WI0800168_GEO THERMAL_20200515

DocuSign Envelope ID: 6EEFD8FO-AB6F-4AA4-9AA1-CEA7ABE75244
ROY COOPER
Governor
MICHAELS. REGAN
Secretary
S. DANIEL SMITH NORTH CAROLIN A
En vironmental Quality Director
Ryan & Clare Karasek
421 W. Blackbeard Road
Wilmington, NC 28409
June 15, 2020
Subject: Geothermal well sampling results
Permit Number WI0800168
New Hanover County
Dear Mr. & Mrs. Karasek:
On March 12, 2020 staff from the Division of Water Resources inspected your geothermal
underground injection well system. Samples were collected from the water supply well and the
water prior to entering the injection well. The samples were analyzed by the Division's laboratory
for coliform bacteria, total dissolved solids, metals, nitrates and other inorganic constituents. No
exceedances of the State Groundwater Standards were observed. Copies of the laboratory results
are enclosed for your review.
Should you have any questions concerning this letter, please feel free to contact me at (910) 796-
7215 or by email at [e-mail].
Enclosure: sample results
Sincerely,
~:;~
G CJl)7,.1;;1515P3B417 ... eorr Keg1ey
DWR -Water Quality Regional Operations Section
Wilmington Regional Office
cc: Shristi Shresta, DWR Central Office
DWR -Laserfiche
Nor th caroli na Depa rtment of £:.nvl ronm ental Qu a lit y I Div is ion of Wat"r Resources
Wllmington Regional Office I 127 Cardinal Or!v" Extension I Wilm ington, North Carolina 28405
910.7%.7215
AC73627 North Carolina Division of Water Resources Water Sciences Section Laboratory Results
Loe. Descr.: Wl0800168 LOUGHER E Sample ID : AC73627
County: New Hanover Collector: GKEGLEY VisitlD PO Number#
Region : Wilmington Report To WIRO Location ID : WIRO NLC Date Received: 03/13/2!!20
River Basin Collect Date: 03/12/2020 Priority ROUTINE Time Received: 08:30
Emergency Collect Time: 14:15 Sample Matrix: GROUNDWATER Labworks LoginlD TASCENZ01
COC Yes/No Sample Depth Loe. Type: WATER SUPPLY Delivery Method NC ~21!!:iir
Final Report Date: 6/12/20
Report Print Date: 06/12121!20
Final Re~ort
ff this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
Result/ Units Method Anal:isis
GAS# Anal~e Name PQL Qualifier Reference Date Validated~
LAB
Sample temperature at receipt by lab 0.3 ·c 3/13/20 MSWIFT
MIC
Coliform, MF Fecal in liquid 1 1 B2,Q1 CFU/100ml SM 9222 D-1997 3/13/20 ESTAFFORD1
Coliform, MF Total in liquid 1 1 B2,Q1 CFU/100ml SM 9222 B-1997 3/13/20 ESTAFFORD1
NUT
14797-55-8 N02+N03 as N in liquid 0 .02 0.02 U mg/Las N EPA 353 .2 REV 2 3/19/20 MIBRAHIM1
WET
24959-67-9 Bromide 0.4 0.4 U mg/L EPA 300 .0 rev2.1 3/26/20 AWILLIAMS
16887-00-6 Chloride 1.0 70 mg/L EPA 300 .0 rev2.1 3/26/20 AWILLIAMS
16984-4B-8 Fluoride 0.4 0.4 U mg/L EPA 300 .0 rev2.1 3/26/20 AWILLIAMS
14808-79-8 Sulfate 2.0 2.0 U mg/L EPA 300.0 rev2.1 3/26/20 AWILLIAMS
Total Dissolved Solids in liquid 12 355 mg/L SM 2540 C-1997 3/18/20 AWILLIAMS
MET
7440-22-4 Ag bylCPMS 1.0 1.0 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7429-90-5 Al by ICP 50 50 U ug/L EPA 200.7 Rev4 .4 4/6/20 ESTAFFORD1
7440-36-0 Antimony by ICPMS 10 10 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7440-38-2 AsbylCPMS 2.0 2.0 U ug /L EPA 200 .8 Rev5.4 4/24/20 ESTAFFORD1
7440-38-3 Ba by ICP 10 10 U IJ g/L EPA200.7 Rev4.4 4/6/20 ESTAFFORD1
7440-41-7 Be by ICP 5.0 5.0 U ug/L EPA200.7 Rev4.4 4/6/20 ESTAFFORD1
7440-70-2 Ca by ICP 0.10 54 , mgJL EPA200.7 Rev4.4 4/6/20 ESTAFFORD1
7440-43-9 Cd by ICPMS 0.50 0.50 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7440-48-4 Cobalt by ICP 50 50 U ug/L EPA 200.7 Rev4.4 4/6/20 ESTAFFORD1
7440-47-3 Crby ICPMS 5.0 5.0 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7440-50-8 CubylCPMS 2.0 2.0 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7439-B9-6 Feby ICP 50 50 U ug/L EPA 200.7 Rev4.4 4/6/20 ESTAFFORD1
7440-09-7 Kby ICP 0.10 5.1 mg/L EPA 200.7 Rev4.4 4/6/20 ESTAFFORD1
7439-93-2 Li ICP 25 25 U ug/L EPA200.7 Rev4.4 4/6/20 ESTAFFORD1
7439-95-4 Mg by ICP 0.10 12 mg/L EPA200.7 Rev4.4 4/6/20 ESTAFFORD1
7439-96-5 Mn by ICP 10 10 U ug/L EPA200.7 Rev4.4 4/6/20 ESTAFFORD1
7439-98-7 MobylCPMS 10 10 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7440-23-5 Na by ICP 0.10 50 mg/L EPA200.7 Rev4.4 4/6/20 ESTAFFORD1
7440-02-0 Ni by ICPMS 2 .0 2.0 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7439-92-1 Pbby ICPMS 2 .0 2.0 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
77B2-49-2 Se by ICPMS 1.0 1.0 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
"Not Detected" or "U" does not indicate the sample is analyte free but that the analyte is not detected at or above the PQL.
Page 1 of3
!NC Cl)u,11{ £a6oratory Section {J?_fsufts/Sampfe Comments/Qy,a{JfierCZ)efi,nitions
Sample ID:
CAS# Anal yte Name PQL
7440-28-0 Thallium (Tl} ICPMS 2.0
7440-62-2 Vby ICP 10
7440-66-6 Zn by ICPMS 10
MIC:Fecal Coliform-82-Counts from all filters"' 0.
MIC:Fecal Coliform-Q1-Sample exceeded holding time prior to receipt at lab.
MIC:Total Coliform-82-Counts from all filters "'0.
MIC:Total Coliform-Q1-Sample exceeded holding time prior to receipt at lab.
AC73627
Result/ Method
Qualifier Units Reference
2.0 U ug/L EPA 200.8 Rev5.4
10 U ug/L EPA 200.7 Rev4.4
10 U ug/L EPA 200.8 Rev5.4
Sample Comments
WSS Chemistry Laboratory>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
Analllsis
Date
4/24/20
4/6/20
4/24/20
"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 2 of 3
Validated by
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
Anal yt e Name
:NC WW1{. La6oratary Section 'F.§su(ts/Sampfe Ccmiments/Ql}lllifari]Jefinitions
Sample ID: AC73627
PQL Qualifier Units
NCDEQ-WSS-Chemistry Lab Data Qualifiers
Method
Reference
Analysis
Date Validated by
A 1 The reported value is an average, where at least one result is qualified with a •u•. The PQL is used for the qualified result(S) to call
B 1 Coliform-Countable membranes with less than 20 colonies. Reported value is estimated or is a total of the counts on all filters repor
82 Coliform-Counts from all filters were zero. The value reported is based on the number of colonies per 100 ml that would have been
83 Coliform-Countable membranes with more than 60 or 80 colonies. The value reported is calculated using the count from the smalle:
84 Coliform-Filters have counts of both >60 or 80 and <20. Reported value is estimated or is a total of the counts on all filters reported
85 Coliform-Too many colonies were present; too numerous to count (TNTC). TNTC is generally defined as >150 colonies .
86 Coliform-Estimated Value. Blank contamination evident.
87 Coliform-Many non-coliform or non-enterococcus colonies or interfering non-coliform or non-enterococcus growth present. In this cc
881 MPN-No wells or tubes gave a positive reaction. Value based upon the appropriate MPN Index and reported as a less than "<" valu,
882 MPN-AII wells or tubes gave positive reactions . Value based upon the MPN Index and reported as a greater than ">" value .
C Total residual chlorine was present in sample upon receipt in the laboratory; value is estimated .
G 1 BOD-The dissolved oxygen (DO) depletion of the dilution water blank exceeded 0.2 mg/L.
G2 BOD-The bacterial seed controls did not meet the requirement of a DO depletion of at least 2.0 mg/Land/or a DO residual of at leai
G3 BOD-No sample dilution met the requirement of a DO depletion of at least 2.0 mg/Land/or a DO residual of at least 1.0 mg/L.
G4 BOD-Evidence of toxicity. This is generally characterized by a significant increase in the BOD value as the sample concentration de
GS BOD-The glucose/ glutamic acid standard exceeded the range of 198 ± 30.5 mg/L.
G6 BOD-The calculated seed correction exceeded the range of 0.6 to 1.0 mg/L.
G7 BOD-Less than 1 mg/L DO remained for all dilutions set. The reported value is an estimated greater than value and is calculated fo1
GB BOD-Oxygen usage is less than 2 mg/L for all dilutions set. The reported value is an estimated less than value and is calculated for
G9 BOD-The DO depletion of the dilution water blank produced a negative value.
J1 Surrogate recovery limits have been exceeded.
J2 The reported value failed to meet the established quality control criteria for either precision or accuracy.
J3 The sample matrix interfered with the ability to make any accurate determination .
J4 The data is questionable because of improper laboratory or field protocols (e.g., composite sample was collected instead of grab, p
JS Temperature limits exceeded (samples frozen or >6°C) during transport or not verifiable (e.g., no temperature blank provided): non-
J6 The laboratory analysis was from an unpreserved or improperly chemically preserved sample. The data may not be accurate.
J7 This qualifier is used to identify analyte concentration exceeding the upper calibration range of the analytical instrument/method. Th
JS Temperature limits exceeded (samples frozen or >6°C) during storage , the data may not be accurate .
J9 The reported value is determined by a one-point estimation rather than against a regression equation. The estimated concentration
J10 Unidentified peak; estimated value.
J11 The reported value is determined by a one-point estimation rather than against a regression equation. The estimated concentration
J 12 The calibration verification did not meet the calibration acceptance criterion for field parameters.
M Sample and duplicate results are "out of control". The sample is non-homogenous (e .g., VOA soil). The reported value is the lower 1
N1 Presumptive evidence and estimated value . The component has been tentatively identified base on mass spectral library.
N2 There is an indication that the analyte is present, but quality control requirements for confirmation were not met (i.e., presence of c
N3 This code shall be used if the level is too low to permit accurate quantification, but the estimated concentration is less than the labo
N4 This code shall be used if the level is too low to permit accurate quantification, but the estimated concentration is less than the labo
N5 The component has been tentatively identified based on a retention time standard.
Q1 Holding time exceeded prior to receipt by lab.
Q2 Holding time exceeded following receipt by lab.
P Elevated PQL* due to matrix interference and/or sample dilution.
S Not enough sample provided to prepare and/or analyze a method-required matrix spike (MS) and/or matrix spike duplicate (MSD).
U Indicates that the analyte was analyzed for but not detected above the reported practical quantitation limit*. The number value repo
X1 Sample not screened for this compound.
X2 Sampled, but analysis lost or not performed-field error.
X3 Sampled, but analysis lost or not performed-lab error.
V Indicates the analyte was detected in both the sample and the associated method blank . Note: The value in the blank shall not be s
Y Elevated PQL* due to insufficient sample size.
Z1 Inability to analyze the sample.
Z2 Questions concerning data reliability.
U, J6 The laboratory analysis was from an unpreserved or improperly chemically preserved sample. The data may not be accurate.
UU Indicates that the analyte was not detected by a screen analysis. The number value was determined by a one-point estimation at tt
WSS Chemistry Laboratory>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
"Not Detected" or "U" does not indicate the sample is analyte free but that the analyte is not detected at or above the PQL.
Page 3 of3
AC73626 North Carolina Division of Water Resources Water Sciences Section Laboratory Results
Loe. Oes(:r.: W1080016!! LQUGHER I Sample ID: AC73626
County: NewHj!nover Collector: Ii KEGLEY VisitlD PO Number#
Region: Wllming!on Report To WIRO Location ID: WIRO NLC Date Received: 03/13/2020
River Basin Collect Date: 03/12/2020 Priority ROUTINE Time Received: 08:30
Emergency Collect Time: 14:00 Sample Matrix: GROUNDWATER Labworks LoginlD TASCENZO1
COC Yes/No Sample Depth Loe. Type: WATER SUPPLY Delivery Method NC Courier
Final Report Date: 6/12/20
Report Print Date: 06/12/2020
Final Re~ort
If this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
Result/ Units Method Anal}!sis
CAS# AnaMe Name POL Qualifier Reference Date Validated bl,'.
LAB
Sample temperature at receipt by lab 0.3 ·c 3/13/20 MSWIFT
MIC
Coliform, MF Fecal in liquid 1 4 B1,Q1 CFU/100ml SM 9222 D-1997 3/13/20 ESTAFFORD1
Coliform, MF Total in liquid 1 1 B2,Q1 CFU/100ml SM 9222 B-1997 3/13/20 ESTAFFORD1
NUT
14797-55-8 N02+N03 as N in liquid 0.02 0.02 U mg/Las N EPA 353.2 REV 2 3/19/20 MIBRAHIM1
WET
24959-67-9 Bromide 0.4 0.41 mg/L EPA 300 .0 rev2 .1 3/26/20 AWILLIAMS
16887-00-6 Chloride 1.0 70 mg/L EPA 300.0 rev2.1 3/26/20 AWILLIAMS
16984-48-8 Fluoride 0.4 0.4 U mg/L EPA 300.0 rev2.1 3/26/20 AWILLIAMS
14808-79-8 Sulfate 2.0 2.0 U mg/L EPA 300.0 rev2.1 3/26/20 AWILLIAMS
Total Dissolved Solids in liquid 12 336 mg/L SM 2540 C-1997 3/18/20 AWILLIAMS
MET
7440-22-4 Ag by ICPMS 1.0 1.0 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7429-90-5 Al by ICP 50 50 U ug/L EPA200.7 Rev4.4 4/6120 ESTAFFORD1
7440-36-0 Antimony by ICPMS 10 10 U ug/L EPA 200 .8 Rev5.4 4/24/20 ESTAFFORD1
7440-38-2 As by ICPMS 2.0 2.0 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7440-38-3 Ba by ICP 10 10 U ug/L EPA 200.7 Rev4.4 4/6/20 ESTAFFORD1
7440-41-7 Be by ICP 5.0 5.0 U ug/L EPA 200.7 Rev4.4 4/6/20 ESTAFFORD1
7440-70-2 Ca by ICP 0.10 53 mg/L EPA 200. 7 Rev4.4 4/6/20 ESTAFFORD1
7440-43-9 Cd by ICPMS 0.50 0.50 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7440-48-4 Cobalt by ICP 50 60 U ug/L EPA 200. 7 Rev4.4 4/6/20 ESTAFFORD1
7440-47-3 Crby ICPMS 5.0 5.0 U ug/L EPA 200.8 Rev5.4 4/24120 ESTAFFORD1
7440-50-8 Cu bylCPMS 2 .0 2.0 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7439-89-6 Feby ICP 50 50 U ug/L EPA 200.7 Rev4 .4 4/6/20 ESTAFFORD1
7440-09-7 Kby ICP 0.10 5.1 mg/L EPA 200.7 Rev4.4 4/6/20 ESTAFFORD1
7439-93-2 Li ICP 25 25 U ug/L EPA200.7 Rev4.4 4/6/20 ESTAFFORD1
7439-95-4 Mg by ICP 0.10 12 mg/L EPA 200.7 Rev4.4 4/6/20 ESTAFFORD1
7439-96-5 Mn by ICP 10 10 U ug/L EPA 200. 7 Rev4.4 4/6/20 ESTAFFORD1
7439-98-7 Moby ICPMS 10 10 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7440-23-5 Na by ICP 0.10 49 mg/L EPA200.7 Rev4.4 4/6/20 ESTAFFORD1
7440-02-0 Ni by ICPMS 2 .0 2.0 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7439-92-1 Pb by ICPMS 2~0 2.0 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
7782-49-2 Se by ICPMS 1.0 1.0 U ug/L EPA 200.8 Rev5.4 4/24/20 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone]
"Not Detected" or "U" does not indicate the sample is analyte free but that the analyte is not detected at or above the PQL.
Page 1 of 3
:NC (l)'Wl{_ La6oratory Section <R.§su{ts/Sampfe Comments/Qua{ifierWefinitians
Sample ID:
CAS# Analyte Name PQL
7440-28-0 Thallium {Tl) ICPMS 2.0
7440-62-2 Vby ICP 10
"7440-66-6 Zn by ICPMS 10
MIC:Fecal Coliform-81-Counts from all filters <20.
MIC:Fecal Coliform-Q1-Sample exceeded holding time prior to receipt at lab.
MIC:Total Coliform-82-Counts from all filters = 0.
MIC:Total Coliform-Q1-Sample exceeded holding time prior to receipt at lab.
AC73626
ResulU Method
Qualifier Units Reference
2.0 U ug/L EPA 200.8 Rev5.4
10 U ug/L EPA200.7 Rev4.4
10 U ug/L EPA 200.8 Rev5.4
Sample Comments
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
AnalJlsis
Date
4/24/20
4/6/20
4/24/20
"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 2 of 3
Validated by
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
CAS#
A1
B1
B2
83
B4
B5
B6
B7
BB1
882
C
G1
G2
G3
G4
GS
G6
G7
GB
G9
J1
J2
J3
J4
J5
J6
J7
JS
J9
J10
J11
J12
M
N1
N2
N3
N4
N5
Q1
Q2
p
s
u
X1
X2
X3
V
y
Z1
Z2
u, J6
uu
AnalyteName
!NC ®u,/1{ La6oratory Section <J?Jsu{ts/Sampfe Comments/Quafifier®efinitions
Sample ID : AC73626
PQL Qualifier Units
NCDEQ-WSS-Chemistry Lab Data Qualifiers
Method
Reference
Analysis
Date Validated by
The reported value is an average, where at least one result is qualified with a "U". The PQL is used for the qualified result(S) to cal1
Coliform-Countable membranes with less than 20 colonies. Reported value is estimated or is a total of the counts on all filters repor
Coliform-Counts from all filters were zero. The value reported is based on the number of colonies per 100 ml that would have been
Coliform-Countable membranes with more than 60 or 80 colonies. The value reported is calculated using the count from the smalle:
Coliform-Filters have counts of both >60 or 80 and <20. Reported value is estimated or is a total of the counts on all filters reported
Coliform-Too many colonies were present; too numerous to count (TNTC). TNTC is generally defined as >150 colonies.
Coliform-Estimated Value . Blank contamination evident.
Coliform-Many non-coliform or non-enterococcus colonies or interfering non-coliform or non-enterococcus growth present. In this cc
MPN-No wells or tubes gave a positive reaction . Value based upon the appropriate MPN Index and reported as a less than "<" valu,
MPN-AII wells or tubes gave positive reactions. Value based upon the MPN Index and reported as a greater than ">" value .
Total residual chlorine was present in sample upon receipt in the laboratory; value is estimated .
BOD-The dissolved oxygen (DO) depletion of the dilution water blank exceeded 0.2 mg/L.
BOD-The bacterial seed controls did not meet the requirement of a DO depletion of at least 2.0 mg/Land/or a DO residual of at leai
BOD-No sample dilution met the requirement of a DO depletion of at least 2.0 mg/Land/or a DO residual of at least 1.0 mg/L.
BOD-Evidence of toxicity. This is generally characterized by a significant increase in the BOD value as the sample concentration de
BOD-The glucose/ glutamic acid standard exceeded the range of 198 ± 30.5 mg/L.
BOD-The calculated seed correction exceeded the range of 0.6 to 1.0 mg/L.
BOD-Less than 1 mg/L DO remained for all dilutions set. The reported value is an estimated greater than value and is calculated fo1
BOD-Oxygen usage is less than 2 mg/L for all dilutions set The reported value is an estimated less than value and is calculated for
BOD-The DO depletion of the dilution water blank produced a negative value.
Surrogate recovery limits have been exceeded .
The reported value failed to meet the established quality control criteria for either precision or accuracy.
The sample matrix interfered with the ability to make any accurate determination.
The data is questionable because of improper laboratory or field protocols (e.g., composite sample was collected instead of grab, p
Temperature limits exceeded (samples frozen or >6°C) during transport or not verifiable (e.g., no temperature blank provided): non-
The laboratory analysis was from an unpreserved or improperly chemically preserved sample . The data may not be accurate.
This qualifier is used to identify analyte concentration exceeding the upper calibration range of the analytical instrument/method. Th
Temperature limits exceeded (samples frozen or >6°C) during storage, the data may not be accurate.
The reported value is determined by a one-point estimation rather than against a regression equation. The estimated concentration
Unidentified peak; estimated value.
The reported value is determined by a one-point estimation rather than against a regression equation. The estimated concentration
The calibration verification did not meet the calibration acceptance criterion for field parameters .
Sample and duplicate results are "out of control". The sample is non-homogenous (e.g., VOA soil). The reported value is the lower,
Presumptive evidence and estimated value. The component has been tentatively identified base on mass spectral library.
There is an indication that the analyte is present, but quality control requirements for confirmation were not met (i.e., presence of c
This code shall be used if the level is too low to permit accurate quantification, but the estimated concentration is less than the labo
This code shall be used if the level is too low to permit accurate quantification, but the estimated concentration is less than the labo
The component has been tentatively identified based on a retention time standard.
Holding time exceeded prior to receipt by lab.
Holding time exceeded following receipt by lab.
Elevated PQL • due to matrix interference and/or sample dilution .
Not enough sample provided to prepare and/or analyze a method-required matrix spike (MS) and/or matrix spike duplicate (MSD).
Indicates that the analyte was analyzed for but not detected above the reported practical quantitation limit*. The number value repo
Sample not screened for this compound .
Sampled, but analysis lost or not performed-field error.
Sampled, but analysis lost or not performed-lab error.
Indicates the analyte was detected in both the sample and the associated method blank . Note : The value in the blank shall not be s
Elevated PQL* due to insufficient sample size.
Inability to analyze the sample .
Questions concerning data reliability.
The laboratory analysis was from an unpreserved or improperly chemically preserved sample . The data may not be accurate.
Indicates that the analyte was not detected by a screen analysis . The number value was determined by a one-point estimation at tt
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
"Not Detected" or "U" does not indicate the sample is analyte free but that the analyte is not detected at or above the PQL.
Page 3 of 3
ROY COOPER
Governor
MICHAELS. REGAN
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
March 25, 2020
Ryan & Clare Karasek
421 W. Blackbeard Rd.
Wilmington, NC 28409
Re: Issuance of Injection Well Permit
PermitNo.WI0800168
Geothermal Heating/Cooling Water Return Well
New Hanover County
Dear Mr. and Mrs. Karasek:
vv2-o-~oof68
In accordance with your permit renewal application received February 13, 2020, I am forwarding
Permit No. WI0800168 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
February 28, 2025, and shall be subject to the conditions and limitations stated therein.
Please Note:
• Samples from the influent and effluent sampling ports of your geothermal well system
were collected on March 11, 2020. 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'
North Carolina Department of Environmental Quality I Division of Water Resources
512 North SaUsbury Street I 1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919.707.9000
cc: Morella Sanchez-King, Geoff Kegley, Wilmington Regional Office
Central Office File, WI0800168
New Hanover County Enviromnental Health Department
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Ryan & Clare Karasek
New Hanover County
FOR THE CONTINUED OPERATION OF TWO (2) GEOTHERMAL HEATING/COOLING WATER
RETURN WELL(S), defined in Title 15A North Carolina Administrative Code 2C .0224, which will be used for
the injection of heat pump effluent. This injection well is located at 421 W. Blackbeard Rd., Wilmington, NC
28409, and will be constructed and operated in accordance with the application received February 13, 2020, and
conformity with the specifications and supporting data, all of which are filed with the Department of
Environmental Quality.
This permit is for continued operation of injection wells and shall be in compliance with Title l SA 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 March 25, 2020 until February 28, 2025, and shall be subject
to the specified conditions and limitations stated therein.
Permit issued this the 25 th day of March 2020.
if-=
For S. Daniel Smith
Director, Division of Water Resources
Permit WI0800168
By Authority of the Environmental Management Commission.
Permit #WI0800168 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
Page 1 of5
PART I -PER.i'\HT GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is grounds
for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [15A NCAC 02C .0224(b)].
3. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data [15A NCAC 02C .021 l(e)].
4. This permit is not transferable without prior notice to, and approval. In the event there is a desire for the
facility to change ownership, or there is a name change of the Permittee, a formal permit amendment request
must be submitted, including any supporting materials as may be appropriate, at least 30 days prior to the
date of the change [15A NCAC 02C .021 l(o)].
5. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, .which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met [15A NCAC 02C .0203].
PART II -WELL CONSTRUCTION GENERAL CONDITIONS
1. The well supplying water for the geothermal heating and cooling system shall be constructed in accordance
with requirements of rule 15A NCAC 02C .0107.
2. Any injection well shall be constructed in accordance with requirements of rule 15A NCAC 02C .0107
except that the entire length of the casing shall be grouted in such a way that there is no interconnection of
aquifers or zones having differences in water quality that would result in degradation of any aquifer or zone.
For screened wells, grout shall be emplaced from the top of the gravel pack to the land surface. For open-
end wells, the casing shall be grouted from the bottom of the casing to the land surface [15A NCAC 02C
.0224(d)(2), (3)].
3. Bentonite grout shall not be used to seal any water-bearing zone with a chloride concentration equal to or
greater than 1,500 milligrams per liter. In areas where elevated chloride levels are known to exist or are
probable, such as coastal areas, chloride levels shall be verified in the field to determine existing conditions
if bentonite is to be used [15A NCAC 02C .0225(h)(8)].
4. The injection well system shall be constructed such that a sampling tap or other collection equipment
approved by the Director provides a functional source of water when the system is operational. Such
equipment shall provide the means to collect a water sample immediately after emerging from the water
supply well and immediately prior to injection into the return well [15A NCAC 02C .0224(d)(4)].
5. Each injection well shall be secured to reasonably insure against unauthorized access and use and shall be
sealed with a watertight cap or well seal, as defined in G.S. 87-85(16).
6. Each geothermal injection well shall have permanently affixed an identification plate according to [15A
NCAC 02C .01070)(2)].
Permit #WI0800168 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
Page 2 of5
7. A copy of the Well Construction Record (Form GW-1) shall be submitted as described in Part V.5 of this
permit within 30 days after completion.
PART III-OPERATION AND USE CONDITIONS
1. The Permittee shall comply with the conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and rules of 15A NCAC 02C .0200, even
if compliance requires a reduction or elimination of the permitted activity [15A NCAC 02C .021 l(i)].
2. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface water
or groundwater resulting from the operation· of this facility. In the event that the facility fails to petfonn
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, such as the repair, modification, or abandonment of the injection facility [ 15A NCAC
02C .0206].
PART IV -INSPECTIONS [15A NCAC 02C .021 l(j)]
1. Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, 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 and appropriate samples associated with the injection
facility's activities.
PART V -MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction, repair, or abandonment shall be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on-site and available for inspection [15A NCAC
02C .0224(f)(2), (4)].
2. Monitoring of any well may be required to ensure protection of the groundwater resources of the State and
compliance with the groundwater quality standards specified in 15A NCAC 02L [15A NCAC 02C
.0224(f)(l )].
3. The Permittee shall report any report any monitoring or other information that indicates noncompliance
with a specific permit condition, that a contaminant may cause the injected fluids to migrate outside the
approved injection zone or area. As specified in rule 15A NCAC 02C .021 l(p), noncompliance notification
shall be as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge· of the
occurrence, to the Wilmington Regional Office, telephone number 910-350-2004.
Permit #WI0800168 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
Page 3 of5
(B) Written notification shall be made within 5 (five) days of the occurrence and submitted to the
addresses in Item #5 below.
(C) The written notification shall contain a description of the noncompliance and its cause; the period
of noncompliance, including dates and times; if the noncompliance has not been corrected, the
anticipated time it is expected to continue; and any steps taken or planned to reduce, eliminate, and
prevent reoccurrence of the noncompliance.
4. The Permittee shall record the number and location of the wells with the register of deeds in the county in
the facility is located [15A NCAC 02C .0224(t)(3)].
5. All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff
Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
And
Water Quality Regional Operations Section
DWR Wilmington Regional Office
127 Cardinal Drive
Wilmington, NC 28405
PART VI-PERMIT RENEWAL [15A NCAC 02C .0224(c)].
As required by rule, and application for permit renewal shall be made at least 120 days prior to the expiration of
this permit. This permit condition does not apply if the Permittee chooses to discontinue operation of the well
for injection of effluent from the geothermal heating and cooling system associated with this permit.
PART VII-CHANGE OF WELL STATUS [15A NCAC 02C .0240].
1. Procedures for temporarily or permanently abandoning a well are the same as those specified in rule 15A
NCAC 02C .0113. While some of those criteria are given below, the Permittee bears the responsibility of
complying with all applicable regulatory requirements.
2. If a well will no longer be used for any purpose, then it should be permanently abandoned according to rule
15A NCAC 02C .0113(b) in order to prevent the well from deteriorating and acting as a source or conduit
of contamination, which is prohibited by General Statute 87-88(c).
3. If a well is taken completely out of service temporarily, the Permittee shall install a water-tight cap or well
seal that cannot be removed without the use of hand or power tools.
4. When injection operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.Ol 13(b), which include, but are not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if any
such removal will not be responsible for, or contribute to, the contamination of an underground
source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to ensure freedom from
obstructions that may interfere with sealing operations.
Permit #WI0800168 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
Page 4 of5
(C) Each well shall be thoroughly disinfected, prior to sealing, in accordance with rule 15A NCAC
02C .011 l(b)(l)(A), (B), and (C).
(D) Each well shall be completely filled with cement grout, which shall be introduced into the well
through a pipe which extends to the bottom of the well and is raised as the well is filled.
(E) In those cases when a subsurface cavity has been created as a result of the injection operations,
each well shall be abandoned in such a manner that will prevent the movement of fluids into or
between underground sources of drinking water.
(F) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in 15A
NCAC 2C .0224(f)( 4) within 30 days of completion of abandonment to the addresses specified
in Part V.5 above.
Permit #WI0800168 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
Page 5 of5
WATER Q UALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW RE QUEST FORM
Date: February 17, 2020
To: Morella Sanchez-King
From: Shristi Shrestha, WQROS -Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
Permit Number: WI0800168
A. Applicant: Ryan & Clare Karasek
B. Facility Name:
C. A pplication:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal
E. Comments/Other Information:
__ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action . Within 30 calendar days, please return a completed W OROS Staff
Report.
When you receive this request form , please write your name and dates in the spaces below, make a copy of
this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact person
listed above.
RO-WOROS Reviewer: __________________ Date: _____ _
COMMENTS:
NOTES:
FORM: WQROS-ARR ver. 092614 Page 1 of 1
ROY COOPER
Governor
MICHAELS. REGAN
Secretary
LINDA CULPEPPER
Dtn?ctor
NORTH CAROLINA
EnvlronmentalQuallty
Ryan & Clare Karasek
421 W. Blackbeard Road
Wilmington, NC 28409
February 17, 2020
RE: Acknowledgement of Application No. WI0800168
Geothermal Heating/Cooling Water Return Well
New Hanover County
Dear Mr. & Mrs. Karasek:
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit application and supporting documentation received on February 13, 2020. 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 919-707-3662 or email at [e-mail].
cc: Wilmington Regional Office, WQROS
Permit File WI0800168
Sincerely,
For Rick Bolich, Chief
Ground Water Resources Section,
NCDEQ Division of Water Resources
North Carolina Department of Environmental QuaUty I Division of Water Resources
512 North Salisbury Street I 1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919.707.9000
North Carolina Department of Environmental Quality -Division of Water Resources
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION'WELi(S)
In Accordance With the Provisions of 15A NCAC 02C .0224 FEB 13
GEOTHERMAL HEATING/COOLING WATER RETURN WELL (S)
These well(s) inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
CHECK ONE OF THE FOLLOWING:
__ New Application ___)(_ Renewal* __ Modification __ Permit Rescission Request*
*For Permit Renewals or Rescission Request, complete Sections A thru E . and M (signature page) only
Print or Type Information and Mail to the Address on the Last Page. Illegible Applications Will Be Returned As Incomplete.
DATE: ~/1 ;i.../ ,20 ;i..,D PERMIT NO. w~o%DO 1b(?eaveblankifNewApplication)
7 J
A. CURRENT WELL USE & OWNERSHIP STATUS (Leave Blank if New Well/Permit Application)
1. Current Use of Well
a. I wish to continue to use the well as ~ Geothermal Well D Drinking Water Supply Well
D Other Water Supply Use-Indicate use (i.e., irrigation, etc.) ________ _
b. Terminate Use: If the well is no longer being used as a geothermal injection well and you wish to
rescind the permit, check the box below. If abandoned, attach a copy of the Well Abandonment
Record (GW-30).
0 Yes, I wish to rescind the permit
2. Current Ownership Status
Has there been a change of ownership since permit last issued? ~YES D NO
If yes, indicate N. ew Owner's contact inform~ion:
Name(s) 11,v,11,,_ \" A...r6....').-~ 1, /J
Mailing Address: 1.,,./)... v.J I D ( ~ e,\L be..~ J R J
City: \J r l ~. c'.,..,,r 1 State: ;JC-zip Code: ,;;,-.R-'-j t9 I County: ec..J l~ <2-/'
Day Tele No.: si ") .. ?.l/~-\ 6 ~ j Email Address.: cy tJ...17 • J. ¥i ~ @'}~/
B. STATUS OF APPLICANT (choose one)
Non-Government: Individual Residence JQ_ Business/Organization __
Government: State Municipal__ County__ Federal
C. WELL OWNER(S)/PERMIT APPLICANT -For single family residences, list all persons listed on the
property deed. For all others, _l~t name of business/agency and name of person and titlf with delegated authority
to sign: fr ~ y:-,cu-.,__s-e_k
7
c.... I It_ re_ lL-A./ ...... '"e..11t..
Mailing Address: 1' ,-.J w c.. )c. J JI .
C..-:a,V'\..,.
City: W ~-State: /J L-zip Code: ).8-3/ f) ? County: ~c,v' ,l/
Day Tele No.: 5/ -1 o/ > · °S 6 3, 7 Cell No.: ,5 ~
EMAIL Address: r r;wt1 , J , 14..n<-'?e_k f ;,.,t{i.f /,t...e~ax No.: /V t2_ I ) I
Geothennal Water Return Well Pennit Application Rev. 4-15-2016 Page 1
D. WELL OPERA TOR (if different from well owner) -For single family residences, list all persons listed on
the property deed . For all others, list name business/agency and name of person and title with delegated authority
to sign: ------~s'-· -~----------------------
Mailing Address:--------------------------------
City: ____________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: Email Address.:
E. PHYSICAL LOCATION OF WELL(S) SITE .. 'jl 1
(1) Parcel Identification Number (PIN) of well site: f A 10 l 8' 'f 7'. 0 5' / County: fW W ,~Q../\.lhl !/'
(2) Physical Address (if different than mailing address):--~':?'--~------'---------
City: _____________ County _________ Zip Code: ____ _
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name: _________________________ _
NC Well Drilling Contractor Certification No.: ____________________ _
Company Name:, _______________________________ _
Contact Person_~; _______________ EMAIL Address:. ___________ _
Address:----------------------------------
City: __________ Zip Code: _____ State: __ County: _________ _
Office Tele No.: Cell No .: Fax No.:. ________ _
G. HV AC CONTRACTOR INFORMATION (if different than driller)
HV AC Contractor's Name: ___________________________ _
NC HVAC Contractor License No.: ________________________ _
Company Name: _______________________________ _
Contact Person.~: --------------~EMAIL Address: __________ _
Address:----------------------------------
City: __________ Zip Code: ____ State: __ County: _________ _
Office Tele No.: Cell No.: _________ Fax No.: ______ _
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES ----NO ___ _
YES ___ _ NO ___ _
I. WELL CONSTRUCTION REQUIREMENTS-As specified in 15A NCAC 02C .0224(d ):
( 1) The water supply well shall be constructed in accordance with the water supply well requirements of
15A NCAC 02C .0107 .
(2) If a separate well is used to inject the heat pump effluent, then the injection well shall be constructed
in accordance with the water supply well requirements of 15A NCAC 02C .0107 , except that:
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page2
(a) For screen and gravel-packed wells, the entire length of casing shall be grouted from the top
of the gravel pack to land surface;
(b) For open-end wells without screen, the casing shall be grouted from the bottom of the casing
to land surface.
(3) A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
____ *EXISTING WELLS ____ PROPOSED WELLS
*For existing wells, please attach a copy of the Well Construction Record (Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
(c)
(d)
•Casing depth below land surface
Casing height "stickup" above land surface f-.
(e) Grout material(s) surrounding casing and depth below land surface
1 3 2020
Note: bentonite grouts are prohibited for sealing water-bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .0107C0(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. OPERATINGDATA
(1) Injection Rate: Average (daily) gallons per minute (gpm).
(2) Injection Volume: Average (daily) gallons per day (gpd).
(3) Injection Pressure: Average ( daily) pounds/square inch (psi).
(4) Injection Temperature: Average (January) ° F, Average (July) __ ° F.
L. SITE MAP-As specified in 15A NCAC 02C .0224{b)(4 ), attach a site-specific map that is scaled or otherwise
accurately indicates distances and orientations of the specified features from the injection well(s). The site map shall
include the following:
(1) All water supply wells, surface water bodies, and septic systems including drainfield, waste
application area, and repair area located within 250 feet of the injection well(s).
(2) Any other potential sources of contamination listed in 15A NCAC 02C .0107 (a)(2 ) located within 250
feet of the proposed injection well(s).
(3) Property boundaries located within 250 feet of the parcel on which the proposed injection well(s) are
to be located.
(4) An arrow orienting the site to one of the cardinal directions (north, south, west, or east)
-;.;n
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page3
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
M. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC s?^r` .t?2 ? 1 r c y requires that all permit applications shall be signed as follows:
I . for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3_ for a municipality or a state, federal, or other public agency: by either a principal executive officer
or ranking publicly elected official;
4. for all others: by all the person[ s listed on the property deed.
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"1 hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information, I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved speci ,rations and conditions of the
Permit."
Signs of Property Owner/ pplicant
Print or Type Full Name and Title
Signature of Property Owner/Applicant
I a.s 11'r„S�
Print or Type Full Name and Title
Signature of Authorized Agent, if any
Print or Type Full Name and Title
Submit two copies of the completed application package to:
Division of Water Resources - UIC
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 4

North Carolina Department of Environmental Quality
Division of Water Resources
PERMIT NAME/OWNERSHIP CHANGE APPLICATION FORM
I. INSTRUCTIONS
1. Complete this form in its entirety as follows:
(a) Change of Ownership — Provide the information in Parts 11 and III and submit legal documentation of the
transfer of ownership such as a contract, deed, article of incorporation, etc. The certifications in part IV
must be signed by both the current permit holder, if available, and the new applicant(s).
(b) Name Chaiwe Only — Provide the information in Parts 1I and III. Sign the certification for the new
applicant in part IV.2.
2. Submit the properly completed form to the address on bottom of Page 2.
H. CURRENT PERMIT INFORMATION
1. Permit Number: (/J Q fj 0 c I los-
2. Permittee name(s): 1 u.f-1 ) -' / - V C ei--5
3. For Business/Governmental Agency- Permit signing official's name and title:
(Person legally responsible for permit)
4. Mailing Address: ') 14_L L e -/ R 1
City: R.) i I +-u i` 07 4 State: 6- Zip: 4i n
Telephone number: (<f ]) 9 C-r 3 j 7Fax number: ( )
yr' y + . j. 1C-,c ..5e -. L.
5. Physical Address of Well(s) (if different than mailing address)
EMAIL Address:
City: County_ Zip:
III. NEW OWNER 1 NAME INFORMATION
1. This request for a permit change is a result of:
(� a. Change in ownership of property/company
b. Name change only
c. Other (please explain):
bL1 13 2010
Permit/Name Change of Ownership Form Rev. 3-1-20 1 6 Page 1

2. New Owner's name(s) as listed on the property deed (Please Print/or Type):
1 c 1 (c-
3, If Business or Governmental Agency- Permit signing official's name and title:
(Person legally responsible for permit)
4. Mailing Address: II; / W ^ -6 (te c LI)e -,/ k e
City: 1./L' + 1 K-1- f' �,• i1-' .-`7 State; - Zip: 2-1/Cl
Day/Cell Phone No. (5 It > -' k, S ? Fax number: ( )
EMAIL Address: ( yo---t . `• jL `� a 4 if EMAIL -t
ITV. CERTIFICATION
1. Current Perrnittee's Certification (Please print or type):
1, , attest that this application for name/ownership change has been reviewed
and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included,
this application package will be returned as incomplete. I understand I will continue to be responsible for
compliance with the current permit until a new permit is issued.
2. New Applicant(s)'s Certification (Please printpr type):
UWe, , attest that this application for
name/ownership change has been reviewed and is accurate and complete to the best of my knowledge. I
understand that if all required parts of this application are not completed and that if all required supporting
information and attachments are not included, this application package will be returned as incomplete. 1 further
certify that I will operate and maintain the perryitted facility in accordance with the permit and related regulatory
requirements.
--`-- Date:
Signature:
Signature: L.ti
(1)64(44-
Date: -;. ! (� 1 a oDD
SUBMIT THE COMPLETE APPLICATION PACKAGE VIA ONE OF THE FOLLOWING METHODS:
U.S. Postal Service:
Water Quality Regional Operations Section
NC Division Of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
Courier / Special Delivery / In Person:
Water Quality Regional Operations Section
NC Division Of Water Resources
512 North Salisbury Street
Raleigh, NC 27604
TELEPHONE NUMBER: [phone]
Permit/Name Change of Ownership Form Rev. 3-1-2016
Page 2

U.S. Postal Service
CERTIFIED MAIL' RECEIPT
Domestic Mail Only
For delivery information, visit our website at Www.usps.comj'.
-riffled Mall Fee
'tra rvicasg eesbocadd lee maippe tit
rL ] Return Receip, Qterv.opy}
D J Return Receipt *wreak) k) S.
• Carrmael Mph Restricted Delivery S
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17 ▪ ,otal Postage E
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Ryan & Clare Karasek
421 W Blackboard Rd.
Wilmington, NC 28409
6
Postmark
Hero
SENDER: COMPLETE THIS SECTION
• Complete items 1, 2, and-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 mailpiece,
or on the front if space permits.
1. Article Addressed to:
Rya.- IL Clare Karasek
421 L'i Blackboard Rd.
Wilmington, NC 28409
11111111
111
11111
11111 NI II 11111111
9590 9402 3665 7335 1023 48
COMPLETE THIS SECTION ON DELII EiiY
A. Signature
XA.
B. Received by (Printed Name)
l7 Agent
Addressee
C. Date of Delivery
D. Is de#fvery address different from item 1? D Yes
if YES, enter delivery address below 0 No
FEB gala
2. MIcle Number (Pansferfroraservice label)
7015 06411 0E07 9832 5029
vuuy eu rm3 1'SN 1530-02-00R-9053
3., Service Typo 0 Priority Mall Express®
Adult Signature 0 Registered Mail,"
Aduft Signature Restricted Delivery t7 Registered Mall Restricted
Certified Man Delivery
O Certified Mall Restricted Delivery A Return Receipt for
LI Collect en Delivery / Merchandise
❑ Collect on Delivery Restricted Delivery 0 Signature Confirmation"'
© insured Mali CI Signature Confinnmiion
M Insured Mall Restricted Delivery Restricted Delivery
(over$51})
Domestic Return Receipt

RoY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
NORTH CAROLINA
Environmental Quality
February 5, 2020
CERTIFIED MAIL # 7015 0640 0007 9832 5029
RETURN RECEIPT REQUESTED
Ryan & Clare Karasek
421 W Blackbeard Rd.
Wilmington, NC 28409
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No. W10800168
New Hanover County
Dear Mr. & Mrs. Karasek:
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of
North Carolina and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above -referenced operating permit for the
geothermal injection well system located on your property at the above referenced address was
issued on March 26, 2014 and expires on May 31, 2019. Per permit conditions and requirements
per 15A NCAC 2C .0224(c), the renewal application must be submitted at least 120 calendar days
prior to expiration of the permit if you wish to continue operating the injection well on your
property.
If Your Geothermal Water Return Well is Still Currently Being Used for Injection:
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit the enclosed renewal
application (Application for a Permit to Construct or Operate Injection Wells - Geothermal
Heating/Cooling Water Return Wells). The form is also available on-line at our website
http://portal.ncdenr.or2 web/wglapslgwprolpermit-at plications.
If Your Geothermal Water Return Well is NO LONGER Being Used for Injection:
If the well is no longer being used for injection, you do not have to renew your permit. Check the
box in Fart 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
OIS
North Canollna Department of Environmerrtal Quality I Division of Water Resauroes
512 Nor1 h Salbbury Street ! 1t236 Hall Service Gutter I Raleigh, North Carolina 2i699-1636
419.7Dr7.44000

according to the regulatory requirements listed under NCAC Title 1 SA, Subchapter 2C,
Section .0240. When the well is plugged and abandoned, a well abandonment record (Form GW
30) must be submitted to our office to certify that the abandonment was properly conducted.
If There has been a Change of Ownership of the Property:
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change" Form must also be submitted in addition to the renewal application.
This form is not enclosed but can be found at the website listed above. Please submit the applicable
forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms in a timely manner may result in the assessment of civil
penalties in accordance with North Carolina General Statute 87-94. Thank you in advance for
your cooperation and timely response. If you have any questions, please contact me by phone at
[phone] or by email at [e-mail].
Regards,
aceriget
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. W10800168 w/o enclosures

U.S., Postal Service'
'CERTIFIED MAIL° RECEIPT
Domestic Mali Only
For delivery information, visit our weasite at www.usps.com".
Certified Mail Fee
rS -ries (!hece add l4lU as v�.r.
D Rehun Rewfpt iherdeepA
Return Receipt felocaonicl i
p renuned Mil Reeeiomd DBtrwry $ 0.544 *mum Required i
Mu1157Ereature Re tncted Delivery $
PoStaae
R O®Doi
Postman: �j
Here ■
ROBERT GIMPEL & SYBLE SGLOMA'°
421 W BLACKBEARD RD.
WILMINGTON, NC 28409
SENDER: COMPLETE THIS SECTION
■ Complete items 1, 2, and 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 maitpleco,
or on the front if space permits.
COMPLETE THIS SECTION ON DELIVERY
A. Signature
X
Agent
© Addressee
B. Received by (Printed Name)
C. Date of Delivery
1. Article Addressed to:
n. ra,tdrr ere, °.#dress ciiffetent from Item 1? E3 Yes
delivery address below: © No
ROBERT GIMPEL & SYBLE SOLOMAN
421 W BLACKBEARD RD.
WILMINGTON, NC 28409
1111111I11I111111111111111111111111111111 I1111
9590 9402 3665 7335 1528 48
2. Article Number (Tiansier from service labep
7017 0190 DODO 1635 3184
PS Form 3811, July 2015 PSN-000-$053
0 Mull Signature
0 Adult Signature Restricted Delve y
0 Certified MaWi
0 Certified Mali Restricted Delivery
0 Colreat on Delivery
0 Collect on Delivery Restricted Delivery
dMall
d Mali Restricted Delivery
0 P(iortty Mall Eciresal
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Delivery
0 Return Receipt for
Merchandise
Signature Confirmatkmur
nature Confirmation
Restricted Delivery
C testis Return Receipt

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER NORTH CAROLINA
Director dtvtrorurtenoal Quality
February 19, 2019
CERTIFIED MAIL ## 7017 0190 0000 1635 3184
RETURN RECEIPT REQUESTED
Robert Gimpel & Syble Soloman
421 W Blackbeard Rd.
Wilmington, NC 28409
Subject: Notice of Expiration (NOE)
Geothermal Water RetumIOpen-Loop Injection Well
Permit No. W10800168
New Hanover County
Dear Robert & Syble:
The Underground Injection Control (LTIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of
North Carolina and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above -referenced operating permit for the
geothermal injection well system located on your property at the above referenced address was
issued on March 26, 2014 and expires on May 31, 2019. 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 Current1N Bein 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 Permit to Construct or Operate Injection Wells — Geothermal
Heating/Cooling Water Return Wells). The form is also available on-line at our website
hup://portal.ncdenr.orgiweb/wo/apsigm.pro/permit-applications.
If Your Geothermal Water Return Well is NO LONGER Beim Used for Injection:
If the well is no longer being used for injection, you (la 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
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11636 Mall Service Center I Raleigh, North Ca.roRna 27699-1636
919-707_900 D

according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C,
Section .0240. When the well is plugged and abandoned, a well abandonment record (Form GW-
30) must be submitted to our office to certify that the abandonment was properly conducted.
If There has been a Change of Ownership of the Property:
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change" Form must also be submitted in addition to the renewal application.
This form is not enclosed but can be found at the website listed above. Please submit the applicable
forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms in a timely manner may result in the assessment of civil
penalties in accordance with North Carolina General Statute 87-94. Thank you in advance for
your cooperation and timely response. If you have any questions, please contact me by phone at
[phone] or by email at [e-mail].
Regards,
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. W10800168 w/o enclosures

ROY COOPER
Governor
M[CHA£L S. REGAN
Secretory
LINDA CULPEPPER NORTH CAROLINA
Director Enrinanalental Qtwitty
February 19, 2019
CERTIFIED MAIL # 7017 0190 0000 1635 3184
RETURN RECEIPT REQUESTED
Robert Gimpel & Syble Soloman
421 W Blackbeard Rd.
Wilmington, NC 28409
Subject: Notice of Expiration (NOE)
Geothermal Water Returrl/Open-Loop Injection Well
Permit No. WI0800168
New Hanover County
Dear Robert & Syble:
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of
North Carolina and is responsible for the regulation of injection well construction and operation
activities within the state. Our records indicate that the above -referenced operating permit for the
geothermal injection well system located on your property at the above referenced address was
issued on March 26, 2014 and expires on May 31, 2019. Per permit conditions and requirements
per 15A NCAC 2C .0224(c), the renewal application must be submitted at least 120 calendar days
prior to expiration of the permit if you wish to continue operating the injection well on your
property.
If Your Geothermal Water Return Well is Still Currently Being Used for Injection:
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit the enclosed renewal
application (Application for a Permit to Construct or Operate Injection Wells — Geothermal
Heating/Cooling Water ReturnWells). The form is also available on-line at our website
http://portal.ncdenr.orglweb/walaps/ oro/permit-applications.
If Your Geothermal Water Return Well is NO LONGER Being Used for Injection:
If the well is no longer being used for injection, you do not have to renew your permit. Check the
box in Part A of the attached renewal application that you wish to rescind the permit and indicate
the current status of the well (i.e., used as water supply well, irrigation well, inactive, plugged and
abandoned, etc.). If it is no longer being used for any purpose, it must be permanently abandoned
Noah catollna DepauJrnenr of E wliamentsl QWllty I Dhitdon of Wpter Re -worms
512, North Sylhiburr Vire11636 Malt Sere Ice Center t Raleigh !evils Ilirtifirto 0699 •I616
vivJQ7.ytH)U

according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C,
Section .0240. When the well is plugged and abandoned, a well abandonment record (Form GW-
30) must be submitted to our office to certify that the abandonment was properly conducted.
If There has been a Change of Ownership of the Property:
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change" Form must also be submitted in addition to the renewal application.
This form is not enclosed but can be found at the website listed above. Please submit the applicable
forms to:
Division of Water Resources
MC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms in a timely manner may result in the assessment of civil
penalties in accordance with North Carolina General Statute 87-94. Thank you in advance for
your cooperation and timely response. If you have any questions, please contact me by phone at
[phone] or by email at shristi.shrestha icy cdenr.gov.
Regards,
a
Shristi Shrestha
Hydro geologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: Wilmington- Regional Office — WQROS w/o enclosures
Central Files - Permit No. WI0800168 w/o enclosures

North Carolina Department of Environmental Quality-Division of Water Resources
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELL(S)
In Accordance With the Provisions of 15A NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELL (S)
These well( s) inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
CHECK ONE OF THE FOLLOWING:
__ New Application ___ Renewal* __ Modification __ Permit Rescission Request*
*For Permit Renewals or Rescission Request, complete Sections A thru E . and M (signature page) only
Print or Type Information and Mail to the Address on the Last Page. lllegible Applications Will Be Returned As Incomplete.
DATE: _______ _, 20 __ PERMIT NO. ______ (leave blank if New Application)
A. CURRENT WELL USE & OWNERSHIP STATUS (Leave Blank if New Well/Permit Application)
1. Current Use of Well
a. I wish to continue to use the well as D Geothermal Well D Drinking Water Supply Well
D Other Water Supply Use-Indicate use (i.e., irrigation, etc.) ________ _
b. Terminate Use: If the well is no longer being used as a geothermal injection well and you wish to
rescind the permit, check the box below. If abandoned, attach a copy of the Well Abandonment
Record (GW-30).
D Yes, I wish to rescind the permit
2. Current Ownership Status
Has there been a change of ownership since permit last issued? D YES D NO
If yes, indicate New Owner's contact information:
Name(s) -------------------------------
Mailing Address: _____________________________ _
City: __________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: Email Address.:
B. STATUS OF APPLICANT (choose one)
C.
Non-Government: Individual Residence Business/Organization __
Government: State Municipal __ County__ Federal
WELL OWNER(S)/PERMIT APPLICANT -For single family residences, list all persons listed on the
property deed. For all others, list name of business/agency and name of person and title with delegated authority
to sign: __________________________________ _
Mailing Address:--------------------------------
City: ____________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: _______________ C~e=l~l N~o~·=--------------
EMAIL Address: Fax No.: --------------------------------
Geothennal Water Return Well Pennit Application Rev. 4-15-2016 Page 1
D. WELL OPERATOR (if different from well owner) -For single family residences , list all persons listed on
the property deed. For all others, list name business/agency and name of person and title with delegated authority
to sign: ____________________________ _
Mailing Address:--------------------------------
City: ____________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: ---------------=E=m=a=il~A=d=d=r=es=s=.: ___________ _
E. PHYSICAL LOCATION OF WELL(S) SITE
(1) Parcel Identification Number (PIN) of well site: __________ County: _____ _
(2) Physical Address (if different than mailing address): ________________ _
City: _____________ County _________ Zip Code: ____ _
F WELL DRILLER INFORMATION
Well Drilling Contractor's Name: _________________________ _
NC Well Drilling Contractor Certification No.: ____________________ _
Company Name: _______________________________ _
Contact Person.~: _______________ EMAIL Address: ___________ _
Address:----------------------------------
City: _________ Zip Code: _____ State: __ County: _________ _
Office Tele No.: Cell No.: Fax No.: ________ _
G. HV AC CONTRACTOR INFORMATION (if different than driller)
HVAC Contractor's Name: ___________________________ _
NC HVAC Contractor License No.: ________________________ _
Company Name: _______________________________ _
Contact Person~: _______________ .EMAIL Address: ___________ _
Address:----------------------------------
City: Zip Code: _____ State: __ County: _________ _
Office Tele No.: Cell No.: Fax No.: _______ _ --------- ----------
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES ___ _
YES ___ _
NO ----
NO ___ _
I. WELL CONSTRUCTION REQUIREMENTS-As specified in 15A NCAC 02C .0224 (d):
(1) The water supply well shall be constructed in accordance with the water supply well requirements of
15A NCAC 02C .0107 .
(2) If a separate well is used to inject the )leat 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 Rev. 4-15-2016 Page2
(a) For screen and gravel-packed wells , the entire length of casing shall be grouted from the top
of the gravel pack to land surface;
(b) For open-end wells without screen, the casing shall be grouted from the bottom of the casing
to land surface.
(3) A sampling tap or other approved collection equipment shall provide a functional source of water
during system operation for the collection of water samples immediately after water emerges from the
supply well and immediately prior to injection.
J. WELL CONSTRUCTION SPECIFICATIONS
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
_____ *EXISTING WELLS ____ .PROPOSED WELLS
*For existing wells, please attach a copy of the Well Construction Record (Form GW-1) if available.
(2) Attach a schematic diagram of each water supply and injection well serving the geothermal
heating/cooling system. A single diagram can be used for wells having the same construction
specifications as long as the diagram clearly identifies or distinguishes each well from one another.
Each diagram shall demonstrate compliance with the well construction requirements specified in Part
H above and shall include, at a minimum, the following well construction specifications:
(a) Depth of each boring below land surface
(b) Well casing and screen type, thickness, and diameter
( c) Casing depth below land surface
( d) Casing height "stickup" above land surface
(e) Grout material(s) 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) __ ° 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 Rev. 4-15-2016 Page3
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
M. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .021 l(e ) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer
or ranking publicly elected official;
4. for all others: by all the person(s ) listed on the property deed.
If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the
applicant that names and authorizes their agent to sign this application on their behalf.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications and conditions of the
Permit."
Signature of Property Owner/ Applicant
Print or Type Full Name and Title
Signature of Property Owner/Applicant
Print or Type Full Name and Title
Signature of Authorized Agent, if any
Print or Type Full Name and Title
Submit two copies of the completed application package to:
Division of Water Resources -UIC
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page4
,.
ROY COOPER
Governor
MICHAELS. REGAN
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
March 25, 2020
Ryan & Clare Karasek
421 W. Blackbeard Rd.
Wilmington, NC 28409
Re: Issuance of Injection Well Permit
Permit No. WI0800168
Geothermal Heating/Cooling Water Return Well
New Hanover County
Dear Mr. and Mrs.-Karasek:
In accordance with your permit renewal application received February 13, 2020, I am forwarding
Permit No. WI0800168 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
February 28, 2025, and shall be subject to the conditions and limitations stated therein.
Please Note:
• Samples from the influent and effluent sampling ports of your geothermal well system
were collected on March 11, 2020. 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 Section1
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street I 1636 Mail Service Center I Raleigh! North Carolina 27699-1636
919.707.9000
cc: Morella Sanchez-King, Geoff Kegley, Wilmington Regional Office
Central Office File, WI0800168
New Hanover County Environmental Health Department
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143, and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Ryan & Clare Karasek
New Hanover County
FOR THE CONTINUED OPERATION OF TWO (2) GEOTHERMAL HEATING/COOLING WATER
RETURN WELL(S), defined in Title 15A North Carolina Administrative Code 2C .0224, which will be used for
the injection of heat pump effluent. This injection well is located at 421 W. Blackbeard Rd., Wilmington, NC
28409, and will be constructed and operated in accordance with the application received February 13, 2020, and
conformity with the specifications and supporting data, all of which are filed with the Department of
Environmental Quality.
This permit is for continued operation of injection wells and shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from March 25, 2020 until February 28, 2025, and shall be subject
to the specified conditions and limitations stated therein.
Permit issued this the 25 th day of March 2020. tr
For S. Daniel Smith
Director, Division of Water Resources
Permit WI0800168
By Authority of the Environmental Management Commission.
Permit #WI0800168 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
Page 1 of5
PART I -PERMIT GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is grounds
for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [15A NCAC 02C .0224(b)].
3. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data [15A NCAC 02C .021 l(e)].
4. This permit is not transferable without prior notice to, and approval. In the event there is a desire for the
facility to change ownership, or there is a name change of the Permittee, a formal permit amendment request
must be submitted, including any supporting materials as may be appropriate, at least 30 days prior to the
date of the change [15A NCAC 02C .0211(0)].
5. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, . which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met [15A NCAC 02C .0203].
PART II-WELL CONSTRUCTION GENERAL CONDITIONS
1. The well supplying water for the geothermal heating and cooling system shall be constructed in accordance
with requirements of rule 15A NCAC 02C .0107.
2. Any injection well shall be constructed in accordance with requirements of rule 15A NCAC 02C .0107
except that the entire length of the casing shall be grouted in such a way that there is no interconnection of
aquifers or zones having differences in water quality that would result in degradation of any aquifer or zone.
For screened wells, grout shall be emplaced from the top of the gravel pack to the land surface. For open-
end wells, the casing shall be grouted from the bottom of the casing to the land surface [15A NCAC 02C
.0224(d)(2), (3)].
3. Bentonite grout shall not be used to seal any water-bearing zone with a chloride concentration equal to or
greater than 1,500 milligrams per liter. In areas where elevated chloride levels are known to exist or are
probable, such as coastal areas, chloride levels shall be verified in the field to determine existing conditions
ifbentonite is to be used [15A NCAC 02C .0225{h)(8)].
4. The injection well system shall be constructed such that a sampling tap or other collection equipment
approved by the Director provides a functional source of water when the system is operational. Such
equipment shall provide the means to collect a water sample immediately after emerging from the water
supply well and immediately prior to injection into the return well [15A NCAC 02C .0224(d)(4)].
5. Each injection well shall be secured to reasonably insure against unauthorized access and use and shall be
sealed with a watertight cap or well seal, as defined in G.S. 87-85(16).
6. Each geothermal injection well shall have permanently affixed an identification plate according to [ 15A
NCAC 02C .0107(j)(2)].
Permit #WI0800168 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
Page 2 of5
7 . A copy of the Well Construction Record (Form GW-1) shall be submitted as described in Part V.5 of this
pennit within 30 days after completion.
PART III-OPERATION AND USE CONDITIONS
1. The Permittee shall comply with the conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and rules of ISA NCAC 02C .0200, even
if compliance requires a reduction or elimination of the permitted activity [15A NCAC 02C .021 l(i)].
2. The issuance of this permit shall not relieve the Pennittee 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 Pennittee shall take immediate corrective actions including those actions
that may be required, such as the repair, modification, or abandonment of the injection facility [ 15A NCAC
02C .0206].
PART IV-INSPECTIONS [15A NCAC 02C .021 l(j)]
1. Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, 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 and appropriate samples associated with the injection
facility's activities.
PART V -MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction, repair, or abandonment shall be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on-site and available for inspection [15A NCAC
02C .0224(f)(2), (4)].
2. Monitoring of any well may be required to ensure protection of the groundwater resources of the State and
compliance with the groundwater quality standards specified in 15A NCAC 02L [15A NCAC 02C
.0224(f)(l)].
3. The Permittee shall report any report any monitoring or other information that indicates noncompliance
with a specific permit condition, that a contaminant may cause the injected fluids to migrate outside the
approved injection zone or area. As specified in rule 15A NCAC 02C .021 l(p), noncompliance notification
shall be as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence, to the Wilmington Regional Office, telephone number 910-350-2004.
Permit #WI0800168 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
Page 3 of5
(B) Written notification shall be made within 5 (five) days of the occurrence and submitted to the
addresses in Item #5 below.
(C) The written notification shall contain a description of the noncompliance and its cause; the period
of noncompliance, including dates and times; if the noncompliance has not been corrected, the
anticipated time it is expected to continue; and any steps taken or planned to reduce, eliminate, and
prevent reoccurrence of the noncompliance.
4. The Permittee shall record the number and location of the wells with the register of deeds in the county in
the facility is located [15A NCAC 02C .0224(f)(3)].
5. All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff
Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
And
Water Quality Regional Operations Section
DWR Wilmington Regional Office
127 Cardinal Drive
Wilmington, NC 28405
PART VI-PERMIT RENEWAL [ISA NCAC 02C .0224(c)].
As required by rule, and application for permit renewal shall be made at least 120 days prior to the expiration of
this permit. This permit condition does not apply if the Permittee chooses to discontinue operation of the well
for injection of effluent from the geothermal heating and cooling system associated with this permit.
PART VII-CHANGE OF WELL STATUS [15A NCAC 02C .0240].
1. Procedures for temporarily or permanently abandoning a well are the same as those specified in rule 15A
NCAC 02C .0113. While some of those criteria are given below, the Permittee bears the responsibility of
complying with all applicable regulatory requirements.
2. If a well will no longer be used for any purpose, then it should be permanently abandoned according to rule
15A NCAC 02C .0113(b) in order to prevent the well from deteriorating and acting as a source or conduit
of contamination, which is prohibited by General Statute 87-88(c).
3. If a well is taken completely out of service temporarily, the Permittee shall install a water-tight cap or well
seal that cannot be removed without the use of hand or power tools.
4. When injection operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0113(b), which include, but are not limited to, the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if any
such removal will not be responsible for, or contribute to, the contamination of an underground
source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to ensure freedom from
obstructions that may interfere with sealing operations.
Permit #WI0800168 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
Page 4 of5
(C) Each well shall be thoroughly disinfected, prior to sealing, in accordance with rule 15A NCAC
02C .011 l(b)(l)(A), (B), and (C).
(D) Each well shall be completely filled with cement grout, which shall be introduced into the well
through a pipe which extends to the bottom of the well and is raised as the well is filled.
(E) In those cases when a subsurface cavity has been created as a result of the injection operations,
each well shall be abandoned in such a manner that will prevent the movement of fluids into or
between underground sources of drinking water.
(F) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in 15A
NCAC 2C .0224(f)( 4) within 30 days of completion of abandonment to the addresses specified
in Part V.5 above.
Permit #WI0800168 Geothermal Heating/Cooling Water Return Well
ver. 3-24-2020
Page 5 of5
S3/14/2012 12:57 9102702988
ARM AND WATERWORKS PAGE 01
.APPLIED RESOURCE MANAGEMENT, P.C.
P. O. BOX 882
NAMP45TEAD, NORTH CAROLINA 28443
PHONE; [phone]
FAX [phone]
FACSIMILE TRANSMITTAL SHEET
TOt
COMPANY:
r �
MAR NIPPER:
PROM
Tatalny &hiring
DATE
3-N r2
TOTAL . OP PAGEL%1NC JDING COVAR:
PRONE NUMBER:
SENDER% RL• PURRNCR N UMSEIL-
Rai
YOUR PBP@RSNC6 N97hR,t
© URGENT O FOR REMEW 0 PLEASE CoMMIINT ❑ PLEASE REPLY 0 PLEASE REM -LE
NOTES/COMM S:
RECEIVED 03-1 '12>12:0o_ F
2I0298 TQ- NC DES P&S MIME

03/14/2012 12:57 9102702988 ARM AND WATERWORKS
PAGE 03
1 ■ ON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Del. -him -et of Environment cord Natured Resomrxs. Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2412
1. WELL CONTRACTOR:
Donald H.Curnminge
Wel Carers Me (IndMdtrdn Nome
Apylied Rtuouroe Mar►lemerrt. PC
Wei Contactor Cc npeny Name
STREET ADDRE$$..7 Transfer 1Na6¢r.r . 13 Bur 882
Ha systeed NC 28443
City or Town mete Zip Code
(9_118 27C019
Area oaf Phone number
2. WELL INFORMATION:
SITE WELL ID der epp;raa)
STATE WELL PERMIT a Of applicable)
DINO or t ThER PERM IT A lid applicable)
WO.L USE Applcable Bout) Monitoring O Muuirap$IIPubMo ❑
IndlrsartahOommeldal O Ag etatur1I ❑ Recoverya Imp^
irrigation 0 Other%) (list we)
DATE DRILLED i12
TIME COMPLETED I1 ANIEI PM
$ WELL LOCATION:
crrr: wilminglsxr Cotogrf Nen Hanover
421 Mack -beard Road W 284109
Mama, Numbers, CanT,u I1y, SubdeiNery, int No., Avail, zip owls
TOPOGRAPHIC 1 LAND SEI TONG;
Oslope[1Va O atOR1 Dpther
(check amm rt 0
LATITUDE 34' 11' 21' N
LONGITUTDE 0771 51' 21*W
i atitudellangitude source: v GPS 0 Topographic map
(Aaaetion of weir must be shown on a USGS topo map end
coact ee M thar tam if no using GPM
A FACILITY.cr me rome AMreOw se is Otmo4
FACIUTY ID Alf spelt:IM i
May be m degreee.
minute% sewndsor
in a decimal format
NAM OF FACILITY
STREET' ADDRESS
City or Town Sete Zia Code
CONTACT PERSON Robert Glmpte & 5ybie Soloman
MAILING ADDRESS 421 U1ackbaard Road W
WlImingtvn NC 28409
City rr Town Stale Ctuie
(910 ).399-2200_
Arno code - Phone number
t. MILL DETAILS:
a. TOTAL DEPTh 150'
A_ Dow WELL REPLACE O[13'L71IIf3 MIL? YES In NO l]
c. WATER LEVELOelow Top of Casing 10 Fi'.
(Ilse'++" IT Mow Top of Cooing)
d. TOP OF CASING IS 1s
'Top of easing terminated
8 variance In accordance
tYIELD (gprnye 48040'
f DISINFECTION: Type
9. WATER ZONES (*OM
From To
From To
From To
PT. Above Land Surfar
aVHTHW har below 'ICAO Id
A2Cmount 3g surfeaa .011m8_
ay roquil
15A
MET OO OF TEST Afrllf
1O%
From To
ROM To
From To
6. CASING:
Depth Diameter
From° To125 Ft its
From To €t
From To Ft.
7. GROUT: Depth Materim
Fran'0 To 125 FL Grout
Prom To Ft
From To Ft
Thickness,
Weight Material
$CH4O PVC
0. SCREEN.: • Depth Diameter
Method
Trernmle
SIDM Size Material
From To F`i. in 4.010 1n PVC
From To Ft In, irn.
From To FL In. in.
I. SANDIGRAVEL PACK:
Depth She
From To FL Coon*
From To FL
From To Ft
Materiel
Sand
i0. DRILLING LQG
From To
a 1r
11' 26'
95'
85
85' 125'
VS' 150
11. REMARKS:
Sand
Formation Desoriplion
❑ay
Sandy Clay
limestone
Mud rocicl Clay
Sandstone
DC mangey C ttwncv THAT nos watt %Imo CONSTRUCTED N ACCORDANCE wn * l
1SA RCAC 2C. V1EI t + STANDARD", ANQ THAT A COPY OF Ton
HPS MEN {_• 1r LlcOOM
�" 'hlLi QF. TI D WELL C
PRINTED NAME OF PERSON CONSTRUCT1NG THE WELL
lzlq
OR DATE
Sub►mP the original teas Division of Water QLiatlty Walla 30 Clays. Atilt: Information Mgt.,
1617 Malt Service Center — Raleigh, NC 27 -16t7 Phone No. MS) TS$4O15 wit Ike.
Form c3W-Ib
Rev. 7105
BECEIVEDT E I4— 2.1 lh - :52-7132$
T6— VG. DERE BY

03/14/2012 12:57 9102702988 ARM AND WATERWORKS
PAGE 02
NON ON RESIDENTIAL WELL CONSTRUCTION RECORD
North Cantina Depart/newt of Environment and Natural P.ceol eeea- Dh isioo of Water Quaky
WELL CONTRACTOR CERTIFICATION # 2412
I. WELL CONTRACTOR:
Donald H. Cumminjs
Well Contractor (Tidwldrsaij Mai*
Applied lice Managu1T*►t, PC
well Co 4 aCfOr Company Name
STREET ADDRESS 267 Transfer SIOSoriMd.. PC) Sox 1182
14arnpstaod NC 21443
or Tq n Slabs Zip Cade
wig 270-2919
Area c Phone number
2. WELL INFORMATION:
SITE WELL ID SO oppilcsborn
STATE WELL PEAIAIT s Of applicobla) vim C l V 3
DM or OTHER PERMIT # Of app000ple)
WELL U5E (Check Anpiceble Box) Monitoring 0 UurtirfpaePublic 0
IndustdMIVCoam►oraal ❑ honk ifsaml ❑ Recovery blactioral
drll9atian1=1 Merin Ps, use)
DATE ORIU.ED 712R19
TIME COMPLETED 400 AAA❑ PM
5. WELL LOCATION:
CITY: W4Fnin rr,i COUNTY Nov Hamr
42191etkd:arre Itaadter 21409
moat Nome. Numbers, Commas* Si.dernisicm, 1 No.. Anil ZIP Cade}
TOPOGRAPHIC 1 LAND SETTING:
alopeOVallmeRatrlildgefinDtiter
(Meek erewegi ee tog
LATf1UDE 346 11' 21' N
L0worrtr SE D77" sE zal• w
Latitude/longinidc smite! p GPS l Topographic map
dforeRmug be shown on a USGS tom MO and
ollacrrcd to this farm not using GPS)
4.FACII.fri htAcrum Ohba. truisms *MOW weft is nalaa
FACILITY MAW appi09B10)
Hey be in degrees,
mi meo. secorets or
in a deeimer Armee
NAME OF FACILITY
STREET ADDRESS
City or Town Stale
CONTACT PERSON RobeltGrmple & 55libie Soloman
MAILING ADDRESS 421 orackbeard a ad if
zip Corte
wllmingtof NC
24409
City or Town Slate
0 ). 39¢2200
Area code - Hlone number
5 WEU. DETAILS:
a TOTAL OEFIN:
rip Cixie
b Don WM. REPLACE E STING MU.? YES 0 N0 0
c. WATER LEVEL Below Top of Casing; 5 Darr,
niaa "a" if Ahem Top of Casing]
d. TOP OF CASING IS 15 FT. Above Land Suriac
"Top of casing terminalad at:rar below land surface may inquire
a variance in Sem le+►oe with 15A NCAC 2C .0116.
a. YIELD (gpm)., 1 0' METHOD OF TEST "
1. DISINFECTION: Type i.m Amoun! Val"
S. WATER ZONESIdepthr:
From To fain To
From To From To
From TO From To
6. CASING: Thickness,
Depth Dianseter Welged Melernei
From T065 Ft.4' So-mo PVC
From To Ft.
From To Ft.
7 GROUT: Depth Material Marthod
F 0 To 65 Ft Grout Tommie
From To Ft.
Frans To Ft
tt• SCREEN: Depth Diameter
SIN Sloe Material
From Ter FL in. 0-010 in. PVC
From To FI In. in,
From To FL In. k1_
1L SAND/GRAVEL PACK:
Depth Sore Moterlat
From To FL came Sand
From To • FL
From To Ff,
10. DRILLING LOG
Ftorn To
0 11'
11'
55'
55' Ifs
II. REMARKS:
Formation Description
Sand
Clay
sandy©ay
Limestone
100 HEREBY sERnFY Tw4T'on vwPdl. uwS CONSTRUCTED IN ACCORDANCE VAIN
TEA NCAc 2G mu_ AND I N+1T A COov op Ills
11Vir
DGA F�uOm'4 FIED WEU. OONTRAC DATE
BEEN
r , ph.
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to die Division of Water Quality within 30 days. A n: Informal on Mgt.,
1617 Mali Service .Center --Raleigh, NC 27099.1617 Phone 14o (119) 733-701e art See.
.:IRE=E11-1244—' 12 1.2-: Oil FRO— • 510Z70298
16—. lig FPS'
Poen GW1b
Rev. 7►055

Permit Number WI0800168
Program Category
Ground Water
Permit Type
..
Injection Heating/Cooling Water Return Well (SA?)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
Robert Gimpel and Syble Soloman SFR
Location Address
421 Blackbeard Rd W
Wilmington NC 28409
Owner
Owner Name
Robert C Gimpel
Dates/Events
Orig Issue
06/29/09
App Received D.raft Initiated
05/27/09
Scheduled
Issuance
Central Files: APS_ SWP_
06/30/09
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Nate Carr
3308 Enterprise Dr
Wilmington
Major/Minor
Minor
NC
Region
Wilmington
County
New Hanover
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Robert C. Gimpel
421 Blackbeard Rd W
Wilmington
Public Notice Issue
06/29/09
NC
Effective
06/29/09
28405
28409
Expiration
05/31/14
_R_e_..g_u_la_t _ed_A_c_ti_v_it_ie_s _______________ .:....:R=e _,,,o=u=es:::.;te.::e=d::...:/Rc.:.e:::..:c:::..:e::..:.i..:..ve::.;d=-=E:..:cv.::::e =n =ts:c-_________ _
Heat Pump Injection RO staff report requested
RO staff report received
Outfall NUL L
Waterbody Name Stream Index Number Current Class
06/03/09
06/16/09
Subbasin
Permit Number WI0800168
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michael .rogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
Robert Gimpel and Syble Soloman SFR
Location Address
421 Blackbeard Rd W
Wilmington NC
Owner
Owner Name
Robert C
Dates/Events
Orig Issue App Received
05/27/09
Reg ulated Activities
Heat Pump Injection
Outfall t\lULL
28409
Gimpel
Draft Initiated
Scheduled
Issuance
Central Files: APS_ SWP_
06/29/09
Permit Tracking Slip
Status
In review
Project Type
New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Nate Carr
3308 Enterprise Dr
Wilmington NC
Major/Minor
Minor
Region
Wilmington
County
New Hanover
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Robert C. Gimpel
· 421 Blackbeard Rd W
Wilmington NC
Public Notice Issue Effective
li/~/09
Re a uested/Received Ev ents
RO staff report requested
RO staff report received
28405
28409
Expiration
sJ31 It<+
06/03/09
06/16/09
Waterbody Name Stream Index Number Current Class Subbasin
J!if/1
NCDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Coleen H. Sullins
Director
Dee Freeman
Secretary
June 29, 2009
Robert Gimpel and Syble Soloman
421 Blackbeard Road West
Wilmington, NC 28409
Re: Issuance of Injection Well Permit
Permit No. \\110800168
Issued to Robert Gimpel and Syble Soloman
New Hanover County
Dear Mr. Gimpel and Ms. Soloman:
In accordance with your application received May 27, 2009, I am forwarding Permit No. WI0800168 for the
construction and operation of a SA 7 geothermal underground injection control (UIC)-well heat pump system
located at 421 Blackbeard Road West, Wilmington, New Hanover County, NC 28409. This permit shall be
effective from the date of issuance until May 31, 2014, and shall be subject to the conditions and limitations
stated therein.
P1easenotifythe Wilmington RegionalOffice (910-796-7215) 48 hours prior to installing and operating the
geothermal system. Water samples will be collected from the influent and effluent sampling ports and sent to a
laboratory for analysis. The water quality results, when received, will be sent to you under separate cover.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an application
to renew the permit four months prior to its expiration date. As indicated in the permit, this permit is not
transferable to any person without prior notice to, and approval by, the Director of the Division of Water
Quality. If you have any questions regarding your permit or the Underground Injection Control Program please
call me at [phone]. ·
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Caro lina 27699-1636
Location: 2728 Capital Bouievard , Raleigh, North Carolina 27604
Phone: [phone] I FAX 1: 919-715-05B8; FAX 2: 919-715-604B I Customer Service: 1-877-623-5748
Internet: www.ncwaterqualitv.org
An Equal Opportunity I Affirmative Action Employer
No~1 C lin 01ul aro . a
)Vaturall!f
1
Best Regards,
.~LJ_ do-r,,___..
Michael Rogers, Environmental Specialist
cc: Charlie Stehman -Wilmington Regional Office
Central Office File -WI0800168
New Hanover County Environmental Health Dept.
James Cornette -Applied Resource Management, P .C.
Attachment(s)
WI0800168
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
Robert Gimpel and Syble Soloman
FOR THE CONSTRUCTION AND 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 421 Blackbeard Road West, Wilmington, New Hanover County, NC
28409, and will be constructed and operated in accordance with the application dated May 27, 2009, 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 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 be effective, unless revoked, from the date of its issuance until May 3 I, 2014, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the day of � !. , 2009.
us4
Rom. Coleen H. Sullins; Director
Division of Water Quality
By Authority of the Environmental Management Commission.
WI0800168 1

PART I -WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be permanently labeled with a warning that it is for injection purposes and the entrance to each well
must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.0213(g).
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to:
Aquifer Protection Section-UIC Staff
163 6 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Wilmington Regional Office
127 Cardinal Drive Extension
Wilmin~rton. NC 28405-2845
[phone]
GW-1 s must be submitted within 30 days of completion of well construction. Copies of the GW-1
form(s) shall be retained on-site and available for inspection.
9. Well construction records must also be submitted for any existing water supply wells on-site as well as a
site map showing any water supply wells on adjacent properties prior to installing the geothermal well(s)
as specified in NCAC 2C .021 l(d)(l)(D).
PART II-WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight ( 48) hours prior to constructing each injection well, the Permittee shall notify the
Aquifer Protection Section-Underground Injection Control (UIC), Central Office staff, telephone number
[phone] and the Wilmington Regional Office Aquifer Protection Section Staff, telephone number
[phone].
WI0800168 2
2. In order for boreholes to not hydraulically connect separate aquifers ( e.g., surficial aquifers, saprolite, and
fractured bedrock aquifer if present), casing shall 'be grouted from the lowermost water bearing zone to
land surface.
PART ID -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, wh,ic~ 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 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 assimilat~ the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART V -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.
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 Aquifer Protection Section-Underground Injection Control (UIC),
Central Office staff, telephone number [phone]. Notification is required so that Division staff can
inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
WI0800168 3
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Wilmington Regional Office, telephone number [phone], any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
3. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
4. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate action as may be required by the Director.
PART VIII -PERMIT RENEW AL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
PART IX-CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(l), Well
Construction Standards.
WI0800168 4
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 wellin 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 thoroughlydisinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
1 SA NCAC 2C .02 l 3(h)( 1) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
WI0800168
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: 6/12/2009
To: Aquifer Protection Section Central OfficePermittee:
County: New Hanover
Robert Gimpel & Syble Soloman
Project Name: WI0800168 Central Office Reviewer: Michael Ro gers , GPU
Regional Login No: Rebecca Gerhart Application No.: _W __ O_O ___ _
L GENERAL INFORMATION
1. This application is (check all that apply): 1:2] New D 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 1:2] Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? 1:2] Yes or D No.
a. Date of site visit: 6/12/2009
b. Person contacted and contact information: Robert Gimpel & Syble Soloman 910-399-2200
c. Site visit conducted by: Rebecca Gerhart
d. Inspection Report Attached: D Yes or 1:2] No.
2. Is the following information entered into the BIMS record for this application correct?
1:2] Yes o~ D No. Ifno, 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:
(If multiple sites either indicate which sites the information applies to. copy and paste a new section into the
document for each site. or attach additional pages for each site)
a. Location(s): 421 Blackbeard Rd. West Wilmington. NC 28409
b. Driving Directions: From 17S. left on Oleander. right on Pine Grove. Follow Pine Grove until it splits
(Masonboro Loop Rd. and Masonboro Sound Rd.). Stay straight to go from Pine Grove to Masonboro
Sound Rd. Left on Buccaneer. Left on Blackbeard W.
c. USGS Quadrangle Map name and number: __
d. Latitude: Longitude: __
II. NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed (or renewals or minor
modifications. skip to next section)
Description Of Waste(S) And Facilities
I. Please attach completed rating sheet. Facility Classification: __
FORM: Staff Report
RE~EIVED / OENR / OWQ
Aquifer ProtP.ction Section
JUN 1-1 2009
AQUIFER PROTECTION SECTIO'N REGIONAL STAFF REPORT
2. Are the new treatment facilities adequate for the type of waste and disposal system?
D Yes D No D N/A. Ifno, please explain: __
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? D Yes D No D N/A. If no, please explain: __
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? D
Yes D No D N/ A. If no, please explain: __
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. 0Yes0No0
NI A. If no, please explain: __
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
D Yes D No D N/A. Ifno, please explain: __
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
D Yes D No D N/A. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV: __
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? D Yes or D No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit: __
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? D Yes D No D N/A. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program: __
10. For residuals, will seasonal or other restrictions be required? D Yes D No D N/A If yes, attach list of sites
with restrictions (Certification B?)
IIL RENEWAL AND MODIFICATION APPLICATIONS (use previous section for new or maior modifi cation
systems)
Descri ption Of Waste(S) And Facilities
1. Are there appropriately certified ORCs for the facilities? D Yes or D No.
Operator in Charge: __ Certificate#: __
Backup-Operator in Charge: __ Certificate#: __
2. Is the design, maintenance and operation ( e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage, etc) of the treatment facilities adequate for the type of waste and disposal system? D Yes or D No.
If no, please explain: __
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? D Yes or D No. If no, please explain:
FORM: Staff Report 2
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
4. Has the site changed in any way that may affect permit (drainage added, new wells inside the compliance
boundary, new development, etc.)? If yes, please explain: __
5. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
D Yes or D No. Ifno, please explain: __
6. Are the existing application rates (hydraulic or nutrient) still acceptable? D Yes or D No. If no, please
explain: __
7. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? D Yes D No D N/A. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Will seasonal or other restrictions be required for added sites? D Yes D No D N/ A If yes, attach list of sites
with restrictions (Certification B?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? D Yes or D No. If yes, please attach a
map showing conflict areas or attach any new maps you have received from the applicant to be incorporated
into the permit: __
I 0. Is the description of the facilities, type and/or volume of waste(s) as written in the existing permit correct? D
Yes or D No. If no, please explain: ____ _
11. Were monitoring wells properly constructed and located? D Yes or D No D N/A. If no, please explain:
12. Has a review of all self-monitoring data been conducted (GW, NDMR, and NDAR as applicable)? D Yes or
D No D N/A. Please summarize any findings resulting from this review:
13. Check all that apply: D No compliance issues; D Notice(s) of violation within the last permit cycle; D
Current enforcement action(s) D Currently under SOC; D Currently under JOC; D Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments (such as NOV, NOD etc): ____ _
14. Have all compliance dates/conditions in the existing permit, (SOC, JOC, etc.) been complied with? D Yes
D No D Not Determined D N/A .. Ifno, please explain: __
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? D
Yes or D No D N/A. If yes, please explain: __
FORM: StaffReport 3
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.)
Descri ption Of Well(S) And Facilities -New, Renewal, And Modification
1. Type of injection system:
[gl 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? D Yes [gl No
3. Are there any potential pollution sources that may affect injection? [gl Yes D No
What is/are the pollution source(s)? Sewer line. Clean-out line from residence to main line in street. Tidal
creek. What is the distance of the in jection well (s) from the pollution source{s )? (wells not yet constructed -
see notes on potential location ) ft.
4. What is the minimum distance of proposed injection wells from the property boundary?-38 ft.
5. Quality of drainage at site: D Good l:gJ Adequate D Poor
6. Flooding potential of site: D Low l:gJ 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? [gl 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)? l:gJ 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.
In jection Well Permit Renewal And Modification Only:
1. For heat pump _systems, are there any abnormalities in heat pump or injection well operation ( e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
D Yes D No. 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 g roundwater remediation permits ( of an y typ e ), will
continued/additional/modified in jections have an adverse im pact on mi gration of the plume or management of
the contamination incident? Yes D No. If yes , ex plain:
FORM: Staff Report 4
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
4. Drilling contractor: Name: Jim Cornette . A pp lied Resource Mana gement
Address: P.O. Box 882
Ham pstead . North Carolina 28443
Certification number: 2424
5. Complete and attach Well Construction Data Sheet.
FORM: StaffReport 5
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.: This property is bordered by
Hewlett's Creek to the East (dock visible in aerial photo). From the driveway, the lawn slopes downward (2 ft.)
to the eastern edge of the property, where there is a ~ 2-3 ft. drop-off into the marsh cord grass and wetland area.
Vegetation and standing water indicate that the tidal creek regularly rises to this boundary. At the NE corner of
the house, a sewer clean-out line is clearly visible and extends from the foundation at an angle. At the foot of
the driveway, the sewer clean-out cap is also clearly visible (painted bright green). On the map provided, the
diagonal dotted line infers the location of the clean-out as it extends across the property. Regarding the location
of the supply well and separate injection well: there is enough space on this property to meet the set-back
requirements but it will be a little 'tight'. Distance from the water supply well to the potential pollution sources
must be carefully measured: 50' from main sewer line, 25' from clean-out line, 25' from high water line of tidal
creek.
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 1:8] 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
Injection well must be grouted to the target Grouting to the target aquifer significantly
aquifer (Castle Hayne) reduces the possibility of the well casing acting
as a water conduit between the Castle Hayne
and surficial aquifer.
FORM: Staff Report 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 preparer(s):
Signature of APS regional supervisor:
Date: ❑6/!.5/o9
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: Staff Report 7

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A QUIFER PROTECTION SECTION
APPLICATION REVIEW RE QUEST FORM
Date: June 3 . 2009
To: □ Landqn Davidson, ARO-APS
□ Art Barnhardt, FRO-APS
□ Andrew Pitner, MRO-APS
D Jay Zimmerman, RRO-APS
0 David May, WaRO-APS
cgj Charlie Stehman, WiRO-APS
□ Sherri Knight, W-SRO-APS
From: Michael Rogers Groundwater Protection Unit
Telephone: (919 ) 715-6166 Fax: [phone]
E-Mail: Michael.Ro e ers @ncmail.net
A. Permit Number: WI 0800168
B. Owner: Robert Gim pel and S \1ble Soloman
C. Facility/Operation: _
cgj Proposed □ Existing D Facility D Operation
D. Application:
1. Permit Type: D Animal D SFR-Surface Irrigation □ Reuse D H-R Infiltration
D Recycle O 1/E Lagoon D GW Remediation (ND)
cgj UIC-5A7 Geothermal well
For Residuals: D Land App. D D&M
D 503 D 503 Exempt
D Surface Disposal
D Animal
2. Project Type: cgj New D Major Mod. D Minor Mod. 0 Renewal D Renewal w/ Mod.
E. Comments/Other Information: cgj I would like to accompany you on a site visit.
NOTE: If m y schedule will allow, I would like to go out durin g the drillin g of these wells.
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:
cgj Return a Completed APSARR Form and attach laboratory analytical results, if applicable.
0 Attach Well Construction Data Sheet.
0 Attach Attachment B for Certification by the LAPCU.
0 Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office-Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: -------------------Date: _____ _
FORM: APSARR 07/06 Page 1 of 1
State of North Carolina oc. WAT R
Department of Environment � 46
and Natural Resources 3
Division of Water Quality > —I
Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
Coleen Sullins, Director
Division of Water Quality
Aquifer Protection Section
Location: 2728 Capital Blvd.
Raleigh, NC 27604
Mailing Address: 1 636 Mail Service Center
Raleigh, N.C. 27699-1636
FAX: [phone]
[phone]
ISl09
Date: �
FAX TO: I t�uz.0 <
FAX NUMBER:
FROM: rice_ &
PHONE:
NO. OF PAGES INCLUDING THIS SHEET:
if you receive this fax by mistake call: Aquifer Protection Section @ 919-733-3221

Ap711
NCDENR
North Carolina department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
lune 1, 2009
Robert C. Gimpel
Sybie Soloman
421 Blackbeard Road West
Wilmington. NC 28409
Subject: Acknowledgement of Application No. WI08001.68
Robert C. Gimpel & Syble Soloman
Surface Irrigation System - SFR
New Hanover
Dear Robert & Syble::
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on May 27, 2009- This application package has been assigned the number listed above and will be reviewed by
Michael Rogers.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days after receipt of a complete
application.
If you have any questions, please contact Michael Rogers at 919-715-6166, or via e-mail at [e-mail]. If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to hill-+:/fh2o.enr.state.nc.usfdocuments/dorechart.lidf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHF'N MAILING TNQUIR10ES ON THIS PROJECT.
Sincerely,
A.
for Debra J. Wa'
Supervisor
cc: Wilmington Regional Office, Aquifer Protection Section
Nate Carr (O'Brien Heating & A/C - 3308 Enterprise Dr., Wilmington, NC 28405)
Permit Application File WIO800168
AQUIFER PROTECTION SECTION
1636 Mail Service Center Raleigh. North Coruna 27699-1636
Location: 2728 Capra' Boulevard, Raleigh, North Carolina 27604
Prone: y19.733-3221 1 FAX. [phone]-D58 ; FAX 2:919-715.60481 Customer Service: 1.877•623.6748
Internet www,ncwetergualtty,orq
An Equal Oppornm,ty Aifirmalive:. on Employer
Dne
N Ol-4hh Carolina
2atura if

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 5-A 7 WELL(S)
_ _.X'-'--_New Permit Application OR ____ Renewal (check one)
DATE: Iha.&/ ,2012!J_
PERMIT NO. ________ (leave blank if NEW permit application)
A. PROPERTY OWNER(S)/APPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative w/authority for signature): 'i<ohert a. G10, pL I a ,1. d
cs y ble-Solo m'41
(1) Mailing Address: '-/ '2/ 'BlacJl bea.rd Road We s I--
City: w,·1 m, ~ mn State: ~Zip Code: Z8tlo't County: Nt /U 1--/4,,,,vw
Home/Office Teleo.: qJD ... 3qq -2 2,QO Cell No.:
EMAIL Address: b e.,, I f'). '7--~ J ~,. ~ ~
(2) Physical Address of Site (if different than above): _______________ _
City: _________ State: __ Zip Code: ______ County : ____ _
Home/Office Tele No.: Cell No.: -----------=~~----------
EM A IL Address: ______________ _
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name: AppAJ fe'.5tJV (U!,.. ~ f C.
Contact Person: J lr) ~flt)/.k.~EMAIL Address: "Jim -Al?Jn @. btJJ&nJU, .nt,;J.
Address: J'.O. 'Box 882
City: Ha.mp:skar/ State:Ll,I(.. Zip Code: Z8f'I$ County: 1J.e.nder
Office Tele No.: q/£2 -J.]{)..,. 2 9/9 Cell No.: q/0-,5t2 -t/8'f O
Website Address of Company, if any: \tJWW, Al2J'Yl -'PC.-CAA .
GPU/UIC 5A 7 Well Permit Application (Revised 9/2007)
RECEIVED/ DENR / owa
Aquifer Protection Section
MAY 27 2009
Page I
C. WELL DRILLER INFORMATION
Company N3Jile: Appl, u/ ~ C€.. fhan"J: n,,-4¢ JJ: C ,
Well Drilling Contractor's Name: ::J:r me.s L ~ror,:;e #e...
NC Contractor Certification No.: ~2=-4_._.'W"""~---------------------
EMAIL Address: :J,o-, -Min € ~//&wtJ, • 11..t.J/-. Contact Person: .::r;tn C!.o-rne:tk.
Address: 'P. 0. '&)(' 8 82
City: lkmpskarl Zip Code: ~3 County: _k~l"")_/,(J_~Z.,,--~------~
Office Tele No.: t/Jo--21tJ-Z9/9 Cell No.: filtJ-S/2 -t/$10 _VA';< d ':fcl -J-788
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: O'&,ea lkl/hoq ll nc/ _A,L (t;oclt 0'1Ylt0tf
Contact Person: /vo k LA,lr U EMAIL Address: J
Address: 33:?S: OJ kLpn ·s, 'Dr.
City: w,1fh,~/z;t.o Zip Code: z8J./{}s-County: NtvJ J.knave.r:
OfficeTeleNo .. 910-79f/-ft~// CellNo.: _______ _
E. STATUS OF APPLICANT
Private: V
State:
Federal:
Municipal: __
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
"Pe«$SJv'L 1¥1 £'/lrnhor, of we ll wake ()SL @r r'lkLm,i-l
h£A f t;/ChMr--
G. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
H.
(I)
(2)
The injection operation?
Personal consumption?
YES ___ _ NO ~>( __ _
YES ___ _ NO ..... X'---'----
WELL C9NSTRUCTION DATA (Ski p to Section I if this is a Permit RENEWAL)
(1)
(2)
✓ 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 Form GW-1 (Well Construction
Record) if available
Date to be constructed: 5/z.57vf Number of borings: ~z_ __ _
170 , (I I Approximate depth of each boring (feet): ___ __,__,___,,"'--'-'-L'-' (JI)
Well casing. Is the well(s) cased? (check either (a.) YES .2! (b.) NO below)
(a) YES \/ If yes, then provide the casing information below.
Type: Galvaniz:d steel __ Black steel __ Plastic / Other (specify) ______ _
Casing thickness:~ diameter (inches): l/ depth: from _,. to/ (;0 ft. (reference to land surface)
Casing extends above ground '7 /2.. inches
GPU/UIC 5A7 Well Permit Application (Revised 9/2007) Page 2
I.
(b) NO
(3) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement__ Bentonite __l{_ Other (specify) _______ _
(b) Grouted surface and grout depth (reference to land surface):
___ Around closed-loop piping; from ____ to ___ (feet).
X Around well casing; from O to ) ZD (feet).
(4) Well(s) Screen Information
Depth of Screen: From ____ to ____ feet below land surface
(5) N.C. State Regulations (Title 15A NCAC 2C .0200) require the Permittee to make prov1s1ons for
monitoring wellhead water quality and processes. A faucet on both Influent (groundwater entering heat
pump) and Effluent (water being inje~tejl back into the well) lines is required. Will there be a faucet on:
(a) Influent line? Yes_~_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 Form GW-1 (Well Construction Record). If Form GW-1 is not available, provide the
following data:
NOTE:
Groundwater Source. From what depth, formation, and type of rock/sediment units will the groundwater
be withdrawn? (e.g. granite, limestone, sand, etc.)
Depth: 0 Formation:'P-t.l f)e,p.. Rock/sediment unit: San.rJob,o t_
THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR PROPOSED WELLS IF
THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
OPERATING DATA
Average (daily) L /5 gallons per minute (gpm).
Average (daily)(. 21' ~allons per day (gpd).
(1) Injection rate:
(2) Injection Volume:
(3)
(4)
Injection Pressure:
Injection Temperature:
Average (daily) L. / S pounds/square inch (psi).
Average (January) ~0 ° F, Average (July)~° F.
J. INJECTION-RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
K. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(1) Include a site map (can be drawn) showing: buildings, property lines, surface water bodies, potential sources
of groundwater contamination and the orientation of and distances between the proposed well(s) and any
existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 1000 feet of the
geothermal heat pump well system. Label all features clearly and include a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
GPU/UIC 5A 7 Well Permit Application (Revised 9/2007) Page 3
L. CERTIFIC.ATION
Note; This Permit Application nnust be signed by each person appearing on the
recorded teed property deed.
-i hereby certify, ender penalty of law. that I have personally examined and am familiar with the infarznitian
submitted in ihis docutaeat and all attachments thereto and that, based on ray inquiry of those individuals
imabediateiy eesportslidc For obtaining said information, f believe that the information is trUo, accurate and complete.
I am aware that there are signifiicatt penalties, including the possibility of fines and imprisonment, for suhmiring
false information, %agree to conatmet, operate. makatekri, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the approved specifications and conditions of the Petxxdc."
GrmP6 c
Fri* >r Type Full Name
)/C1L1L)
of Property Owner/Applicant
r-
5�f (ate 5j 0 vi —+i
Print or type Rail Istwarg fr
Signature of Authorized Agent, i�
.„„—• et- rtt s
Priam or Type Full Name
Please return two aupies of the completed Appbiaatiion package to:
North Carolina DENR-DWQ
Aquifer Protection Section
[TIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
0d
GPt 7.1C M7Wen Permit Application (Revised 9'2007) Page 4
RECEIVED I DENR r DM/
Aquifer Prottctan SeciOn
MAY 27 2009

moiled Resource Management, EC.
May 22, 2009
NCDENR, DWQ, APS
UIC Program
Attn.: Mr. Mike Rogers
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Re.:
Well Permit Application for
421 West Blackbeard Road
Wilmington, North Carolina
Dear Mr. Rogers,
Enclosed is a permit application for a residence at the referenced address. This permit
is for the purpose of installing two (2) wells for Injection with a Geothermal Heat Pump
System. Ms. Bernice Johnson with the Cape Fear Water and Sewer Authority confirmed
on Thursday May 14, 2009 that the surrounding area was connected to their services for
both water and sewer. Also, a roadside well survey was conducted on May 11, 2009, and
no wells were observed in the surrounding area.
The wells will each be approximately 170' and 100' in depth and 4" SCH40 PVC casing will
be used. The proposed drilling date is May 25, 2009.
Thank you for your help.
Sincerel
James L`errr e' P.G.
Project Manager
encs.
cc. O'Brien Heating and Air, wiencs.
RECEIVED / DENR I DWQ
Aquifer Protection Section
MAY 27 2009
Pa box 882
Rompaeaei, NC 28443
910.270 2919
FAX [phone]

Note: Adapted from USGS Wrightsville Beach, NC Topographic Quadrangle (1970).
TITLE: SITE VICINITY MAP
7kpclieci Resource Management PC
JOB: PO. Box ad, Hamperead, MC 28443 SCALE: DATE: DRAWN BY:
[phone] FAX [phone] WW -1"= 2,000' 105/07/09 KLC
FIGURE:

Map adapted from Google Earth Image, May 2009
Note: Properties are in this area are on sewer service.
Approximate Well Locations
Approximate Property Line
1,000' Radius Line
.� Irnaa�e 72!+, e_,H nover County, NC
4.
A(
pplied Resource Mat1agement f C
P0. Box 882, Hampstead, NC 28443
910) 270-2919 FAX [phone]
TITLE:
JOB:
ww
Hewlett's Creek
SITE MAP
421 W BIACKBEARD ROAD
SCALE: DATE: DRAWN BY:
As Shawn 05/07/09 DNH
FIGURE:
1

Approximate Well Locations
Approximate Property Line
Map adapted from New Hanover GIS, May, 200C
Note: Properties are in this area are on sewer and water service provided by
Cape Fear Sewer and Water Authority.
TITLE:
F,lied R ource Mana ement PC
7tk
O, Box 882, Hampstead, NC 28443 JOB: SCALE: DATE: DRAWN BY:
910) 270-2919 FAX [phone] \NN 1 „ = -50' 05/07/09 DNH
SITE MAP
421 W BLACKBEARD ROAD
FIGURE:
3

r.,KirtrturN3111111
20094 1 e:68
FOR FtSt MSjf aIr ram nF DEvs
iz�rrr [ lf2747 P1i
BK1539 1tTjsNC 1,3fi3J
i ION I 11Ai81
NORTH CAROLINA GENERAL WARRANTY DEED
Prepared by: James S. Price & Associates
5125 Oleander Dr., STE C-3
Wilmington, NC 28403
Return to: James S. Price & Associates
Excise Tax: $1,363.00 0 Parcel 11NO R06
Brief Description for the Index: Lot 35 of PIRATES COVE
THIS DEED, made this" s day of March 2009, by and between:
GRANTOR
Loretta S. Nobel, unmarried
GRANTEE
Robert C. Gtagpel and wife,
Syble Solomon
Mailing Address:
421 Blaekbesrd Road West
Wilmington, NC 28409
The designation Grantor and Grantee as used herein shall include said parties, their heirs,
successors, and assigns, and shrill include singular, plural, masculine, feminine or neuter as
required by context.
WITNESSED", that the Grantor, for a valuable consideration paid by the Grantee, the receipt
of which is hereby acknowledged, has and by these presents does grant, bargain, sell and convey
unto the Grantee in fee simple, all that certain lot or parcel of land and none particularly
described as follows:
BEING ALL of Lot 35 of PIRATES COVE, as the sane it skews so a snap
thereof recorded in Map Book 10, Page 48 of the New Hanover County
Registry, reference to which is hereby swede for a more particular
LESS AND EXCEPT that certain parcel of lend conveyed A Reg C. Healy
and wife, Cyathla G Heady n Hook 1454 at Page 259; further described as:
BEGINNING at a pant that marks the Wextera dividing censer between
Lob 34 and 35 as sheen as a sup of Pirates Con recorded is Map Book 10,
rage 48 of the New Hanover Canty Registry; running theme frost begins/rig point mules the dividing lire between the 0� Late 34
add 35 South 84 degrees S0 tweet East 10E78 feet ere a paint at the edge of
the marsh; running thence with he edge eel the marsh Sends 44 &te ees 21
aeiarries West LS.0 feet to a pet numbs &Met Nerds 77 degrees 49
odnetes 15 seconds West 100.0 feet to a pone is the Eastern right of way Rue
ei Blacid,arrd Road, said point bong imbed Sands 02 degrees 58 eesiantes 30
seeaads West LO het from the point of begjeniaj ranui-g the with the

Eastern right of way line of Blickbeard Road as It curves to the West to the
point of beginning, sad being part of Lot 35 as ehowa on a map of Pirates
Cove recorded in Map Book l0, Page 411 of the New Hanover County
Registry.
SUBJECT TO the Protective Covenants of Pirate Cove recorded in Book
869, Page 619 of the New Hanover County Registry, and any amendments
thereto; and ell rarreats and rigs of way of rsc+ord, ell governreabd land
age statatsg, vrdiaaaces and regabttioas, hue add zaul■g< sobdivWan and
building reguladons.
Also being the sage property described in that deed to Loretta S. Nobel
recorded September lily 2006 la Hoek S J06 Page 1977 of the aforemeadened
TO HAVE AND TO HOLD the aid lot or parcel of land and all privileges and
appurtenances thereto belonging to the Grantee in flee simple.
Aad the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee
simple, has the right to convey the same in floe simple, that tide is marketable and free and clear
of all encumbrances, and that Grantor will warrant and defend the tide against the lawful claims
of all persons whomsoever except for the exceptions der stated
Tide to the property bereinebove described is subject to the following exceptions:
1. Rights of way and easements ofrecord, if any.
2. Zoning and/or subdivision ordinances and relations, if any.
3. Restoctive covenants of record, if any.
4. Ad valorem taxes for 2009 and subsequern years.
IN WITNESS WHEREOF, the Grantor has hereants set kb Mad end anal, or if corporate,
has canted tkb instrument to he aiRaed In its corporate mare by its duly entkorlaed
otlfcer(s), the day and year first above rotten.
(SEAL)
Loretta S. NobeI
Bar (SEAL)
State of_____________________
County of LAM *MC V.Y
I certify that the following person(s) ply appeared before inc this day, having been
properly identified by a driver's licxaise or other photo ideanii6cation, each acknowledging to n
that he or she voluntarily signed the foregoing document for the impose stated therein and in the
capacity indicated:
Lonnie S. Nobel, namanried
Witness my hand and notarial seal, this _ 2.14 day of MLWt Y► , 2009.
Typed or Printed Name of Notary
My Commission Expires: ( 701

JENNIFER H. MACNEISH
REGISTER OF DEEDS, NEW HANOVER
216 NORTH SECOND STREET
WILMINGTON, NC 28401
Flied For Registration: 03/27/2009 01:43:47 PM
Book: RE 5391 Page: 1114-1118
Document No.: 2009010681
3PGS $17.00
NC REAL ESTATE EXCISE TAX: $1,363.00
Recorder: JOHNSON, CAROLYN
State of North Carolina, County of New Hanover
PLEASE RETAIN YELLOW TRAILER PAGE WITH ORIGINAL DOCU MENT.
*2009010681*
2009010681
Sanitary Well Electric Line
Seal To Service
4" Well Casing
> t 2" Above Grade
Castle Hayne
Limestone
Aquifer 1 I I
Pee Dee
Limestone I 1 I
Aquifer I I I
r 1
I 1 1
I 1 I
I I I
IT
Water To
Heat Exchanger
� 1111-� -
1111-111I
1111 - "
1111 - Min, 20' Grout
Seal
1111_
1111
w 1111
• 1111-
'III Submersible
IEiI -
Pump
�1111T
▪ 1111=
-E 1111
1111-
1111
111 Casing Bottom
Grout Seal
r-�
Ii1I1
1 1 r I
111
1 1 1 Ii
1111
I1L111!1
1 I I_ 1 f
11 1 1
111 IFI 1
r r 1 r 1
i 1 1
1 1 I I f 1 I I I I
I_LTTrTi 1 111 1r] i l i
Approx. 17 0'
Total Well Depth
Water From
Heat Exchanger
>
Sanitary Well Seal
4" Well Casing
1111 1111 I,,.
1111
1111 Min. 20' Grout
Seal
1111
• 1111-
1111..
▪ 1111
1111= Annular Packer
=2j/ To Minimize Oxygen
IIII : Contact
• 1111
III!
1111-
u1I-
1II1= Casing Bottom
Grout Seal
r l 1
I 1
Castle Hayne 1 ! 1
Limestone I I 1
Aquifer " 1 r Lr I
1 I I_
1111
1 r
f11 1 1! 1 11 11 f 1] 11 I r 1
_LI_ 1 1 1 1 1 i 1
Approx. 100'
r Total Well Depth
-710\-.-
ppliec1 Resource Marialemert C'C
P.O. Box 882, Hampstead, NC 28443
[phone] FAX [phone]
TITLE:
Geothermal Well Pair
JOB: SCALE: DATE: DRAWN BY:
WW NTS 5/19/09 JLC
FIGURE:
1