WI0700308_Staff Report_20210730

North Carolina Department of Environmental Quality - Division of Water Resources
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support

WQROS Staff Report Rev. 4/15/2016 Page 1
Permit No._WI0700308____
Date: __7/30/21___________ County: ___Craven____________________
To: _Shristi Shrestha___________Permittee/Applicant: __Mr. & Mrs. Washburn____________
Central Office Reviewer Shristi Shrestha Facility Name: _Washburn Geotherm. Return Well
I. GENERAL INFORMATION
1. This application is (check all that apply): New Renewal
Minor Modification Major Modification
a. Date of Inspection: 7/27/21
b. Person contacted and contact information: Laural Washburn [phone]
c. Site visit conducted by: R. Sipe
d. Inspection Report Printed from BIMS attached: Yes No.
e. Physical Address of Site including zip code: No change since last inspection
f. Driving Directions if rural site and/or no physical address: No change since last inspection
g. Latitude: N/A Longitude: N/A (No change since last inspection)
Source of Lat/Long & Accuracy (i.e., Google Earth, GPS, etc.):________________________
II. DESCRIPTION OF INJECTION WELL(S) AND FACILITY
1. Type of injection system:
Geothermal Heating/Cooling Water Return
In situ Groundwater Remediation
Non-Discharge Groundwater Remediation
Other (Specify: )
2. For Geothermal Water Return Well(s) only
a. For existing geothermal system only:
Were samples collected from Influent/Effluent sampling ports? Yes No.
Provide well construction information from well tag: See attached GW-1
b. Does existing or proposed system use same well for water source and injection? Yes No
If No, please provide source/supply well construction info (i.e., depth, date drilled, well contractor,
etc.) and attached map and sketch location of supply well in relation to injection well and any other
features in Section IV of this Staff Report.
3. Are there any potential pollution sources that may affect injection? Yes No
What is/are the pollution source(s)? ____________________________________________________________
What is the distance of the injection well(s) from the pollution source(s)? _____________________________
4. What is the minimum distance of proposed injection wells from the property boundary? _N/A – existing wells
5. Quality of drainage at site: Good Adequate Poor
6. Flooding potential of site: Low Moderate High

DocuSign Envelope ID: 953ADA0F-65F1-474E-B2D9-0510DD4CC5CC

WQROS Staff Report Rev. 4/15/2016 Page 2
7. For Groundwater Remediation Injection Systems only, is the proposed and/or existing groundwater monitoring
program (number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? Yes No.
If No, attach map of existing monitoring well network if applicable and recommend any changes to the
groundwater-monitoring program. N/A
8. Does the map included in the Application reasonably represent the actual site (property lines, wells, surface
drainage)? Yes No. If No, or no map, please attach a sketch of the site. Show property boundaries,
buildings, wells, potential pollution sources, roads, approximate scale, and north arrow. See attached map
9. For Non-Discharge Groundwater Remediation systems only (i.e., permits with WQ__________prefix):
a. Are the treatment facilities adequate for the type of waste and disposal system? Yes No N/A.
If No, please explain:
b. Are the site conditions (soils, topography, depth to water table, etc.) consistent with what was reported by
the soil scientist and/or Professional Engineer? Yes No N/A. If no, please explain:
III. EVALUATION AND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? Yes No. If Yes, explain.
2. List any items that you would like WQROS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason

3. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason

4. Recommendation
Deny. If Deny, please state reasons:
Hold pending receipt and review of additional information by Regional Office
Issue upon receipt of needed additional information
Issue
5. Signature of Report Preparer(s):
Signature of WQROS Regional Supervisor:
Date:
DocuSign Envelope ID: 953ADA0F-65F1-474E-B2D9-0510DD4CC5CC
7/30/2021

WQROS Staff Report Rev. 4/15/2016 Page 3
IV. ADDITIONAL REGIONAL STAFF REVIEW COMMENTS/ATTACHMENTS (Optional / If Needed)
Please update the telephone number for the Washburns in BIMS to [phone]. The current phone number
is not valid.

DocuSign Envelope ID: 953ADA0F-65F1-474E-B2D9-0510DD4CC5CC