrill's injection well in Newport, Carteret County.
1. Please review the application and submit any comments to RCO-UIC. Retain the
application for your UIC file.
2. Please inspect the injection well facility to visually determine the integrity of wellhead
construction, the presence and accessibility of effluent and influent taps, and other requirements
for compliance with the NCAC Tl5A:02C.0200 standards, using the enclosed Injection Facility
Inspection Report (form B) as a guide.
3. 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).
4. Please return any application review comments and sample and inspect the injection
well facility by February 27, 1998 (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.
cc: UIC Files
WiROFiles
Enclosures
61
h DENR
'l
•, ;JAM a5B. FIUNTiiti`F,
>1 QiOVSRNOR •!�` ��
Mr. John Morrell
115 Ricky Lane
�i14�lilelr_nrvrrK " -Newport, NC, 2 B 5 7
NORTH CAROL.INA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
❑iYISION OF WATER QUALITY
GROUNDWATER SECTION
January 13, 1998
'9�GR6�ART'r 1ady'.."rj�F.
: �, bear Mr. Morrell:
h y
;, application for a permit to construct
^ r� 4sToHNar.1� „ ,"lor injection with a heat pump system is
,�-,included is a copy of the North Carolina
- ;*. _, , I. ' tandards applicable to injection wells.
Co
'r
rya =
C-1 -
and/or use a .:ove]. i
enclosed. Also, -
Well Construction
f you have any questions regarding the permit application
lease feel free to contact me at [phone].
.: Sin - rely,
4\ Amy on, Program Manager
Underground Injection Control
} '^ Groundwater Section
lid . ti-• Y
.-. C: UIC File
=;=.enclosures
7�sx n -,I- M , s" A 7r ',-, j
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j
C:\MyF11es1Shelldocs\FIRSTAPP.WPP
*• d •}'• 'rtlf' GROUNDWATER SECTION
,,�,., �, ,� �''• � P.a BOX 29578, RALEIGN, NC 27826-0578 - 2728 CAPTTAL BLVD,, RALEIaH, NC, 276,04
rs� s PHONC O19-733-3221 FAH 919.715-a888
}- . - .y:. - , AN EQUAL OPPCkRTUNPTYIAF•FIRMATIVE ACTION Empf-eyER • 509n' RECYCLCb/tC)% POST -CONSUMER PAPER
....- R... n V .7

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT ANDIOR 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 5A715QM Wells
TO. DIRECTOR, NORTH CAROLINA DMSION OF WATER QUALITY - -
DATE: _ :Tin, I9 Qk
J
Please type or print clearly. -
A. SYSTEM CLASSIFICATION Does the proposed system re -circulate only potable f-
water without any additives such as corrosion inhibitors or antifreezes in continuous U3
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.
ND If no, then continue completing this form.
B. PERMIT APPLICANT
Name: JaIke e loYrt
Address: /%-f— [gC l L`.
City:+ e b a Y "r Zip code: 2 8s d
County:
��` Telephone:
C. PROPERTY OWNER (if different from applicant)
Name:
Address:
City: Zip code'
County: Telephone:
D. STATUS OF APPLICANT
Private:_ Federal: Commercial:
State: Public: Native American Lands:
E. FACILITY (SITE) DATA (FLU out ONLY if the Status of Owner is Federal, State, Public
or Commercial).
Name of Business or Facility:
GW-57 HP (March 1997) Page I of 4

Address: ________________________ _
City: ___________ _ Zip code: _________ _
County: _________ _ Telephone: __________ _
Contact Person: ______ _
Standard Industrial Code(s) which describe commercial facility: _______ _
F. HEAT PUMP CONTRACTOR DATA
Name: L <&n J"""" :Sea,, He.a...,-+~03 Coe,\, O ~ Se.rv \ c_e_
Address: 3 « O » c e, Y R \.I.. -r1
City: Ne w /oocT Zip code: ~8'57 0 Councy: G:u--Tev-e+
Telephone: 919-,2.;:l3 -5~.S-5 Contact Person: A LL sTi n N g.__ I I y
G. INJECTION PROCEDURE (Briefly describe how the injection well(s) will be used.)
:). " LQeJUL ~ SH ill.,u.> totl-9:-'. ~ San:, WiJ.--k,.-. T!7 /-le,a..-} (?u_wp
wo...+4--µ.,ill 6-e. re,UJr-ne..d ~ L"~ Uc.. pfp,'&j
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 X NO __ _
(b) Your personal consumption? YES __ _ NO_X.,<......."'-_
I. CONSTRUCTION DATA (CHECK ONE)
~ EXISTING 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 WELL(S) to be constructed for use as an injection
well(s). Furnish items 1-6 as P,ROPOSED construction specifications. Submit
Form GW-1 after construction.,
(1) Well Drilling Contractor's Name: _____________ _
NC Driller Registration number:
(2) ,Date to be constructed: _, __ _ Number of borings: ____ _
Approximate depth of each boring: _____ feet
(3) Well casing: Is the well(s) cased?
(a) YES v' If yes, then provide casing information below.
Casing type: Galvanized steel V"'Black steel_ Plastic_
-Other (specify) ________ _
Casing depth: from. ___ to/S-D ft. (reference to land surface)
Casing extends above ground __ inches
(b) 1'0 ~
GW-57 HP (March 1997) Page 2 of 4
(4) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement; Bentonite_; Other (specify)
(b) Grouted surface and grout depth (reference to land surface):
around closed -loop piping; from to ft.
around well casing; from to ft.
(5) Screens (if applicable):
(a) Depth: From to I_5V feet below ground surface
(5) 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 be a faucet on:
(a) the influent line? yes�o____ (b) on the effluent line?yes no
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR ETI'HER DUSTING OR
PROPOSED WELLS IF THI5 INmmvIAT10N L5 UNAVAILABLE BY OTHER MEANS.
J. PROPOSED OPERATING DATA
(a) Injection rate: Average (daily) t gallons per minute (gpm)
(b) Injection volume: Average (daily) - dD Gallons per day (gpd)
(c) Injection pressure: Average (daily) (psi)
(d) Injection temperature: Annual Average ° F.
K. INJECTION FLUID DATA
(1) fluid Source. If underground, From what depth, formation and type of
rock/sediment unit will the fluid be drawn(e.g., granite, limestone, sand).
Depth: , � Formation: _ __ __ Rock unit:
(a) SOURCE WELL CONSTRUCTION INFORMATION (if different from injection well).
Attach a copy of Form GW-I (Well Construction Record). If Form GW-I 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 ; Total hardness ppm (parts per million or mgll};
Iron ppm-, Chioride ppm; Nitrate _ ppm;
Coliform bacteria counts/100m1
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, HealLh, and Natural Resources.
L. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the (1) injection
equipment, and (2) exterior pipinz/tubina associated with the injection
operation. The manufacturer's brochure, if detailed, should satisfy (1).
GW-57 HP (March 1997) Paec 3 of 4

M. LOCATION OF WELL(S) Attacb two naps
(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 trap 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 tinder 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
appurtenances in accordance with the approved specifications and conditions of she
Permit"
{Signattre of Owner or Authorized Agent}
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 Construction Standards
(Title I5A NCAC Subchapter 2C .0200)
(Signature of Property Owner if Different From Applicant)
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])
GW-57 HP (March 1997) Pale 4 of 4

� UNITED PATES:
DEPARTMENT OF THE INTERIOR'
GEOLOGICAL SURVEY
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NCDENR
JAMes B. HUNTER.
G.VERNOR
'WAYNE McDEVfTT
SECRETARY
,,A. PREBTON RMARb,
JR., PE.
DfREc7oR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
GROUNDWATER SECTION
January 29, 1998
Mr. John Morrill
115 Ricky Lane
Newport, NC 28570
� one 11
DIVISION OF WATER QUALITY
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 Amy Axon at [phone].
Sincerely,
r
Marcus A. Geist
Underground Injection Control Program
cc: UIC Files
GROUNDWATER SECTION
P.Q Box 29578, RALEIGFf, NC 27626-0578 - 2728 CAPITAL 81-VO., RALEfGH, NC, 27604
PHONE [phone] FAX 919-71 S-DS88
AN EQUAL DPPGRTUNITY 1AFFIRMATfVE Ac71aN EMPLOYER • 50% RECYCLED/10 POST -CONSUMER PAPER

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