WI0800218_GEO THERMAL_20160314

ROY COOPER
Governor
MICHAELS. REGAN RECEIVED
JAN 12 202\
NCDEQ/DWR
central Office
Secretary
S. DANIEL SMITH NORTH CAROLINA
Environmental Quality Director
December 29, 2020
CERTIFIED MAIL# 7009 2250 0000 8087 1627
RETURN RECEIPT REQUESTED
Michael & Cheryl Mc Williams
3605 Owencroft Ct.
Wilmington, NC 28409
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No. WI0800218
New Hanover County
Dear Mr. & Mrs. Mc Williams:
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 January 27, 2015, and expires on December 31, 2020. Per permit conditions and
requirements per 15A NCAC 2C .0224(c), the renewal application must be submitted at least 120
calendar days prior to expiration of the permit if you wish to continue operating the injection well
on your property.
If Your Geothermal Water Return Well is Still Currently Being Used for In jection:
In order to comply with the regulatory requirements listed under North Carolina Administrative
Code (NCAC) Title ISA, 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.or g/web/wq/ap s/ gwpro/permit-app lications.
If Your Geothermal Water Return Well is NO LONGER Being Used for Injection:
If the well is no longer being used for injection, you do not have to renew your permit. Check the
box in Part A of the attached renewal application that you wish to rescind the permit and indicate
the current status of the well (i.e., used as water supply well, irrigation well, inactive, plugged and
abandoned, etc.). If it is no longer being used for any purpose, it must be permanently abandoned
according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C,
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
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 Chance 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
t]IC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms 30 days before the expiration of the permit ma 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.shresthaircdenr.izov.
Regards,
cArd,ffita
Shristi Shrestha
Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
RECENED
JAN 12 ZOZ
Central pDtfice

North Carolina Department of Environmental Quality-Division of Water Resour~es
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. Illegible Applications Will Be Returned As Incomplete.
DATE: -...,1/,_=b _____ , 20 2 / PERMIT NO. ()J '[O~t>l)J/g (leave blank ifNew Application)
A.
B.
C.
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 {\eeSVSoent
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 0"No
If yes, indicate New Owner's contact information:
JAN 12. 202\
NCDEO/DWR
central Office
Name(s) ______________________________ _
Mailing Address: ____________________________ _
City: __________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: Email Address.:
Non-Government:
STATUS OF APPLICANT (choose one)
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 al! others, list name of business/age and P,ame of person and title with delegated authority
to sign: I t,,(/ / -r (A" ra✓.1//IP,'k'
Mailing Address: J'66 J-{)We'Ut ~ t.1/
City: wtf,,,_,-,.. oh v State: il__Lzip Code: zr r " 5
Day Tele No.: Cell No.: S/()
EMAIL Address: CM M r (.,J ;( /; ,-u f t, yJtl , £,41/lpax No.:
County: _____ _
I, I ] "7/7~
Geothermal Water Return Well Permit Application Rev. 4-15-2016 Page 1
D. WELL OPERATOR (if different from well owner) -For single family residences, list all persons listed on
the property deed. For all others, list name business/agency and name of person and title with delegated authority
to sign: ____________________________ _
Mailing Address: _______________________________ _
City: ____________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: ---------------=E=m=a=il'-"-A=d=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 0, _JJ._
Well Drilling Contractor's Name: ----~-J_p_~_t-_J ___ 6_(i_l"_(/_~{_ { c<!. __________ _
NC Well Drilling Contractor Certification No.: ____________________ _
Co~pany Name: _______________________________ _
Contact Person~: _______________ EMAIL Address: ___________ _
Address: __________________________________ _
City: _________ Zip Code: ____ State: __ County: ________ _
Office Tele No.: ________ Cell No.: ~/0 a7o Jj '\r Fax No.: _______ _
G. HV AC CONTRACTOR INFORMATION (if different than driller)
HV AC Contractor's Name: 6,(£g,,,_I i)O/
H.
I.
NC HVAC Contractor License No.: ________________________ _
Company Name: _______________________________ _
Contact Person~: _______________ EMAIL Address: ___________ _
Address: _________________________________ _
City: _________ Zip Code: ____ State: __ County: _________ _
Office Tele No.: ti) (0 (, \O' oOS""l Cell No.: ________ Fax No.: _____ _
WELL USE Will the injection well(s) also be used as the supply well(s) for the followiyg?
(1) The injection operation? YES ____ NO ./.
(2) Personal consumption? YES ____ NO ✓
WELL CONSTRUCTION REQUIREMENTS -As specified in ISA NCAC 02C .0224{d):
(1) The water supply well shall be constructed in accordance with the water supply well requirements of
ISA 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 ISA 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/or sealing water-bearing zones with 1500
mg/L chloride or greater per 15A NCAC 02C .0107(0(8 )
(t) 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 ISA 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 he selected showing topographk contours or elevation
data
M. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15 A NCAC 02C .01:11 t 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 personas) 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."
cotD
011!
004cia
Gent
Signature/f 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 Page 4

o 001E
OUALI Y
March 10, 2016
Michael and Cheryl McWilliams
3605 Owencroft Court
Wilmington, NC 28409
Subject Geothermal well sampling results
Permit Number WI0800218 Water Quality
New Hanover County Regional OPera1lono seakin
PAT MCCRORY
GOVelnu..
DONALD R. VAN DER VAART
Setsvuoy
S_ JAY ZIMMERMAN
RECEIVED/NCDEO/DWR
Dear Mr. & Mrs. McWilliams:
MAR 14 2016
On January 11, 2016 staff from the Division of Water Resources sampled the influent and effluent lines of
your geothermal underground injection well heat pump system. The samples were analyzed by the
Division's laboratory for coliform, total dissolved solids, metals, nitrates and other inorganic constituents.
No exceedances of the State Groundwater Standards were observed. A copy of the lab results are
enclosed for your review.
Should you have any questions concerning this letter, please feel free to contact me at [phone] or
by email at geoff.kegley�}a ncdenr.gov.
Sincerely,
Geoff Kegley
Water Quality Regional Operations Section
'Wilmington Regional Office
Division of Water Resources, NCDENR
Enclosure: sample results
cc: Michael Rogers, DWR Central Office
State of North Carolina Department of En►5ronmeotal Quality I Divisicn of WaterRcsoorces
127 Cardinal Thine Ext., Wihaingtnn, NC 23405
919 7967215

AC25569
TYfrilik Water Sciences Section -Chemistry Laboratory Jesuits
County.
River Bes1n
Report To
New Hanover
NA
WIRO
Collector: G KEGLEY
Region: WIRO
Sample Matrix: GROUNDWATER
Loc. Type. Water SUPPLY
Emergency Yes/No
COC Yes/No
DWR
Division of Water Resources
Final Report
VisitID
Lac. Descr.: MCWILLIAMS GEOTHERMAL WI0800218
Sample ID:
PO Number #
Date Received:
Time Received:
Labwarks LoginI❑
Final Report Date:
Report Print Date:
AC25569
1800006
01/12/2016
08.40
MSWIFT
2P1116
02/01 /20113
Location ID: WIROAPNLC
Collecl Date: O1/11/2015
Collect Time: 13:00
Sample Depth NA
If this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
CAS # Analyte Name
LAB
Sample temperature ai_receipt_bxlab
PIM
Result)
Qualifier
2.4
Units
°C
Method Analysis Validated by
Reference Date
1/12/16 MSWIFT
MIC
Coliform, MF Fecal in liquid
1
182Q1 CFL111O0ml APHA9222D-20th 1/12/16 ESTAFFORD1
Coliform, MF Total in liquid
1
1 B2Q7 CFU/100m1 APHA9222B-201h 1/12/16 ESTAFFORD1
WET
Ion Chromatography
_TITLE_
mg/L EPA 300.0 rev2.1 1/19/16 CGREEN
Fluoride
0.4 0.4 U mg/L EPA 300.0 rev2.1 1/19/16 CGREEN
Chloride
1_Q 51 mg/L EPA300.0 rev2.1 1119116 CGREEN
Bromide
0.4 0.4 U mg/L
EPA 300.0 rev2.1 1/19/16 CGREEN
Sulfate
2.0 2.8 mg/L EPA 300.0 rev2.1 1/19/16 CGREEN
Total Dissolved Solids in liquid
12 289 mglL SM 2540 C-1997 1/14/16 CGREEN
NUT
N024-NO3 as N in liquid
0.02
0.02 U mg/L as N EPA353.2 REV 2 1/13/16 CGREEN
MET
744D-22-4 Ag by ICPMS
1.0 1.0 U ug/L
EPA 200.8
1l27116 ESTAFFORD1
7429-90-5 Al by ICP
50 50 U ug/L
EPA 200.7
1/21/16 ESTAFFORD1
7440-36-0 Antimony by ICPMS
10 1a U ug/L
EPA 200.8
1127/16 ESTAFFORD1
7440-38-2 As by ICPMS
2.0 2.0 U ug/L
EPA 200.8
1127116 ESTAFFORD1
7440-38-3 Ba by ICP
10 10 U ug/L
EPA 200.7
1/20/16 ESTAFFORDI
7440-41-7 Be by ICP
5.0 5.0 U ug/L
EPA 200.7
1121116 ESTAFFORD1
7440-70-2 Ca by ICP
0.10
42
mg/L
EPA 200.7
1/20116 ESTAFFORD1
7440-43-9 Cd by ICPMS
0.50
0.50 U ug/L
EPA 200.8
112711E ESTAFFORD1
7440-48-4 Cobalt by ICP
50 5D U ug/L
EPA 200.7
1/21/16 ESTAFFORDI
7440-47-3 Cr by ICPMS
5.0 5.0 U ug/L
EPA 200.8
1127116 ESTAFFORD1
7440-50-6 Cu by ICPMS
2.0
3.6
ug/L
EPA 200.6
1/27/16 ESTAFFORD1
7439-69-6 Fe by ICP
50 50 U ugn-
EPA 200.7
1/21/16 ESTAFFORDI
7440-09-7 K by ICP
0.10 5.7 mg/L EPA 200.7
1/20/16 ESTAFFORD1
7439-93-2 Li ICP
25 25 U ug/L
EPA200.7
1/20/16 ESTAFFORD1
7439-95-4 Mg by ICP
0.10 14 mg1L EPA200.7
1/20/16 ESTAFFORD1
7439-96-5 Mn by ICPMS
10 10 U use
EPA 200.8
1/21/16 ESTAFFORDI
WSS Chemistry Laboratory»' 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed deserialion o} Ma adareer codes Mar ro<hUD://porta1.nedenr.or2/web/wo/ons/methods-and-tauls>
Page 1 of 2

:NC (l)'W\1t La6oratory Section ~sufts
Location ID: WIROAPNLC Sample ID: AC25569 Collect Date: 01/11/2016 Collect Time:: 13:00
MET
CAS# Anal yt e Name PQL Result/ Units Method. Analysis
Qualifier Reference Date
7439-98-7 Mo by ICPMS 10 10 U ug/L EPA200.8 1/27/16
7440-23-5 Na by ICP 0.10 50 mg/L EPA200.7 1/20116
7440-02-0 Ni by ICPMS 2.0 2.0U ug/L EPA200.8 1/27116
7439-92-1 Pb by ICPMS 2.0 2.0U ug/L EPA200.8 1/27/16
7782-49-2 Se by ICPMS 1.0 1.0U ug/L EPA200.8 1/27116
7440-28-0 Thallium (Tl) ICPMS 2.0 2.0U ug/L EPA200.8 1/27/16
7440-62-2 V by ICP 10 10U ug/L EPA200.7 1121/16
.7440-66-6 Zn bylCPMS 10 10U ug/L EPA200.8 1127/16
Sample Comments
Geothermal Wells -Sou~e Well
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed descrlotion of the QUalifoercodes refer to <httu://oortal.ncdenr.onz/web/wa/oos/methods-and-oals>
Page 2 of2
Validated by
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
AC25570 :NC (})'WR_ Water Sciences Section-Cliemistry £a6oratory 1?.§su{ts
County :
River Basin
Report To
Collector:
New Hanover
WIRO
G KEGLEY
Region : WIRO
Sample Matrix: GROUNDWATER
Loe. Type : Water Supply
Emergency Yes/No
COC Yes/No
DWR
Division of Water Resourc.es
Final Re p ort
VisitlD
Sample ID:
PO Number#
Date Received:
Time Received:
Labworks LoginlD
Final Report Date:
Report Print Date:
AC25570
16G0007
01/12/2016
08:40
MSWIFT
2111/16
02/11/2016
Loe. Descr.: MCWILLIAMS GEOTHERMAL WI0800218
I Location ID: WIROAPNLC I Collect Date: 01/11/2016 I Collect Time: 13:15 l Sample Depth NA I
ff this report is labeled preliminary report, the results have not been validated. Do not use for Regulatory purposes.
CAS#
LAB
Anal yt e Name PQL Result/
Qualifier Units Method
Reference
Analysis Validated by
Date
Sample _tempe_rat.ure at..rec;~iptJ~y Jgf;!______ _____________ ____ 2.4 oc 1/12/16 MSWIFT
MIC
Coliform, MF Fecal in liquid 1 B2Q1 CFU/100ml APHA9222D-20th 1/12/16 ESTAFFORD1
Coliform, MF Total in liquid 1 82Q1 CFU/100ml APHA9222B-2oth 1/12/16 ESTAFFORD1
WET
Ion Chromatography _TITLE_ mg/L EPA 300 .0 rev2 .1 1/19/16 CGREEN
Fluoride 0.4 0.4U mg/L EPA 300.0 rev2 .1 1/19/16 CGREEN
Chloride 1.0 52 mg/L EPA 300.0 rev2.1 1/19/16 CGREEN
Bromide 0.4 0.4U mg/L EPA 300 .0 rev2.1 1/19/16 CGREEN
Sulfate 2.0 2.8 mg/L EPA 300.0 rev2.1 1/19/16 CGREEN
Total Dissolved Solids in liquid 12 283 mg/L SM 2540 C-1997 1/14/16 CGREEN
NUT
N02+N03 as N in liquid 0.02 0.02 U mg/Las N EPA 353 .2 REV 2 1/13/16 CGREEN
MET
7440-22-4 Ag by ICPMS 1.0 1.0 U ug/L EPA200.8 1/27/16 ESTAFFORD1
7429-90-5 Al by ICP 50 sou ug/L EPA200.7 1/21/16 ESTAFFORD1
7440-36-0 Antimony by ICPMS 10 10 U ug/L EPA200.8 1/27/16 ESTAFFORD1
7440-38-2 As by ICPMS 2.0 2.0 U ug/L EPA200.8 1/27/16 ESTAFFORD1
7440-38-3 Ba by ICP 10 10 U ug/L EPA200.7 1/20/16 ESTAFFORD1
7440-41-7 Be by ICP 5.0 5.0 U ug/L EPA200.7 1/21/16 ESTAFFORD1
7440-70-2 Ca by ICP 0.10 43 mg/L EPA200.7 1/20/16 ESTAFFORD1
7440-43-9 Cd by ICPMS 0.50 0.50 U ug/L EPA200.8 1/27/16 ESTAFFORD1
7440-48-4 Cobalt by ICP 50 sou ug/L EPA200.7 1/21/16 ESTAFFORD1
744047-3 Cr by ICPMS 5.0 5.0 U ug/L EPA200.8 1/27/16 ESTAFFORD1
7440-50-8 Cu by ICPMS .2.0 2.0 U ug/L EPA200.8 1/27/16 ESTAFFORD1
7439-89-6 Fe by ICP 50 sou ug/L EPA200.7 1/21/16 ESTAFFORD1
7440-09-7 _K by ICP 0.10 5.7 mg/L EPA200.7 1/20/16 ESTAFFORD1
7439-93-2 Li ICP 25 25U ug/L EPA200.7 1/20/16 ESTAFFORD1
7439-95-4 Mg by ICP 0.10 14 mg/L EPA200.7 1/20/16 ESTAFFORD1
7439-96-5 Mn by ICPMS 10 10U ug/L EPA200.8 1/21/16 ESTAFFORD1
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
For a detailed description oflhe aualifier codes refer to <htto:/ /oortal.ncdenr.onz/web/wa/oos/methods-and-oals>
Page 1 of 2
:NC ID'U-'\1c La6oratory Section CR.!sults
Location ID : WIROAPNLC Sample ID: AC25570 Collect Date: 01/11/2016. Collect llme:: 13:15
MET
CAS# Anal yt e Name POL Result/ Units Method Analysis
Qualifier Reference Date
7439-98-7 Moby ICPMS 10 10 U ug/L EPA200.8 1/27/16
7440-23-5 Na by ICP 0.10 50 mg/L EPA200.7 1/20/16
7440-02-0 Ni by ICPMS 2.0 2.0 U ug/L EPA200.B 1/27/16
7439-92-1 Pb by ICPMS 2.0 2.0 U ug/L EPA200.B 1/27/16
7782-49-2 Se by ICPMS 1.0 1.0 U ug/L EPA200.8 1/27/16
7440-28-0 Thallium (Tl) ICPMS 2.0 2.0 U ug/L EPA200.B 1/27/16
7440-62-2 V by ICP 10 10 U ug/L EPA200.7 1/21/16
7440-66-6 Zn by ICPMS 10 10U ug/L EPA200.8 1/27/16
Sample Comments
Geothermal Wells -Prior to injection
WSS Chemistry Laboratory» 1623 Mail Service Center, Raleigh, NC 27699-1623 (919) 733°3908
For a detailed desMption of the oualifiercodes refer to <htto:/ /oortal.ncdenr.ofl!/web/wa/oos/methods-and-oals>
Page 2 of 2
Validated by
ESTAFFORD1
ESTAFFORD1
ESTAFFOR01
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
ESTAFFORD1
Permit Number
Program Category
Ground Water
Permit Type
WI0800218
Injection Heating/Cooling Water Return Well
Primary Reviewer
michael.rogers
Coastal SWRule
Permitted Flow
Facility
Facility Name
Michael and Cheryl McWilliams SFR
Location Address
3605 Owencroft Ct
Wilmington NC
Owner
Owner Name
28409
..
Michael McWilliams
Dates/Events
Orig Issue
12/17/2010
App Received
12/4/2015
Regulated Activities
Heat Pump Injection
Outfall
Waterbody Name
Draft Initiated
Scheduled
Issuance Public Notice
Central Files : APS SWP
1/25/2016
Permit Tracking Slip
Status
In review
Version
Project Type
Renewal
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Wilmington
County
New Hanover
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Michael McWilliams
3605 Owencroft Ct
Wilmington
Issue Effective
NC 28409
Expiration
Requested /Received Events
RO staff report requested
RO staff report received
Streamlndex Number Current Class
12/11/15
1115/16
Subbasin
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Water Resources
ENVIRO.NMENT AL QUALITY
Michael and ·Cheryl M¥ Williams
3605 Owencroft Court
Wilmington, NC 28409
Re: Issuance of Injection Well Permit
Permit-No. WI0800218
January 21, 2016
Geothermal Heating/Cooling Water Return Well
. New Hanover County _· ·
Dear Mr. and Mrs. Mc Williams:·
Secretary
S. JAY ZIMMERMAN
Director
In accordance with your permit renewal application received December_ 4, 2015, I am forwarding
Permit No. WI0800218 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 December 31, 2020, and shall be subject to the conditions and limitations stated therein.
Please Note:
• Samples from the influent and effluent sampling ports of your ge.othermal well system
were collected on .January 11, 2016. Laboratory analytical results will be fonvarded 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 Direc~oi-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,
~{!_~
Michael Rogers, P.G.v (N6~ FL)
Underground Injection Control (UIC) Manager -Hydrogeologist
Division of Water Resources, NCDEQ
Water Quality Regional Operations Section
State ofNorth Carolina I Environmental Quality I Water Resources
1611 Mail service Center I Raleigh, Nonh C_arolina 27699-16 1 J
919707 9000
cc: Jim Gregson and Morella Sanchez-King, Wilmington Regional Office
Central Office File, WI0800218
New Hanover County Environmental Health Department
Page 2 of2
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143; and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Michael and Cheryl McWilliams
FOR THE CONTINUED OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER
RETURN WELLS), defined in Title 15A North Carolina Administrative Code 02C .0224(a), which will be used
for the injection of heat pump effluent. The injection well(s) located at 3605 Owencroft Court, Wilmington, New
Hanover County, NC 28409 will be operated in accordance with the application submitted December 4;2015,
and conformity with the specifications and supporting data received, all of which are filed with the Department
of Environmental Quality and are considered a part of this permit.
This permit is for continued operation of an injection well shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until December 31, 2020, and shall be
subject to the specified conditions and limitations set forth in this permit
Permit issued this the 27th day of January 2016.
tio*;
,.. `S. Jay Zimmerman, P.G.
®® Director, Division of Water Resources
By Authority ofthe Environmental Management Commission_
Permit #W1O30O218
UlC/5A7
vcr. 1 I Il 5/2015
Paee I of 5

p ART I -PERMIT GENERAL CONDITIONS
I. The Pennittee shall comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is grounds
for enforcement action as provided for in N.C.G.S. 87-94
2. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data [15A NCAC 02C .021 l(a)].
3. This permit shall become voidable unless the facility is constructed in accordance·with the conditions of
this permit, the approved plans and specifications, and other supporting data [15A NCAC 02C .021'1(1)].
4. This permit is not transferable without prior notice and approval. In the event there is a desire for the facility
to change ownership, or there is a name change of the Permittee, a formal permit amendment request must
be submitted, including any supporting materials as may be appropriate, at least 30 days prior to the date of
the change [ISA NCAC 02C .021 l(q)].
5. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthennore, the issuance of this permit does · not imply that all
regulatory requirements have been met [15A NCAC 02C .0203].
PART II -WELL CONSTRUCTION GENERAL CONDITIONS
1. The well supplying water for the geothermal heating and cooling system shall be constructed in accordance
with the requirements of rule 15A NCAC 02C .0107 except as required in Item #2 below.
2. · Any injection well shall be constructed in accordance with the requirements of rule 15A NCAC 02C .0107 ·
except that the entire length of the casing shall be grouted in such a way that there is no interconnection of
aquifers or zones having differences in water quality that would result in degradation of any aquifer or zone.
For screened wells, grout shall be em placed from the top of the gravel pack to the land surface. For open-
end wells, the casing shall be grouted from the bottom of the casing to the land surface [15A NCAC 02C
.0224( d)(2),(3 )].
3. Bentonite grout shall not be used to seal any water-bearing zone with a chloride concentration equal to or
greater than 1,500 milligrams per liter. In areas where elevated chloride levels are known to exist or are
probable, such as coastal areas, chloride levels shall be verified in the field to determine existing conditions.
[15A NCAC .0225(g)(8)J.
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)J.
5. Each well shall be secured to reasonably insure against unauthorized access and use and shall be sealed
with a watertight cap or well seal as defined in G.S. 87-85(16).
6. Each well shall have permanently affixed an identification plate [15A NCAC 02C .01070)(2)].
Pennit #WJ08002 l 8 UIC/5A7
ver. 11/15/2015
Page 2 of 5
7. A completed Well Construction Record (Form GW-1) shall be submitted as described in Part V.5 ofthis
pennit.
PART Ill-OPERATION AND USE CONDITIONS
I. Toe Permittee shall comply with the conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and the rules of ISA-NCAC 02C .0200,
even if compliance requires a reduction or elimination of the permitted activity [15A NCAC 02C ;02110)].
2. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface water
or groundwater resulting from the operation of this facility. In the event that the facility fails to perform
satisfactorily,' including the creation of nuisance conditions or failure of the injection zone to adequately
assimilate the injected fluid,-the Permittee shall take immediate corrective actions that may be required,
such as the repair,.modification, or abandonment of the injection facility [ISA NCAC 02C .0206]. -
PART IV-INSPECTIONS [15A NCAC 02C :021 I(k)]
1. ·Any duly authorized officer, employee; or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable tinie for the purpose of determining compliance with this permit, may
inspect or copy any records that must be maintained under the terms and conditions of this permit, and may
obtain samples of groundwater, surface water, or injection fluids.
2. DWR representatives shall have reasonable. access for purposes of inspection, observation, and sampling
associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary samples of the injection facility's activities.
PART V -MONITORING AND REPORTING REQUIREMENTS
l. 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 [ISA NCAC
02C .0224(±)(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 monitoring or other information that indicates noncompliance with a specific
permit condition, that a contaminant may cause a violation of applicable groundwater quality standards, or
that a malfunction of the injection system may cause the injected fluids to migrate outside the approved
injection zone or area As specified in rule 15A NCAC 02C .021 l(r), noncompliance notification shall be
as follows: •
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence,to the Wilmington Regional'Offi.ce, telephone numbe_r 910-796-7215.
(B) Written notification shall be made within five days of the occurrence and submitted to the addresses
in Item #5 below.
Permit #W10800218 UIC/5A7
ver. 11/15/2015
Page 3 of 5
(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. Tue Pennittee shall record the number and location of the wells with the register of deeds in the county in
which the facility is located. [15A NCAC 02C .0224(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 Extension
Wilmington, NC 28405
PART VI -PERMIT RENEWAL [15A NCAC 02C .0224(c)]
As required by rule an application for permit renewal shall be made at least 120 days prior to the expiration
date of the permit. This permit condition does not apply if the Permittee chooses to discontinue operation
of the well for injection of effluent from the geothermal heating and cooling system associated with this
permit.
Permit #WJOSOO~l.8 UIC/5A7
ver. 11/l5/2015
Page 4 of 5
PART VII-CHANGE OF WELL StATUS [15A NCAC 02C .0240]
1. Procequres for temporarily or permanently abandoning a well are the same as those specified in rule 15A
NCAC 02C .0113. While some ofthcise 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 .Ol 13(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 purp.ose, the
Pennittee shall permanently abandon that injection well in accordance with the procedures specified in ISA
NCAC 02C .Ol 13(b), which include, but are not limited to, the following:
(A)
(B)
(C)
(D)
(E)
(F)
All casing and materials may be removed prior to initiation of abandonment procedures if
such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water.
The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that_ may interfere with sealing operations.
Each well shall be thoroughly disinfected prior to sealing in accordance with rule 15A
NCAC 02C .0111 (b ){1 )(A),(B), and (C).
Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
In 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.·
The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0224(f)(4) within 30 days of completion of abandonment.
5. The written documentation required in Part VII ( 4 )(F) shall be submitted to the addresses specified in Part
V.5 above.
Permit #WJ0~00 2 J 8 UfC/5A7
ver. I 1/15/2015
Page 5 of5
Division of Water Resources
Water Quality Regional Operations Section
REGIONAL STAFF REPORT
Date: 1/11/2016 Permittee(s): Michael & Chervil McWilliams
Permit No.: WI0800218
To: Michael Rogers County: New Hanover
Project Name: Geothermal Open -Loon Infection Well
Regional Login No: Geoff Kegler
I. GENERAL INFORMATION
1. This application is (checkall that apply):❑ SFR Waste Irrigation System ® UIC Well(s)
❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
REceivnNcar:QOWR
JAN 15 Z0 r6
Vi'ater ( ualiry
RetTieni]+ Coa ti;r]S+w:tlan
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Remediation Z Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a. Date of site visit: 1/11/2016
b. Person contacted and contact information: Cheri 1 McWilliams emmcwilliams!a1, ahoo_com
c. Site visit conducted by: Geoff Kegley
d. Inspection Report Attached: ❑ Yes or ® No.
2. Is the following information entered into the BIMS record for this application correct?
® Yes or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For SFR Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude: Method Used (GPS, GoogleTM, etc.);
e_ Regulated Activities / Type of Wastes (e.g., subdivision, food processing, municipal wastewater):
For UIC 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 additionalnages for each site)
a. Location(s):
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude; Method Used (GPS, GoogleTM, etc.); GPS
APS-GPU Regional Staff Report (Sept 09) Page 1 of 4 Pages

.
Division of Water Resources
Water Quality Regional Operations Section
REGIONAL STAFF REPORT
JV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed-loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description of Well(s) and Facilities-New, Renewal, and Modification
1. Type of injection system:
IZ! Heating/cooling water return flow (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 IZI No
3. Are there any potential pollution sources that may affect injection? D Yes IZI No
What is/are the pollution source(s)? . What is the distance of the in jection well(s) from the pollution
source(s)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? 15..fb
5. Quality of drainage at site: IZ! Good D Adequate D Poor
6. Flooding potential of site: IZ!Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? IZI Yes or D No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
Injection Well Permit Renewal and Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation ( e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
0 Yes IZI No. If y es, 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 , ex plain:
3. For renewal or modification of g roundwater remediation permits ( of anv typ e). will
continued/additional/modified in jections have an adverse im pact on migration of the plume or management of
the contamination incident? D Yes D No. If yes, explain:
APS-GPU Regional Staff Report (Sept 09) Page 2 of 4 Pages
Division of Water Resources
Water Quality Regional Operations Section
REGIONAL STAFF REPORT
4. Drilling Contractor: Name:
Address:
NC Certification number:
Complete and attach NEW Injection Facility Inspection Report, if applicable
V. EVALUATION AND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the Application:
This review was conducted for a permit renewal request for an open loop underground
injection geothermal well heat pump system for the Mcwilliams residence. On January
11, 2016, staff visited the home to inspect the well system. Source well water and water
prior to re-injection was sampled for Metals, total and fecal coliform, Nitrates, Chloride
and Total Dissolved Solids. Sampling results will be forwarded to the Central Office when
received. System operation has been normal.
2. Attach new Injection Facility Inspection Form, if applicable
3. Do you foresee any problems with issuance/renewal of this permit? D Yes [8J No . If yes, please explain
briefly. __ .
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:
APS-GPU Regional Staff Report (Sept 09) Page 3 of 4 Pages
Division of Water Resources
Water Quality Regional Operations Section
REGIONAL STAFF REPORT
Condition
Reason
7 Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information;
Issue; ❑ Deny. If deny, please state reasons:
8. Signature of report Preparer(s): +'
Signature of APS regional supervisor: '
Date: °+�1aiaf0
VI. ADDITIONAL INFORMATION AND SITE MAP (Sketch of site showing house and waste irrigation
system, sprat or drip field, location of well(s), and/or other relevant information- SHOW NORTH ARROII j
APS-GPU Regional Staff Report (Sept 09) Page 4 of 4 Pages

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW REQUEST FORM
Date: December 11, 2015
To: Jim Gregson & Morella Sanchez-King
From: Michael Rogers, WQROS-Animal Feeding Operations and Groundwater Protection Branch
A.
B.
C.
D.
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
Permit Number: WI0800218
Applicant: McWilliams
Facilitv Name:
Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renev,,al
E. Comments/Other Information:
D I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above-referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a com pleted W 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 I of 1
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
Water Resources
ENVIRONMENTAL QUALITY S. JAY ZIMMERMAN
December 11, 2015
Michael a:nd Cheryl Mc Williams
3605 Owencroft Comi
Wilmington, NC 28409
RE: Acknowledgement of Application No. WI0800218
Geothennal Heating/Cooling Water Return Well
New Hanover County
Dear Mr. and Mrs. McWilliams:
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit application and supporting documentation received on December 4, 2015. Your application
package has been assigned the number listed above, and the primary reviewer is Michael Rogers.
Central and Wilmington Regional Office staff will perform a detailed review of the
provided application, and may contact you with a request for additional information. To ensure
maximum efficiency in processing permit applications, the Water Quality Regional Operations
Section (WQROS) requests your assistance in providing a timely and complete response to any
additional information requests.
Please note that processing standard review permit applications may take as long as 60 to
90 days after receipt of a complete application. If you have any questions, please contact
Michael Rogers at [phone] or [e-mail] .
cc: Wilmington Regional Office, WQROS
Permit File WI08002 l 8
Sincerely,
.. ~~
f~(" Debra J. Watts, Supervisor
if Animal Feeding Operations & Groundwater
Protection Branch
Division of Water Resources
State of North Carolina i Environmental Quality ' Water Resources
l6ll Mail sen1ce Center I Raleigh, North Carolina 17699-l 61 I
919 707 9000
Director
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR A PERMIT TO CONSTRUCT OR OPERATE INJECTION WELLS
In Accordance With the Provisions of 15A NCAC 02C .0224
GEOTHERMAL HEATING/COOLING WATER RETURN WELLS
These wells inject groundwater directly into the subsurface as part of a geothermal heating and cooling system
/ Renewal* Modification
(check one) New Application
*For renewals complete Parts A-D and I, the signature page.
Print or Type Information and Mail to the Address on the Last Page Illegible Applications Will Be Returned As Incomplete.
DATE: Noixta4r- a 3 , 20 /4—
PERMIT NO. WI U$OO Z Jr
(leave blank if New Application)
A. STATUS OF APPLICANT (choose one)
Non -Government:
Goverrunent:
Individual Residence ti/ Business/Organization
State Municipal County Federal
RECEIVED/DENRIDWR
DEC 442O15
Water Quality Regional
Operations Section
B. WELL OWNERIPERMIT APPLICANT - For individual residences, list owner(s) on property deed. For all
others, list name of entity and name of person delegated authority to sign on behalf of the business or agency: _
14.1 cmi AL/0 Orere ,41c4i-. /i&-1 t _ -
Mailing Address: 05` ad c GW"- Gi
City: ll 0 State/Ut-Zip Code: arvo ] __. County: N fig#06,-
Day Tele No.: _ 'IO - 6I -7/e) e Ce11 No.: i/a ' 7r98P
EMAIL Address: Ci A.jC.W,1''Chr.P (- yzydro, ,GSM Fax Na:_rj - ��� `- �•r'� r
C. WELL OPERATOR (if different from well owner) - For individual residences, list owner(s) on property
deed. For all others, list name of entity and name of person delegated authority to sign on behalf of the
business or agency:
Mailing Address:
City: State: Zip Code: County:
Day Tele No.: .__ Cell No__
EMAIL Address: Fax No_:
D. LOCATION OF WELL SITE - Where the injection wells are physically located:
(1) Parcel Identification Number (PIN) of well site: I.I u2f County: HANOd i4
(2) PhysicaI Address (if different than mailing address):
City: _ State: NC Zip Code:
CIPLVL'IC 5A7 Permit Application (Revised 5/23/20)41 F' ec I

E. 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.: ________ _
F. HV AC CONTRACTOR INFORMATION (if different than driller)
HV AC Contractor's Name:
G.
NC HVAC Contractor License No.: _________________________ _
c:;ompat1:Y Name: ________________________________ _
Contact Person_: _______________ EMAIL Address: ___________ _
Address:------------------------------------
City: __________ Zip Code: _____ State: __ County : _________ _
Office Tele No.: Cell No.: Fax No.: ------------------
WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1)
(2)
The injection operation?
Personal consumption?
YES ___ _
YES ___ _
NO ___ _
NO ___ _
H. WELL CONSTRUCTION REQUIREMENTS -As specified in 15A NCAC 02C .0224.(ill:
(l) 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:
(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.
G P \J/U IC 5A 7 l'ennit Application (Rl'vis ed 5/23.12014) Pa!!e 2
I. WELL CONSTRUCTION SPECIFICATIONS
J.
(1) Specify the number and type of wells to be used for the geothermal heating/cooling system:
I *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)
(c)
(d)
Well casing and screen type, thickness, and diameter
Casing depth below land surface
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(()(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
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.
K SITE MAP -As specified in l SA NCAC 02C .0224 t 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)
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 GJS website. Typically, the property can be searched by
owner name or address. The locatio11 of tlte wells in relation to properly boundaries, houses, septic tanks, other
wells, etc. can the11 be drawn in by hand. Also, a 'layer' can be selected showing topographic contours or
elevation data.
GPU/lJfC 5A7 Permit Application (Revised 5/23/2014) Page 3
L. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .0211(e) requires that all permit applications shall be signed as follows:
1_ for a corporation_ by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive
officer or ranking publicly elected official;
4. for all others: by the well owner (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. 1 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."
<77
Sigr/x[ re oiProperty Owner/Applicant
r.+.."/
Print or Type Full Name
1
Signature of ryiperty Owner/Applicant
Print I Type Full Name
Signature of Authorized Agent, if any
Print or Type Full Name
Submit two copies of the completed application package to:
Underground Injection Control Program
NC Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPUIUIC SA7 Pennii Applieaiinn (Reviaed 5/23/201 1) Page 4

GEOTHERMAL HEATING/COOLING WELL CONSTRUCTION DETAIL
Choose applicable injection Well design and check the appropriate boxes. Fill in depths and details of well construction on
the blank lines provided. Use additional sheets as needed
Open -Hole Well Design
❑ Proposed 0 Existing
❑ Injection; ❑ Supp}y;
❑ Dual Purpose
Land Sillrice
Record Depths Below
Land Surface on Lines
Provided
i Ft, E
(Ft.)
Screened Well Design
❑ Proposed ❑ Existing
❑ injection; ❑ Supply;
❑ Dual Purpose
Return or Supply Line
Casing
Grout
WELL DETAILS
Casing Material:
Casing Diameter (in.):
Casing Thickness (in.):
Grout Type:
(cement, bentonite, or mix)
Screen Material:
Screen Slot Size (in.):
Sand/Gravel Pack
Material
Bentonite Seal
Of present)
Bedrock
Sand/Gravel Pack 0.
Open Hole
Screen
lr
(Ft.)
Record Depths Below
Land Surface on Lines
Provided
(FL)
NC Certified Well Driller Name I>A4\0(
yr - A
Certification #

•
'AVA
NCDENR
North Carolina Department of Environmental Quality
Donald R. van der Vaart Pat McCrory
Governor RECEIVED/DENR/DWR secretary
DECO 4 2015
November 3, 20t'VaterQuality Regional
CERTIFIED MAIL# 7014 1200 0001 3432 8558 Operations -Section
RETURN RECEIPT REQUESTED
Michael and Cheryl Mc Williams
3605 Owencroft Court
Wilmington, NC 28409
Subject: Notice of Expiration (NOE)
Geothermal Water Return/Open-Loop Injection Well
Permit No. WI0800218
New Hanover County
Dear Mr. and Mrs. Mc Williams:
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 December 17, 2010, and expires on November 30, 2015. Perpermit 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. According to our records, the permit renewal application is now past due.
Please submit your renewal application (attached) as soon as possible if you wish to continue using
the well for injection.
If Your Geothermal Water Return Well is Still Currentl · 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 .org/web/wq/aps/ gwpro/permit-applications.
If Your Geothermal Water Return Well is NO LONGER Bein g 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
1636 Mail Service Center, Raleigh, North Carolina 27699-i636
Phone: [phone]\ internet: http://w¼w.ncwa1er.org
An Equal Opportunity\ Affirmalive Action Emp loyer-Made in part by recycled paper
McWilliams SFR Page2
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 Chan ge of Ownership of the Pro pe rtv :
If there has been a change of ownership of the property, an "Injection Well Permit
Name/Ownership Change" Form must also be submitted in addition to the renewal application.
This form is not enclosed but can be found at the website listed above. Please submit the applicable
forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit the applicable forms in a timely manner may result in the assessment of civil
penalties in accordance with North Carolina General Statute 87-94. Thank you in advance for your
cooperation and timely response. If you have any questions, please contact me by phone at (919)
807-6406 or by email at Michael.Rmr:ers (c. ncdem.!.I OV .
Regards,
~ QJ-#~
Michael Rogers, ~-;~(i c & FL)
Hydro geologist
Division of Water Resources
Water Quality Regional Operations Section
Enclosures
cc: Wilmington-Regional Office -\VQROS w/o enclosures
Central Files -Permit No. WI0800218 w/o enclosures
NON ON d■ ES!DENTIAL WELL CONSTRUCTION RECORD
\Irrlli Carolina DcpiIrTlnent 11f klr1 iroimmit and Natural !Zoo arcs- Division ol-ll :ALr f >Il lliR
WELL CONTRACTOR CERTIFICATION ICATION l;r 2-112-A
1. WELL CONTRACTOR:
Donald H. Cummin_is _
Weil Contractor (Individual) Name
Ai' lied ResourceManai:lement P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hams -stead
City or Town
( 910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI 080021 8
OTHER ASSOCIATED PERMIT#tlr appritiaule)
SITE WELL ID #tit appticable) Injection Wei!
NC_ _28443
State Zip Code
3. WELL USE (Check One Box) Monitoring ❑ MunicipallPubiic ❑
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injeciion 0
Irrigation❑ Olt,er i/'(Iist use) Geothermal
DATE DRILLED 12/23/10
4_ WELL LOCATION:
3605 Owencroft Court _
(Street Name, Numbers. Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wtlmlriaton couNTY New Han.
TOPOGRAPHIC / LAN(] SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat ❑Ridge pOther
LATITUDE 34
10 ' 39.0001} " DMS QR
LONGITUDE 77 sT 21-cooa " DMS OR
DD
DO
Latitude/longitude source: VPS Qropographic map
{location of well must be shown Oil a USGS topo map andattached to
this form rf not using GPS)
5, FACILITY (Name of the business where the well is located_)
Facility Name Facility ID# (rf applicable)
Street Address
City or Town State Zip Code
Michap1 Mr.Williarrls
Contact Name
3605 °wtrLcrnft Court
Mailing Address
WiImin❑fcn
City or Town
( 910 ) 617-7198
Area code Phone number
6, WELL DETAILS:
a. TOTAL DEPTH: ? 00'
b. DOES WELL REPLACE EXISTING WELL?
NC 28409
Slate Ztip Code
YES GI NO
c. WATER LEVEL Below Top of Casing: 18 FT.
(Use "+" if Above Top of Casing)
Top
Top
Top
d. TOP OF CASING IS _ 1 FT Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD tgpmy: +60 METHOD OF TEST Airlift
f, DISINFECTION: Type HTH Amount 3f10%
g. WATER ZONES (depth):
Top _ _ Bottom Top Bottom
Top Bottom Top_ Bottom _
Top Bottom Top _ _ _ Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +1 Bottom 150 Ft. 4" sch40 PVC
Top_ Bottom Ft.
Top Bottom Ft.
&. GROUT. • Deplll Material Method
Top 0 Bottom 26 Ft Bentonite Trernriiie_
Top Bottom Ft.
rop Bottom Ft.
9. SCREEN: Depth
Top Bottom
Top Bottom
Top
Diameter Slot Size
Ft. in. in.
Ft. tn. - in.
Bottom _ Ft. in, in
10, SAND/GRAVEL PACK:
Depth
Bottom
Size Material
Ft.
Bottom Ft.
Bottom Ft.
11. DRILLING LOG
Top Bottom
Material
Formation Description
0' / 8' Sand
$' 130' Cia,
30' / 36 _ Coarse Sand
36' 1 80' Sand, cla; l cI . s
80' 1 120' Limestone
120' / 160' Aiternatin1 cia, & rock
160' / 200' Sandstone
12. REMARKS:
I GO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTCO IN ACCORDANCE Win'
15A NCAC 2C, WELL CONSTRUCTION STANOAR0S, AND THA r A COPY OF THIS
R CORO HAS ESEEr,pr;i •VIO Fl o TF1E WELL OWNER
t�- _ .. , _... :1 Ili '' � _l'!`�I' 1 _ 121? 311_0
: SIG, •ATURE OF CE -`. I• '- - L CONT - i.., TOR DATE
Donald H Cummino.
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev 2/09

7
t. WELL CONTRACTOR:
Donald H. Cummings
Well Contractor (individual) Name
Applied Resource Management. P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#WI 0800218
State Zip Code
OTHER ASSOCIATED PERMIT#(irapplicable)
SITE WELL ID #{ir applicable} Supply Well
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial ❑ Agricultural In Recovery D Infection fa
Irrigation❑ Other jt,{(list use) Geothermal
DATE DRILLED 12/21/10
4. WELL LOCATION:
3605 Owencroft Court
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington cowry New Han.
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
°Slope ❑Valley ❑Flat ORidge ❑Other
LATITUDE 34 ' to ' 40.0D0o " DMS OR D❑
LONGITUDE 77 ' 51 • 27,0000 " DMS OR DD
Latitudellongitude source: 114PS propographic map
(location of well must be shown on a USGS tape map andettached to
this form If not using GPS)
5, FACILITY (Name of the business where the welt Is located.)
Facility Name Facility ID# (if applicable)
Street Address
City or Town
Michael McWilliams
Contact Name
3605 Dwencrnft Court
Mailing Address
Wilminatnn
City or Town
State
Zip Code
NC 28409
State Zip Code
( 910 ) 617-7198
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 700'
b. DOES WELL REPLACE EXISTING WELL? YES i/ NO ❑
c. WATER LEVEL Below Top of Casing: 1_6
(Use "+" if Above Top of Casing)
FT.
.[ ■ ON1 ESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2412 A
3 figs f
d. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): +60 METHOD OF TEST Airlift
f. DISINFECTION: Type KW Amount 3na 1 l%
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom_ Top_ Bottom _ _
7. CASING: Depth
Top -11 Bottom 170
Top Bottom
Top Bottom
8. GROUT: Depth
Top 0 Bottom 26
Top Bottom Ft.
Top Bottom Ft.
Thickness/
diameter Weight Material
Ft. 4" sch40 PVC
Ft.
Ft.
Material
Ft. Bentonite
Method
Tremmie
9. SCREEN: Depth Diameter Slot Size Material
Top 170 Bottom 20Q Ft. 4" in. .010 in. PVC
Top Bottom Ft. in. in,
Top Bottom
10, SAND/GRAVEL PACK:
Depth
Top 168 Bottom 200
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
0' r 8'
[' �r 30'
30' / 36
36' /'
80' / 120'
12Q' / 160'
1 § 0 ' r 2co'
f
12. REMARKS:
FL in. in.
Size Material
Ft. Coarse Sand
Ft.
Ft.
Formation Description
Sand
Clay
Coarse Sand
Sandy clay/ clays
l-imPstone
Alternating clay & rock
Sandstone
i NI25 2U1
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED tN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RE r }iAS BEEN P •�� . D T+THE . OWNER
SIGNATU • E ❑ CER 1~IE r WELL CONTRACT
_Donald H. Cummings_
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]
Form GW-lb
Rev. 2/09

1 ►' ON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2412-A
1. WELL CONTRACTOR:
Donald H. Cummings
Weil Contractor (individual) Name
Ap_lied Resource Manauement, P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town State Zip Code
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI 0800218
OTHER ASSOCIATED PERMtT#(ir applicable)
SITE WELL ID #(if applicable) Iniection Well
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
IndustrialICommerciaf ❑ Agricultural 0 Recovery ❑ Injection 0
irrigation❑ Other d(list use) Geothermal
DATE DRILLED 12/23/10
4. WELL LOCATION:
3605 Owencroft Court
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY New Han.
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
©Slope ❑Valley ❑Flat 0Ridge DOther
LATITUDE 34 a 10 ' 3.0000 " DMS OR
LONGITUDE 77 ° 5't 2711000 " DMS OR
DD
DD
Latitude/longitude source: BPS ❑topographic map
(location of well most be shown on a USGS topo map andettached to
this form if not using GPS)
S. FACILITY (Name of the business where.the well is located.)
Facility Name Facility ID# (if applicable)
Street Address
City or Town State Zip Code
Michael McWilliams
Contact Name
36.5 OwencLoft CjIrt
Mailing Address
WiIrnin010D NC 28409
City or Town Slate Zip Code
010 ) 617-7198
Area code Phone number
6. WELL DETAILS:
a. TOTAL 'DEPTH: 2Q0r
b. DOES WELL REPLACE EXISTING WELL? YES NO ❑
c. WATER LEVEL Below Top of Casing: _1 B FT.
(Use "+" if Above Top of Casing)
5A7
3 0so
d. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C 0118.
e. YIELD (gpm): +60 METHOD OF TEST Airlift
f. DISINFECTION: Type HTH Amount 3i:[Cf� 1 f %i
g. WATER ZONES (depth)
Top Bottom Tap Bottom
Top Bottom Top Bottom_
Top Bottom Top Bottom
Thickness!
7. CASING: Depth Diameter Weight Material
Top +1 Bottom 150 Ft. 4" sch40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT Depth Material Method
Top 0 Bottom 26 Ft. Bentonite Tremmie
Top Bottom Ft.
Top Bottom- Ft.
9. SCREEN: Depth
Top Bottom
Top
Top
Bottom
Bottom
10. SAND/GRAVEL PACK:
Depth
Top Bottom
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
Diameter
Ft. in.
Ft. in.
Ft. in.
Slot Sire Material
in.
in.
in.
Size Material
Ft_
Ft.
Ft.
Formation Description
0' / 8' Sand
8' 130' Clay_
30' 1 36 Coarse Sand
36' / 80' Sandy clay/ clays
80' / 120' Limestone
120' f 160' Alternating clay & rock
160' / 200' Sandstone
1
1
12. REMARKS:
5
DO HEREBYCERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WrrH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
R Ct-RivtAs SEE r Pf 1VJDE _Lu THE WELL OWNER.
StGTNATURE OF G
{ tL 1A' 12/23110
WELL CONTF,;q TOR DATE
Donald H. Cummings
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30. days of completion to: Division of WaterQuality - information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]a
Form GWN-lb
Rev. 2109

Permit Number WI0800218
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well (5A7)
Primary Reviewer
michaeLrogers
Coastal SW Rule
Permitted Flow
Facilitv
Facility Name
Michael and Cheryl McWilliams
Location Address
3605 Owencroft Ct
Wilmington
Owner
Owner Name
Michael
Dates/Events
NC 28409
McWilliams
Central Files: APS_ SWP_
12/20/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Diaria Helias
PO Box 882
Hampstead NC
Major/Minor
Minor
Region
Wilmington
County
New Hanover
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Michael McWilliams
3605 Owencroft Ct
Wilmington NC
28443
28409
Orig Issue
12/17/10
App Received Draft Initiated
Scheduled
Issuance Public Notice Issue Effective
12/17/10
Expiration
11/30/15 11/22/10 12/17/10
_R_e~g~u_la_t_e_d_A_ct_iv_i_ti_e_s ________________ ~R~e~g=u~e~s~te~d=/~R~e~c~e~iv~e~d~E~v~e~n=ts~-----------
Heat Pump Inj ection RO staff report received 12/14/10
Outfall j\'.;J! L
Waterbody Name Stream Index Number Current Class Subbasin
rjr-/64-74. 1-1)
Permit Number W1080021 S
Central Files APS SWP
12/17/10
Permit Tracking Slip
Program Category
Ground Water
Permit Type
Status Project Type
In review New Project
Version Permit Classification
Injection Heating/Cooling Water Return Well (5A7) Individual
Primary Reviewer Permit Contact Affiliation
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit.
Facility Name
Michael and Cheryl McWilliams
Location Address
3605 Owencroft Ct
Wilmington
Owner
Major/Minor Region
Minor Wilmington
County
New Hanover
NC 28409 Facility Contact Affiliation
Owner Name Owner Type
Individual
Michael McWilliams Owner Affiliation
Michael McWilliams
U:}t_-slEveat=
brig Issue App Received Draft Initiated
11/22/10
Scheduled
Issuance
3605 Owencroft Ct
W ii m ington
Public Notice Issue
NC 28409
Effective Expiration
Revuiated Activities Rea ;r-stedtReca[vGd Events
Heat Pump Injection
Outfall NULL
RC staff report received 12/14/10
Weterbody Name Stream index Number
Current Class Subbasin

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Duality
Beverly Eaves Perdue Coieen H. Sullins Dee Freeman
Governor Director Secretary
December 17.1010
Michael and Cheryl McWilliams
3605 Owencroft Court
Wilmington. NC 28409
Re: Issuance of Injection Well Permit
Permit No. WI08002] 8
Issued to Michael and Cheryl McWilliams
New Hanover County
Dear Mr. and Mrs. McWilliams:
In accordance with your application received November 22. 2010. I am forwarding Permit No,
W10800218 for the construction and operation of a SA7 geothermal underground injection control (UIC)
well heat pump system located at the above referenced address. This permit shall be effective from the
date of issuance until November 30. 2015, and shall be subject to the conditions and limitations stated
therein.
Please notify Charlie Stelunan or Jim Barber with the Wilmington Regional Office two business days
prior to Construction of the geothermal well.
In order to continue unintemipted legal use of this well for the stated purpose, you should submit an
application to renew the permit 120 days prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water Quality. If you have any questions regarding your permit or the Underground Injection
Control Program please call me at [phone].
Best Regards,
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
cc: C:narles Stehn7ar, Wilmington Regional Office
Central Office File, W10800218
New Hanover County Environmental Health Dept.
AQUIFER PROTECTION SECTION
15:fi Mail Service Censer, Raleigh, Haab Carolina 27699-1636
Lecation. 272E Capital Bou4evard Raleiatr. Noah C;arWlna 27604
Phone: g 19 73S 2271 FAX 1. t19-715-0..3d; FAX ' 915-71E-643,4 Custempr Service: 1-677-623-5748
rrnemet www.r cwateruualisv.or:
' r LG7z! 617rww-unn -arra^. ErnalOVer
_One.
Ortiz Carohm:
tr alit Alit

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
Michael and Chery! McWilliams
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 3605 Owencroft. Court, Wilmington. New Hanover County, NC
28409, and will be constructed and operated in accordance with the application. November �2, 2010, and
conformity with the specifications and supporting data, all of which are filed with the Department of
Environment and Natural Resources and are considered a part of this permit_
This permit is for Construction and Operation of an infection well shall be in compliance with Title 15A North
Carolina Administrative Code 2C .0100 and .0200, and any other Laws. Roles, and Regulations pertaining to
well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until November 30, 2015, and shall
be subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the �l day of , 201 n
A3JA
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.
W10800218 1

PART I -"'ELL 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.
" This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be permanently labeled with a warning that it is for injection purposes and the entrance to each well
must be secured with a locking cap.
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.0213(g).
8. A completed Well Construction Record (Form GW-1) must be submitted for each injection well to :
Aquifer Protection Section -UIC Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Aquifer Protection Section -Wilmington Regional Office
127 Cardinal Dr. Extension
Wilmin~rton. NC 28405
[phone]
GW-ls must be submitted within 30 days of completion of well construction. Copies of the GW-1
fonn(s) shall be retained on-site and available for inspection.
PART II -WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight ( 48) hours prior to constructing each injection well, the Permittee shall notify the
Aquifer Protection Section-Underground Injection Control (UIC), Central Office staff, telephone number
[phone] and the Wilmington Regional Office Aquifer Protection Section (APS) Staff, telephone
number (910) 7Y6-7215.
2. Within 30 days of injection well completion, Permittee must contact the \Vilmington Regional Office
APS Staff in order to have samples collected at the source well and injection well.
WI0800218 2
3. Continued operation of the injection •system will be contingent upon the effluent not impacting
groundwater quality. The water quality of the effluent cannot be that of a lower quality than the influent,
which results in a degrading of water quality of the aquifer.
4. The injection well system must be constructed with sampling ports so that system influent and effluent
may be sampled.
5. The injection well must b e constructed to a depth such that it is injecting water into the same aquifer that
the source well is drawing from.
PART III-OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee , a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate , at least 30 days prior to the date of the change.
3 . The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules , regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
PART IV-PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater which will render it unsatisfactory for normal use . In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected fluid, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwater resulting from the operation of this facility.
PART V -OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
WI0800218 ,.,
.)
3. At least forty-eight (48) hours prior to the initiation,of the 0peration of the facility for injection, the
Perrnittee must notify by telephone the Aquifer Protection Section-Underground Injection Control (UIC),
Central Office staff, telephone number [phone] Notification is required so that Division staff can
inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
PART VI -INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Department representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
PART VII -MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
, Division of Water Quality to insure surface and ground water protection, will be' established and an
acceptable sampling reporting schedule shall be followed.
2. The Permitfee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the \:Vilrning1on 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 RENEWAL
The Permittee shall, at least 120 days prior to the expiration of this permit, request an extension.
WI0800218 4
PART IX-CHANGE OF WELL STATUS•
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to ISA NCAC 2C .0213(h)(1), Well
Construction Standards.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in ISA NCAC 2C
.0214, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
(B) The entire depth of each well shall be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that
failure to do so could lead to the contamination of an underground source of drinking
water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled. '
(E) In the case of gravel-packed wells in which the casing and screens have not been
removed, the casing shall be perforated opposite the gravel pack, at intervals not
exceeding 10 feet, and grout injected through the perforations.
{F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G) The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
ISA NCAC 2C .0213(h)(l) within 30 days of completion of abandonment.
3. The written documentation required in Part IX O) and (2) (G) shall be submitted to:
WI0800218
Aquifer Protection Section-DIC Program
DENR-Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
5
f {tyA Ir :};t W £ ✓ 8# d-( ti>
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 12/03/2010 County: New Hanover
To: A quifer Protection Section Central Office Permittee: Michael & Che n ,1 Mac Williams
Central Office Reviewer: Michael Ro gers Project Name: McWilliams 5A7
Regional Login No: Charles Stehman Application No.: WI008000:XX
I. GENERAL INFORMATION
1. This application is (check all that apply): IZJ 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 IZJ Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? D Yes or [8J No.
a. Date of site visit: 11/29/20 I 0
b. Person contacted and contact information: Chery l McWilliams
C,
c. Site visit conducted by: Charles Stehman c:::>
rT1
("")
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;o ~ .,., d. Inspection Report Attached: D Yes or [8J No. ;x. ,
.{:'"" C: •
--4' '
2. Is the following information entered into the BIMS record for this application correct? --0 fl"\ .-,
:i;::
[8J Yes or D No. If no, please complete the following or indicate that it is correct on the current appl~tion .
..:-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 multi ple sites either indicate which sites the information a pp lies to . co py and paste a new section into the
document for each site . or attach additional pages for each site)
a. Location(s): 3605 Owencroft Ct.. Wilmin gtn, NC
b. Driving Directions: Windward Oaks Subdivision
c. USGS Quadrangle Map name and number: Wri ghtsville Beach
d. Latitude: 34 IO' 39.83 Longitude: 77 51' 28.87 . Injection Well Coordinates
II. NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or minor
modifications, skip to next section )
Description Of Waste (S) And Facilities
I. Please attach completed rating sheet. Facility Classification: __
2. Are the new treatment facilities adequate for the type of waste and disposal system?
FORM: McWiliams 5A7 staff report Dec2010.docx 1
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
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. Ifno, 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. Ifno, please explain: __
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. 0Yes0No D
NI A. If no, please explain: __
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
D Yes O No D N/ A. If no, 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?)
/IL RENEWAL AND MODIFICATION APPLICATIONS (use previous section fo r 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: Mc Wiliams 5A7 staff report Dec2010.docx 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: __
10. 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. Ifno, 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: McWiliams 5A7 staff report Dec2010.docx 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 OfWell(S) And Facilities -New, Renewal , And Modification
1. Type of injection system:
[gj Heating/cooling water return flow (SA 7)
D Closed-loop heat pump system (5QM/5QW)
D In situ remediation (SI)
D Closed-loop groundwater remediation effluent injection (5L/"Non-Discharge")
D Other (Specify: )
2. Does system use same well for water source and injection? D Yes IZI No
3. Are there any potential pollution sources that may affect injection? D Yes IZI No
What is/are the pollution source(s)? n/a. What is the distance of the in jection well(s) from the pollution
source (s)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? 32 ft.
5. Quality of drainage at site: IZI Good D Adequate D Poor
6. Flooding potential of site: IZI Low D Moderate D High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monit(?ring parameters, etc.) adequate? D Yes D No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program: __
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? [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 Onl y:
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 ves . 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 tvpe ), will
continued/additional/modified in jections have an adverse imp act on mi gration of the plume or management of
the contamination incident? Yes D No. If yes . explain:
4. Drilling contractor: Name: ARM Water Works , H. Michael Sa!!e
FORM: McWiliams 5A7 staff report Dec2010.docx 4
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address: P.O. Box 882
Ham pstead, NC 28443
Certification number: 2531 A
5. Complete and attach Well Construction Data Sheet.
FORM: McWiliams 5A7 staff report Dec2010.docx 5
AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVALUATION AND RECOMMENDATIONS
l . Provide any additional narrative regarding your review of the application.: This modern subdivision is served
by public water and sewer. All required setbacks have been met for both the source and injection wells. The
source and return of groundwater utilizes the PeeDee Cretaceous Aquifer.
2. Attach Well Construction Data Sheet - if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yes, please explain
briefly.
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item
None
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
None
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
Annual Monitoring
Reason
7. Recommendation: D 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 reaso
8. Signature of report preparers):
Signature of APS regional supervisor:
Date: 12-./
FORM: McWiliams 5A7 staff report Dec201O.docx 6

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: Mc Wiliams 5A7 staff report Dec2010.docx 7
Rogers, Michael
From: Slusser, Thomas
Sent: Monday, December 13, 2010 10:18 AM
To: Stehman, Charles; Rogers, Michael; Watts, Debra
Subject: McWilliams 5A7 geothermal permit application
Hey Charlie,
Diana Helias called me about the subject permit application. She said that you were waiting for a permit number to be
assigned to this application before sending your staff report. At this point l would recommend sending your staff report
to Mike without a permit number, especially if the applicant is eager to get the system installed. The application was
received 3 weeks ago but the admin staff have not yet entered it into RIMS, so it does not yet have a permit number.
—Thomas Slusser, L.G.
Program Manager
Underground injection Control Program
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, N C 27699-1636
thorn as.salusserC ncdenr. Pov
pl-Vf 919-715-6164
faxg 919-715-0588
b' r'•

Post Office Box 882 Hampstead, NC 28443
[phone] Fax[910) 270-2988
November 19, 201 O
NCDENR-DWQ
Aquifer Protection Section
UIC Program
1636 Mail Ser✓lce Center
Raleigh, North Carolina 27699-1636
Re.: 3605 Owencroft Court
Wilmington, North Carolina
Dear Sir or Madame,
Please find enclosed two (2) copies of a Type 5-A? Open-Loop Well Permit application for the
above referenced address. I hope to expedite the permitting process for this application as the
homeowners would like to have this project completed before the end of the year. I am also
sending a copy of the permit application directly to Dr. Charles Stehman in the Wilmington
Regional Office. I spoke with Dr. Stehman and he indicated that would be acceptable to him for
me to do so.
Please contact me with any questions or concerns . Thank you in advance for your cooperation
and timely processing of this application.
Sincerely,
@~~
Diana Helias
Project Coordinator
cc: Dr. Charles Stehman
Wilmington Regional Office
Clean Water. It's What We Do Best!
NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEO THERMAL HEAT PUMP SYSTEM FOR:
TYPE 5-A7 OPEN -LOOP WELL(S)
X New Permit Application Renewal Modification (check one)
DATE: November 17.2010
PERMIT NO.: WI fJ �� (leave blank if NEW permit application)
A. PROPERTY OWNER(S)IPERMTT 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): Michael and Chen1 McWilliams
(1) Mailing Address: 3605 Owencroft Court
City: Wilmington State: NC Zip Code:28409 County: New Hanover
Home/Office Tele No.: 910-617-7198 Cell No.:
Fax No. EMAIL Address: cmmcwilliamsa.vahoo.com
(2) Physical Address of Site of Wells) (if different than above):
City: State: Zip Code: County:
Home/Office Tele No.:
Fax No.
Cell No.:
EMAIL Address:
B. AUTHORIZED AGENT OF OWNER, IF ANY [attach a letter from the property owner authorizing the
Contractor/Agent (driller, heat pump contractor or other type of contractor/agent) to install and operate
UIC well]
Company Name:
Contact Person: EMAIL Address:
Address:
City: State: Zip Code: County:
Office Teie No.: Fax No. Cell No.:
Website Address of Company, if any:
C. WELL DRILLER INFORMATION
Company Name: Applied Resource Management. P.C.
Well Drilling Contractor's Name: H. Michael Sage
NC Contractor Certification No.: 2531 A Contact Person: James Corvette
GPJ!UIC 5A7 Well Permit Application (Rev. August 2009) Page 1 of 4

Company Website: WWW.ann-pc.com Email Address:
Address: --~P"'"'.O=-·-=B=-o=x=-8=-8=2~--------------------------
City: Ham pstead Zip Code: 28443 County: -----=-P-=en=d=e=r _____ _
Cell No. Office Tele No.:_---"-9"""'10"--=-27'""'0'-'-2=9~1"""9 __ Fax No. 910-270-2988 ---------
D. HEAT PUMP CONTRACTOR INFORMATION (if different than Driller)
Company Name: ___ O~'B~r=ie~n~S~e~M~·c_e ~C~o~m .... o~an=---y _______ _
Contact Person: --~N~at~e~C~arr ________ _
Company Website: www.obrienservice.com Email Address: Nate@ obrien service.com
Address: __ ~33~0~8~E_n_t_erp_n_·s_e _D_r_iv_e _______________________ _
City: Wilmingt on Zip Code:-28405 County: ___ N~e~w~H~an=o~v~e~r ___ _
Office Tele No.: 910-799-6611 Fax No. Cell No.
E. STATUS OF APPLICANT
Private: _x_
State:
Federal:
Municipal: __
------------------
Commercial:
Native American Lands:
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
Passive infiltration of well water use for geothermal heat exchange
G. 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 X ----
NO --=X"'----
H. WELL CONSTRUCTION DATA (Ski p to Section I if this is a Permit RENEWAL)
X 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.
(1)
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: 12/15/10 Number of borings: __ 2 __ _
Approximate depth of each boring (feet): 180' & 180'
(2) Well casing. Is the well(s) cased? (check either (a.) YES 2! (b.) NO below)
(a) YES X If yes, then provide the casing information below.
Type: Galvanized steel __ Black steel __ Plastic X Other (specify) ______ _
Casing thickness: SCH40 diameter (inches): 4" depth: from O to 160' & 160' ft.
(reference to land surface)
Casing extends above ground __ 1_2_" _&_12_" ___ inches
(b) NO
(3) Grout (material surrounding well casing and/or piping):
(a) Grout type: Cement __x__ Bentonite* Other (specify) --------
(b) Grouted surface and grout depth (reference to land surface):
GPU/UIC 5A 7 Well Permit Application (Rev. August 2009) Page 2 of4
I.
___ Around closed-loop piping; from ____ to ___ (feet).
__ X __ Around well casing; from _O ___ to 20 (feet).
*By selecting bentonite grout, a variance is requested to ISA NCAC 2C .0213(d)(l)(A) that
requires a cement type grout.
(4) Well(s) Screen Information, if any
Depth of Screen: From ____ to ____ feet below land surface
(5) N.C. State Regulations (Title ISA NCAC 2C .0200) require the Permittee to make prov1s10ns for
monitoring wellhead water quality and processes. A faucet on both Influent (groundwater entering heat
pump) and Effluent (water being injected back into the well) lines is required. Will there be a faucet on:
(a) Influent line? Yes X No__ (b) Effluent line? Yes X No __
(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: 180' Formation: Pee Dee Rock/sediment unit: Sandstone
THE WELL DRILLING OR HEAT PUMP CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF TIIlS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
OPERATING DATA
(1) Injection rate:
(2) Injection Volume:
(3)
(4)
Injection Pressure:
Injection Temperature:
Average (daily) <15 gallons per minute (gpm).
Average (daily) <21.600 gallons per day (gpd).
Average ( daily) _<_1_5~_ pounds/square inch (psi).
Average (January) 60 ° F, Average (July) _6=5'----° F.
J. INJECTION-RELATED EQUIPMENT
Attach a diagram showing a schematic or cross-section of the well construction (i.e., the total depth, casing,
location/extent of grout, stickup, location of influent/effluent sampling ports, etc.). If this is a modification, show
the engineering layout or proposed modification of the injection equipment and exterior piping/tubing associated
with the injection operation. The manufacturer's brochure may provide supplementary information.
K. LOCATION OF WELL(S)
Attach two copies of documents showing information mentioned below.
(1) A site map (can be drawn) showing: House(s)/Building(s), 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) A topographic map of the area extending 1/4 mile from the property boundaries and
indicate the facility's location and the map name.
(3) A property deed or tax record (can be obtained from your county GIS website) showing present property
ownership.
NOTE: In most cases, an aerial pliotograpli of the property parcel showing property lines and structures can be
obtained and downloaded from tlie applicable County GJS website. Typically, the property can he searched by owner
name or address. The location of the wells in relation to property boundaries, houses, septic tanks, other wells, etc.
can then he drawn in by hand. Also, a 'layer' can he selected showing topographic contours or elevation data.
GPU/UIC 5A7 Well Permit Application (Rev. August 2009) Page 3 of4
11/01/2616 14: d7 91027b23BE
ARM AND WATERwORKS PAGE 137
L, CERTIFICATION
Note: This Permit Application must be signed by Each person appearing on the
recorded legal property deed.
"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 Eh possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, r air, and if applicable, abandon the injection well and
all related Appurtenances in accordance with the approved s cifications and conditions of the Penn it"
Signatpre of Property Owner/Applicant
� j:
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Print or Type Full Name
Signature of lerty OwneriA ipticant
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Print or Type Foil Name
Signature of Authorized Agent, if any
Print or Typo Full Name
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
(frtllfliC 5A7 Wrll Petrol! Appliciama (Rev. Aiigiss 7.Oi)91
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PARID: R06714-003-052-000
MCWILLIAMS MICHAEL l CHERYL
Parcel Residential
Alt ID 314507.57.4679.000
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~-------~ Owners
Owner
City
State
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Zip
3605 OWENCROFT CT
WILMINGTON
5134
RES-Residential
10-1 Fam Res
1
0
R-15-RESIDENTIAL DISTRICT
LT 91 SEC 2 WINDWARD OAKS
WM
MCWILLIAMS MICHAEL J CHERYL
WILMINGTON
NC
28409
THE DATA IS FROM 2010
3605 OWENCROFT CT CURRENT RECORD
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Data Copyright New Hanover County [Disclaimer] [Privacy Policy] Last Updated: 15 Nov 2010
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http://etax.nhcgov.com/Forms/Datalets.aspx?idx=l&slndex=O 11/17/2010
YiDiOrGeagls
120 11
imagery Date. Oct 23, 2010 34'10'39.99 rth77�51'28 ,19" W r:ev 25 tt
Subject Property
Proposed Supply Well
Proposed Injection Well
Eye. alt �81t
Note: Property and surrounding area serviced by public sewer and water,
Map adapted from New Hanover County GIS and Good Earth, November, 2010,
7i0c.
Iie. Resource Mana.:.ement f CP.O. Box 882, Hompstsad. NC 28443
910) 270-2919 FAX [phone]
TITLE: 3605 OWENCROFT COURT FIGURE:
WILMINGTON, NC
JOB: SCALE: DATE: DRAWN BY'
McWilliams As shown 1 1 /1 7/10 DH
2

Adapted from USGS Topographic Map
"Wrightsville Beach, NC," 1970
Contour Interval = 5 Feet
N
76c }.?ptiecl Resource Manalerttent PC
P.0, Box 882. Hampstead, NC 28443
[phone] FAX [phone]
TRE:
SITE VICINITY MAP
JOB: SCALE: DATE: DRAWN BY:
McWilliams 111-2,000' 11/18/2010 KLC
FIGURE:
3

Imagery Cate Oct 23' 2010
Subject Property
34 10'39 10' ti .:77'51'26 98- W elry 25 it
Evidence of irrigation weft
Notes: Surrounding area serviced by public sewer and water.
Map adapted from New Hanover County GIS and Good Earth, November, 2010,
p lied C�esource Mara.gemert I C
PO, Box 882, Hampstead, NC 28443
[910) 270-2919 FAX [phone]
TITLE: 3605 OWENCROFT COURT
WILMINGTON, NC
JOB: SCALE: DATE: ,DRAWN BY'
McWilliams As shown 11/17/10 I DH
FIGURE:
1