WI0700343_Permit (Issuance)_20130920

R EIENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Programs
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Director Secretary
September 20, 2013
George and Kathleen Giffim
821 Pelican Drive
New Bern, North Carolina 28560
Re: Issuance of Injection Well Permit
Permit No. WI0700343
Issued to George and Kathleen Giffin
Craven County
Dear Mr. and Mrs. Giffin:
s
In accordance with your application received August 28, 2013, and additional information
received September 9, 2013, I am forwarding Permit No. WI0700343 for the construction and
operation of geothermal heating/cooling water return well located at the address referenced
above. This permit shall be effective from the date of issuance until August 31, 2018, and shall
be subject to the conditions and limitations stated therein.
Please Note the Following:
• Per Permit Condition Part I.9, a copy of the Well Construction Forms (GW-1),
which is completed and signed by the well contractor, must be submitted to this
office and the Washington Regional Office within 30 days of completion of the
injection well. Copies of the GW-1 shall be retained on -site and available for
inspection.
• Per Permit Condition Part II.4, within 30 days of injection well completion and
operation, Permittee must contact the Washington Regional Office APS Staff (252-
946-6481) to have influent and effluent samples collected.
• Per Permit Condition Part H.1, prior to the next permit renewal cycle in August
2018, the well head of the supply well shall be repaired and completed at least 12
inches above land surface per 15A NCAC .0107(d)(5).
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: www.ncwaterqualitv.orq
An Equal 0pportunity 1 Affirmative Action Employer

George and Kathleen Giffi..
Page 2 of 2
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit
an application to renew the permit 120 days prior to its expiration date. As indicated in the
permit, this permit is not transferable to any person without prior notice to, and approval by, the
Director of the Division of Water Resources. If you have any questions regarding your permit or
the Underground Injection Control Program please call me at [phone].
Best Regards,
Michael Rogers, P.G. "(NC & FL)
Hydrogeologist
cc: David May, Washington Regional Office
Central Office File, 700343
Craven County Environmental Health Department
Karen Corbett, ARM, 257 Transfer Station Road, Hampstead, North Carolina 28443

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT C6MMISSION
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
George and Kathleen Giffin
FOR THE CONSTRUCTION AND OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING
WATER RETURN WELL(S), defined in Title 15A North Carolina Administrative Code 2C .0224, which will
be used for the injection of heat pump effluent. This injection well is located at 821 Pelican Drive, New Bern,
Craven County, NC 28560, and will be constructed and operated in accordance with the application received
August 28, 2013, and conformity with the specifications and supporting data received September 9, 2013, 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 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.
JThis permit still be effeetive, unless revokd, from the— ifiits issuance until August 31, 2018, and shall be
subject to the specified conditions and limitations set forth in Parts II through IX hereof.
Permit issued this the SU day of Jocre-1/4ug, 2013
SUJ
crThomas A. Reeder, Director
Division of Water Resources
By Authority of the Environmental Management Commission.
Permit #WI0700343
UIC/Return Well - New Construction_ Page 1 of 5
ver. 09/2013

PART I - WELL CONSTRUC ' - N GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall be constructed in such a manner that water from land surface cannot migrate into
the gravel pack or well screen.
5. Each injection well shall be secured to reasonably insure against unauthorized access and use. Each well
shall be permanently labeled with a warning that it is for injection purposes and the entrance to each well
must be sealed with a watertight cap or well seal, as defined in G.S. 87-85(16).
6. Each injection well shall be afforded reasonable protection against damage during construction and use.
7. Each geothermal injection well shall have permanently affixed an identification plate according to 2C
.0107(j).
9. A copy of the Well Construction Record (Form GW-1) completed and signed by the well contractor, must
be submitted for each injection well to:
Division of Water Resources — Underground Injection Control (UIC) Staff
1636 Mail Service Center
Raleigh, NC 27699-1636
and
Division of Water Resources — Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Copies of the GW-1 form(s) shall be retained on -site and available for inspection.
PART II — WELL CONSTRUCTION SPECIAL CONDITIONS
1. Prior to the next permit renewal cycle (August 2018), the well head of the supply well shall be repaired
and completed at least 12 inches above land surface per 15A NCAC .0107(d)(5).
2. At least forty-eight (48) hours prior to constructing each injection well, the Permittee shall notify the
Division of Water Resources -Underground Injection Control (UIC), Central Office staff, telephone
number [phone] and the Division of Water Resources Washington Regional Office staff,
telephone number 252-946-6481.
Permit #WI0700343
UIC/Retum Well - New Construction Page 2 of 5
ver. 09/2013

3. Within 30 days of injection &;:11 completion and operation, Permitt idfiust contact the Washington
Regional Office staff to have influent and effluent samples collected.
4. Continued operation of the injection system will be contingent upon the effluent not impacting
groundwater quality. The water quality of the effluent cannot be that of a lower quality than the
influent, which results in a degrading of water quality of the aquifer.
5. The injection well system must be constructed with sampling ports so that system influent and effluent
may be sampled.
6. Each injection well must be constructed to a depth such that it is not injecting groundwater of a lower
quality from a supply aquifer (if present).
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 Resources (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.
CContinuec injection system will— a con mgen upon e e uen no impacting
groundwater quality. The water quality of the effluent cannot be that of a lower quality than the influent,
which results in a degrading of water quality of the aquifer.
PART 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 Resources 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.
Permit #WI0700343
UIC/Return Well - New Construction Page 3 of 5
ver. 09/2013

PART V — OPERATION ANL ... AINTENANCE REQUIREMENTu
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
PART VI — INSPECTIONS
1. Any duly authorized officer, employee, or representative of the Division of Water Resources 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 Vil — MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Resources to insure surface and ground water protection, will be established and an
acceptable sampling reporting schedule shall be followed.
2. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Washington Regional Office, telephone number 252-946-6481, 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.
Permit #WI0700343
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PART IX — CHANGE OF WEE',: 4TATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose that well must be permanently abandoned according to 15A NCAC 2C .0240,
Abandonment and Change -of -Status of Wells.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with the procedures specified in 15A NCAC 2C
.0240, including but not limited to the following:
(A) All casing and materials may be removed prior to initiation of abandonment procedures if
the Director finds such removal will not be responsible for, or contribute to, the
contamination of an underground source of drinking water.
03)
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 thorou•hly 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 1 ee an grou mjec a oug a pe ora ons.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been
created, each well shall be abandoned in such a manner that will prevent the movement of
fluids into or between underground sources of drinking water and in accordance with the
terms and conditions of the permit.
(G)
The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .0224(f)(4) within 30 days of completion of abandonment.
3. The written documentation required in Part IX (1) and (2) (G) shall be submitted to:
Division of Water Resources-UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Permit #WI0700343
UIC/Return Well - New Construction Page 5 of 5
ver. 09/2013

Central Files: APS SWP
09/16/13
Permit Number WI0700343 Permit Tracking Slip
Program Category
Ground Water
Status Project Type
In review New Project
Permit Type Version Permit Classification
Injection Heating/Cooling Water Retum Well Individual
Primary Reviewer Permit Contact Affiliation
michael.rogers Jim Cornette
Coastal SW Rule
Permitted Flow
Facility
Facility Name
George and Kathleen Giffin SFR
Location Address
821 Pelican Dr
New Bern NC 28560
Owner
PO Box 882
Hampstead
NC 28443
Major/Minor Region
Minor Washington
County
Craven
Facility Contact Affiliation
Owner Name Owner Type
Individual
George Giffin OwnecAffiliation
George Giffin
821 Pelican Dr
Dates/Events New Bern NC 28560
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
08/28/13 %61i3 q/a.6/13 R'/aill g
Regulated Activities Requested/Received Events
Heat Pump Injection
Outfall NULL
Additional information requested 09/05/13
Additional information received 09/09/13
RO staff report requested 09/10/13
RO staff report received 09/13/13
Waterbody Name Stream Index Number
Current Class • Subbasin

Permit Number WI0700343
Central Files: APS SWP
09/20/13
Permit Tracking Slip
Program Category
Ground Water
Permit Type
Injection Heating/Cooling Water Return Well
Status Project Type
Active New Project
Version Permit Classification
1.00 Individual
Primary Reviewer Permit Contact Affiliation
michael.rogers Jim Cornette
Coastal SW Rule
Permitted Flow
Facility
Facility Name
George and Kathleen Giffin SFR
Location Address
821 Pelican Dr
New Bern NC 28560
Owner
PO Box 882
Hampstead
NC 28443
Major/Minor Region
Minor Washington
County
Craven
Facility Contact Affiliation
Owner Name Owner Type
Individual
George Giffin Owner Affiliation
George Giffin
Dates/Events
821 Pelican Dr
New Bern
NC 28560
Orig Issue App Received Draft Initiated
09/20/13 08/28/13
Scheduled
Issuance
Public Notice Issue Effective Expiration
09/20/13 09/20/13 08/31/18
Regulated Activities Requested/Received Events
Heat Pump Injection
Outfall NULL
Additional information requested 09/05/13
Additional information received 09/09/13
RO staff report requested 09/10/13
RO staff report received 09/13/13
Waterbody Name Stream Index Number Current Class Subbasin