WI0300380_Well Construction Record(s) (GW-1)_20230927

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GASTON COUNTY DEPARTMENT OF HEALTH & HUMAN SE11V10ES
ENVIRONMENTAL HEALTH DIVISION
991 W. HUDSON BLVD , GASTONIA, N.C. 28052 ` '] r
704-853-5200 ] (1
Permit Void After 60 Months WELL INSTALLATION OR REPAIR PERMIT
Owner/Applicant: Oak
Mailing Address: Phone:(H)
Lot Area Subdivision/Park Li
PROPERTY LOCATION g4,IU (fit_ a t3�yl C-04e. Z
PERMIT # 1 2696
Date: 5- ;�, - 1?)
t # Block #
nl au' nuthoriUd agent
Type JAI tkeA Size VLk Depth Casing De lth (gam '
Casing ype Static Level Yield Grout MIDI 1'�' 0.c�
Grout Date Contractor/Driller — l ; 0 t
SITE SKETCI I —No Scale
Distances Must Conform
To Local/sUlte Codes.
Most Common F-inuiples Arc:
I. Water Tight Sewer Line...... 50'
Z. Ground Absorption
Se►4°nge System ................ 100'
3. Rifliding Foundations .......... 25'
PIN#
CRUM
This permit does nol relieve
the weillseptic contractor w
from complying with all
Gaston County amilor INQa'111
Carolina Laws, Rules,v
Regulations and Or(1inances. l
9- r*5vv,
"ELL _R) &L
WATER SUPI'l,Y 1NI ORMATION:
• tii'cll location, inst:a!]:alimi antE prolccfinn must uacel stale: atl to nl regulations, :uui mull c ins wiled and approved by a representative of
the Gaston County lleallh Department before any portion of the iill' I�iDn is put into n:
• 'I'be siting of the well by the health Deparinaent staff is to provide protectt� I from KNQI'N possible sources of contamination. No quantity
and/or quality of iyater is guaranteed at any site by the health Department.
• After the well is in service, conlacl file Gaston Coanly I'nvisSZnmemal licallit Seelioy(q4-853-5200) for bacteriological and inorganic walcr
s:unl�les. � � l
DATE ISSUED S 3 Ells
DATE WELL HEA6 INSPECTION COMPLE,14',
FEE PAID $_3DO — DATE 1 i
DATE SAMPLES COLLECTED DATE
IRI?CEIPT4 La �PS _ 1119 vl £�_5 `Z
K AC ERIOLOGICAL RESIJ rs RESULTS
Pink: inspection Dept. Yellow: Applicant Copy
Original White: Health Departmenl

GASTON COUNTY CODE ENFORCEMENT
*** CUSTOMER RECEIPT ***
Batch ID: EKING 5/02/18 02 Receipt no: 665
Type SvcCd Description Amount
SP SEPTIC IMPROVEMENT PERMIT
Qty 1.00 $55.00
SEPTIC IMPROVEMENT
WP WELL PERMIT
Qty 1.00 $480.00
NEW WELL/ ABANDON QED WEL
Tender detail
CK Ret#: 354 $535.00
Total. tendered: $535.00
Total payment: $535.00
Trans date: 5/02/18 Time: 8:51:42
THANK YOU

Gaston County Application for Construction, Repair, or Abandonment of a Private
Drinking Water Well
IF THE INFORMATION IN THE APPLICATION FOR A PRIVATE DRINKING WATER WELL PERMIT IS FALSIFIED CHANGED
OR USE of WELL CHANGES, THEN THE PERMIT SHALL BECOiMP INVALID. THE PERMIT [S VALID FOR 60 MONTHS.
Applying for: ❑ New Well ❑ Repair Existing Well X Abandon Well
Applicant Infortmation
GR_AINDA BUILDERS PO BOX 1221 CORNELIUS, N_ C 28031
Applicant's Name Mailing Address
704-892-7640 INFORGRAINDABUILDERS.COM
Home/Work/Cell Phone 9 Email Address
GARY & SUSAN CLARK 8426 CATAWBA COVE DR BELMONT NC 28012
Owner's Name Mailing Address
Home/Work/Cell Phone # Email Address
Property Information
8426 CATAWBA COVE DR BELMONT NC 28012
Street Address City Zip Code
Subdivision Name Lot #JBlock/Phase Lot Size Tax ID 9 (PIDIPIN)
Intended Use(s) of Property:
X Residential ❑ Commercial - Specify type of business:
Are there any current or pending restrictions regarding groundwater use?
X No ❑ Yes If yes, please explain
Are there any variances regarding well construction or location?
X No ❑ Yes If yes, please explain
Will this be a sharer] well? X No ❑ Yes
I have read this application and certify that the information provided herein is true, complete and correct. Authorized county
and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws
and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners
and making the site accessible so that a complete site evaluation can be performed. It is the responsibility of the person
signing below to ensure compliance with any other local town, city, or county ordinances.
Property o ne ow is legal representative"* signature (required) Date '
' or
"Must pro do docu lion to support claim as owner's legal representative.
Revised 11110

Gaston County Application for Construction, Repair, or Abandonment of a Private
Drinking Water Well
1 t? xSC 1L WORMMN llv xE[Zl APPLICATION FOR A PRIVATE MMaNG WATER'4'i�l.><.)'Ea3t JCU X?AI Sw11 cHANGF .
OR USE OB WELL CHANGES, TBENTHE l? ) [Y SlrALLBECOME WALID. 7 1 PElti17�'i' I5 VALED FORGO-MO1
Applying for: New WeII ❑- Repair Existing Well P(Abandon'Well
Applicant Information
Applican s Name r3 Ma Iing Address -- .� Homearork/Cell Phone #
�n��
Owlter's Naine Mailing. Address UomefWork/Cell Phone #
Property Information
Street ,Address City Zip Code
Subdivision Name
Detailed Directions to the Site
Lot #Block (Phase
Tax ID # (PID/.I"
REQ G 6I`. Z Svcs ONY-S N10 l ) i (AT
- C+-f� --� i M # ►ST'p� Cat 1 �C t CxT
Intended Use(s) of Property: _ _�( d�l�z•� .� � J�-�-� � �M
eFIResidential ❑ Commercial - Specify type of business:
Are there any current or pending restrictions regarding groundwater use?
V�No ❑ Yes N yes, please explain
Are there any variances regarding well constrn&ion or location?
pV No ❑ Yes if yes, please explain
Will this be a shared vvell? , No i? Yes
I have read this application and cerfffy that the information provided herein is irue, complete and correct. Authorized county
and state officials are granted right of entry to conduct necessary inspections to determine compliance ►vith applicable laws
and (rules. f understand that f am solely responsible for like properidentiflcation• and labeling of all property lines and corners
and malting the site accessible so that a uoniplete siter evaluation•ean�. be ptrformed. It is Me 3responsibility of'tha person
signing below to ensure compliance with any other local town, city, or county ordinances.
s or ry e s iepreseuia#ive� signature (rcgin d) Date
ccwtentaCion to suppad claim as owner's legal representative.
Re SO 11I14

Print Map and Report
Page 1 of 1
194468 05J0512014
Tax Information
LOCATION: 8426 CATAWBA COVE DR
PID #: 194468
PIN #: 3581.29.1138
NBHD #: 4DOD3
NBHD NAME: CATAWBA COVE
WATERFRONT
TOWNSHIP: SOUTH POINT TOWNSHIP
OWNER ID: 1666061
CURRENT OWNERS: CLARK GARY G CLARK
SUSAN D
MAILING ADDRESS: 8426 CATAWBA COVE
DR, BELMONT , NC 28012-6710
JANUARY 1st OWNERS: CLARK GARY G
CLARK SUSAN D
Tax Information
DEED TYPE: VJD
DEED BOOK: 47171 PAGE: 1739
DEED RECORDING DATE: 0212SQ014
SALES AMOUNT: $458,000
PLAT BOOK: 0331 PAGE: 055
LEGAL DESC.1: LAKE WYLIE
LEGAL DESC. 2: BLK 19 L 36
STRUCTURE TYPE: CONTEMPORARY
YEAR BUILT: 1980
SQUARE FOOTAGE: 2516
BASEMENT: YES
BEDROOMS; 31 BATHS: 2
MULTI -STRUCTURES: NO
ACREAGE: 0.68
DISTRICT CODE: 380
TAX DISTRICT: NEW HOPE FD
VOLUNTARY AG DISTRICT: NO
MARKET LAND VALUE: $238,000
MARKET IMPV. VALUE- $207,261
MARKET VALUE; S445,261
FARM DISCOUNT: NO
TAXABLE VALUE: $445,261
reap & parcel Gate is bel:evea la he accurate, put
ast q��e{tee its accu acy. Values shown are as of January 1, 2015, - Document croated for printrng on 5/3/2018
PRECINCT NAME: UNION
https:Hgis.gastongov.comlGastonGIS/PrintMapAndReport.aspx 51312018

GASTON COUNTY SEPTIC TANK INSPECTION RECORD4 S.L 10 ( +3l.aJ
CODEISUB
ENVIRONMENTAL HEALTH DIYISIOFj
D Q rKs y 4y�} OATE:�
Owner Name:. M444-
r r No. of Tanks L aL- GrpCap: am
Tanks:! nCU,�9— Cap: 00 D
Address;
No, cf
CirylSt :.. j�,
�„ Type Sewer System: (Sal
Zip:
Site Class: f
Pray Owner:
WATER SYSTEM (:
Sys. Name:
SEPTIC TANK I,D. /:
DI ysLoclSubDlv.: o
Date Installed:_
d - 49-4•r -
Improve. Permit (:
Type Dwelling:
u c C
No. of Badreams
�-
( UsorvTot. People:
7- Type Well:. Lct { Block )—
Garbage Uispasag.
hV o (YIN) LOl Area:
Basement—
Plumbing: Y IY" CanGaetar. �—Mm
Est.Dairy Flaw:.
7 a o Precast ContractorNo.
of Trenchm
(Repair] ( Trenches:
Sq. Ft.: Lin. FL:Width: Depth
Sq. FL: 6 el d Lin. Ft.: ZOO Wkth: 3G'< _ Max. Depth
Sep, TronchlWash:
Sq. FR.: Lln. FL: Width: Max, depth
DopN of Stone:
t 2 ° _ Other Matedab:
Tax Book (:
Code /:
Tax Map (: Tax Parcel (:
X Coordinates: Y Coordinates:
(A) Public Comm.
(B) Public NOn•Ccmrn. (C) Pr'iv. (D( Camt ] {E} ]
IP Issued By:
Inspects 4
N)

GASTON COUNTY SEPTIC TANK INSPECTION RECORD I/ S.T. ID
ENVIRONMENTAL H H DIVISION
CODE7SU6 DATE'�6
Owner Name:.._.'
Address:
CiryfSt:
rp;
Prev. Owner.
SEPTIC TANK LD. /: ! 6 17 3
Dale Installed: 4 C/
Improve. Permk j: i 1 T.Z !—
Type Dwelling: a "d S e
No. of Bedrooms: s
j Users(Tot. People: 3 -
Garbage Dlsposal: Al (Y/N)
Basement. �4 _ Plumbin9:(Y1N}
Eat. DarTy Flow:
No. of Trenches: c� Sq. Ft.: TP 4' Lin,
[Repair] j Trencher: Sq. Fl.: Lin,
Sep, Trenol% Wash: Sq. FL: Lin.
N . of Tanks: 2 crap: !GN D 0 G .
NO. of Tanks: Can:
Type Sewor Symom: _--�1
2 W 4-1 (Sand. Pump)
Sito Class: PS_ _ _ — -_ _ (S. PS, N)
WATER SYSTEM I -
Sys. Name:
LOU Dv.;
L
Type well: Lot ) BlOtk
Lot Area: ( 2
Contraclor. Q Pfi e
Precast Contractor:,
FL: fart Width: , 3s r Max. Dep h;-3.
FL: WldHh: Max. Depth:
Ft.' Widthh: Max. Depth:
Depth of Stooa: + z Other Materials:
Tax Book j: Tax Map j:. Tax Parcel j: y _
Code 1: X Ccordlnates: Y Coordinates:
(A) Public Comm. (B) Pubtk Non -Comm. r / CC) Priv, (D) Comm. (E) p
IP Issued By: M "t A (f SDI l �I/�I _ Inspected By:
z
faatzt
O
s
„n
V�

WELL CONSTRUCTION RECO GW-9 , .. . .
For ljitgrnal Use Only,
1, Well Cor,trae(or Information:
�Iej L.I" - -
WEI1 C ont r&CIC r N ame
NC Well CentrevorCettifiQlloa Number
James Darby Well Drilling LLC
fompanyNamc 12696
2. Well Construction Permit #: U V
01.11 applicahie nrllCarh'mivirN, p:mdu Cec. UK, t'AMfy,, Stara, Yariaaet etc)
3. Well Use {check well USC):
Supply Well:
{He8.dnVCooling Supply)
Nun-WAter 54DPly well:
ion Well:
iCer Recharge
iferStorage and Recover]`
ifet Test
Il Technology
(Closed LcoP)
[3hiunicipalleublic
gestdentiel Water Supp;y (si"'O)
j3Residenlisl Water Suppty (shared)
Recovety
MGroundvater RemediWon
Salinity Barrier
Mormwatcr Araina?a
subsidence Control
Tracer
a. Date Wetl(s) COMPleted: I Well IDa
$a. Well Location:
Gary Claris
Facility/OwnerNaim Faoitity)Qd(ifapplitsble) —
8426 Catawba Cove Rd Belmont 28012
Physi cal Addre 58_ City, ynd Zip
Gaston
Cgnn►r
Parcel }dend9cattoo No. MN)
5b. Latitude and longitude IM degrees1minu1esliecand9 or decimal degrees:
(if well ffel$ one latdeng is:ufticfer t}
6. Is(are) thrwell($)0Perm sneol or M.POrau
7,15 this R rCp3ir to an exisfingweU= []Yes or EDNo
IIlhlr o a repair, j1N mrr urm+•,r 11"d ce ViV110+r lnfpmu elan anJ erplafn 1hs rwlure 4fltrc
repair u+rJer f•Il remarks l6w0j, or an the hook of ift fi;1w..
& For Ge❑probe/VPT or Closed -Loop Geothermal Wells hsving the same
construction) -only 1 QW-1 is needed, )pdicate, TOTAL NUM 6EROf-14
ddlw: —
9. yotal Well depth below land surface! soa (n )
p ur ^a bloc wed: 111 r a1I dq ehe ifd�ered! fex4nrprr4g2AA' onc/ 2@100')
10. $tatic water level below top orcasing:
IJ'woarin.rl it ahow < ass
11. Dort hole dlatnate r: L 114
12. Well constructlon method) R©tary
Ii.a augur, relasy, cshle, direct pVSh, etc.)
FORWATERSUPPLVWF t7VLY:
13a. Yield (EP—)
%?cthod of tc5r. BIDW
13h. Disinfection lypa: HTH Amount- 45 fYl.
"tii{u •�:
N1f !ilt:.
a, itel 1 ,���;: 1fr � v' s• '.:�L i; Fi�!'�°Fit%.".'7 �'�:I��e:�;i.�r�i-i�7•'
y4 `i tti f"i6..
pR 11
•TO
DPSCRIPTION
„1'S�IDfA � •#9
FRONT 1 70
it?til'.
I,-
1 DL%Mi:'r;H
,� E f,,.. •1s�k>iie
7 ICKNE55
:;':_,j; :;!,::_6:.ii•
MATESIAL
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MATERfAL
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MATERIAL',MPLACENIM
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tt£THOD
ft.
fit
{�DlfiilL{I.r7d
'Cltiiidillirbvt6l'�{Ei'
F "'p tfLt�.tC+'"��4ai�.�niy''''ti'-^t=;::?s
D85CatkTlB� color, Aaean sett rode insiva ate•}
MOM
7
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ft.
ir.
it
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�`. l;6� tt4'i .i4. �u +t %�. �ii�a" �'Rt.rii:!
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i l Conuacto �
By =IVIIII r6;., la ne 1 hareby roWpy 16al:Na irrn(a) +wa (ware) cogs rt ued i^ am p,lonrr
sr11R !SA NCAC' 02C .01a0 a l iA MA[: 41C' .0200 well CnMYLVion Slanlw(4- 0%J Aral e
caps• of 1A1a re,,01V ft77S h,,e)p p'pridua io the iivfr. a irnor.
23. Site diagram oraddlllonal well details:
you Tnay use the back of this page to provide additional well site delail3 or well
construction details, You may also gttachnddltional pages ifnecessafy.
�t![iIFfIT7AL 1N�RUCI'lO:VB
24n. For All Welts: Submit th'ss form within 30 days of Completion of well
eonscmction to thefollo%in3:
p[vl3lon of WatcrResoorco. Into rmafiO0 Prozessiog Urtlt,
1617 r1Ril Service Center, Raleigh, NC 27699-161.7
24b. Far ).nleclion Wens: In addition to sending the form to the address in 24a
al2Ove, also submit one copy of this Form within 30 days of completion of well
constrvctiort to the following:
ptvislon of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
"c. Qqr Woe r Sunnly $ lnlectlDn WellAt in addition to sending the form to
the address{as) above, also submit ort0 cony Of this form withln 30 days of
coinplerion of %vcli construction to the county health depsrnnent of the wunty
svhcrc constructed.
Fonn O W- I Nortlt Carolina pqb rhneaS of Emi Iron ire alai Qu31 i y - of Visiots of Watar )tee oum ee Ravised 2-22-2016

NORTH CAROLINA
ROY COOPER Environmental Quality
C&wnor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Intent Olriedw
July 26, 2018
Gary G. & Susan D. Clark
8426 Catawba Cove Dr.
Belmont NC 28012
Re: Issuance of Injection Well Permit
Permit No. WI0300380
Geothermal Heating/Cooling Water Return Well
Gaston County
Dear Mr. and Mrs. Clark:
In accordance with your permit application received June 4, 2018, 1 am forwarding Permit No.
W10300380 for the construction/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 June 30,
2023, and shall be subject to the conditions and limitations stated therein.
Please Note:
Within 30 days of injection well completion/operation, the Permittee shall contact the
Mooresville Regional Office Staff in order to have samples collected at the source well and
injection well. [15A NCAC 02C .0211(k)]
Records of well construction, repair, or abandonment shall be submitted within 30 days of
completion of such activities. Copies of such records shall be retained on -site and available for
inspection [15A NCAC 02C .0224 ft2), (4)].
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].
North Carolina Department of Environmental Quality I division of Water Resources IAFOGW Section
512 North Salisbury Street 11636 Mail Service Center I Raleigh, North Carolina 27699-1636
919.707.9129

Best Regards,
011 01111w"
Shristi Shrestha
Underground Injection Control (UIC)- Hydrogeologist
Division of Water Resources, NCDEQ
Water Quality Regional Operations Section
cc; Cory Basinger -Edward Watson, Mooresville Regional Office
Central Office File, WI0300380
Gaston County. Environmental Health Department

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143; and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Gary G. & Susan D. Clark
FOR THE CONSTRUCTION/ OPERATION OF 1 GEOTHERMAL HEATINGICOOLING WATER RETURN
WELL(S), defined in Title 15A North Carolina Administrative Code 02C .0224(a), which will be used for the
injection of heat pump effluent. The injection well(s) located at 8426 Catawba Cover Dr., Belmont, Gaston
County, NC 28012 will be constructed/operated in accordance with the application submitted June 4, 2018, and
conformity with the specifications and supporting data, all of which are filed with the Department of
Environmental Quality and are considered a part of this permit.
This permit is for construction/ 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 June 30, 2023, and shall be
subject to the specified conditions and limitations set forth in this permit.
Permit issued this the 26th day of July 2018.
For Linda Culpepper, Interim Director
Director, Division of Water Resources
By Authority of the Environmental Management Commission.
Pennit OW10300380 WOW Pagel of5
❑er. 11 / 15/2015

PART I — PERMIT GENERAL CONDITIONS
The Permittee 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 [I 5A NCAC 02C .0211(a)).
3. This pen -nit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data [ 15A NCAC 02C .0211(1)],
4. This pen -nit 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 maybe appropriate, at least 30 days prior to the date of
the change [ l 5A NCAC 02C .0211(q)].
5. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met [ 15A NCAC 02C .0203).
PART II - WELL CONSTRUCTION GENERAL CONDITIONS
l . 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.
If a separate injection well is used then it shall also be constructed in accordance with the requirements of
rule 15A NCAC 02C .0107 except that the entire length of the casing shall be grouted in such a way that
there is no interconnection of aquifers or zones having differences in water quality that would result in
degradation of any aquifer or zone. For screened wells, grout shall be emplaced from the top of the gravel
pack to the land surface. For open-end wells, the casing shall be grouted from the bottom of the casing to
the land surface [ 15A NCAC 02C .0224(d)(2), (3)].
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 Iiter. 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 detennine existing conditions.
[15A NCAC .0225(g)(8)].
4. The injection well system shall be constructed such that a sampling tap or other collection equipment
approved by the Director provides a functional source of water when the system is operational. Such
equipment shall provide the means to collect a water sample immediately after emerging from the water
supply well and immediately prior to injection into the return well [ 15A NCAC 02C .0224(d)(4)].
5. Each well shall be secured to reasonably insure against unauthorized access and use and shall be sealed
with a watertight cap or well seal as defined in G.S. 87-85(16).
G. Each well shall have permanently affixed an identification plate [I 5A NCAC 02C .01070)(2)].
Permit #WI0300380 UICISA7 Page 2 of 5
per, 11/15/2015

7. A completed Well Construction Record (Form GW-1) shall be submitted as described in Part VI.5 of this
permit.
PART III —WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight (48) hours prior to constructing each injection well, the Permittee shall notify the
Underground Injection Control (UIC) Central Office staff, telephone number 919-707-3662 and the
Mooresville Regional Office Staff, telephone number 704-663-1699. [ 15A NCAC 02C .0211(k)].
2. Within 30 days of injection well completion/operation, the Permittee shall contact the Mooresville Regional
Office Staff in order to have samples collected at the source well and injection well. [I5A NCAC 02C
.0211(k)]
PART IV — OPERATION AND USE CONDITIONS
1. The Permittee shall comply with the conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and the rules of 15A NCAC 02C .0200,
even if compliance requires a reduction or elimination of the permitted activity [15A NCAC 02C .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 [15A NCAC 02C .0206].
PART V — INSPECTIONS [ 15A NCAC 02C .0211(k)]
Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable time for the purpose of determining compliance with this permit, may
inspect or copy any records that must be maintained under the terms and conditions of this permit, and may
obtain samples of groundwater, surface water, or injection fluids.
2. DWR representatives shall have reasonable access for purposes of inspection, observation, and sampling
associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary samples of the injection facility's activities.
PART VI,— MONITORING AND REPORTING REQUIREMENTS
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 [I 5A NCAC
02C .0224(f)(2), (4)].
2. Monitoring of any well may be required to ensure protection of the groundwater resources of the State and
compliance with the groundwater quality standards specified in 15A NCAC 02L [15A NCAC 02C
.0224(f)(1)].
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3. The Pennittee 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 .0211(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 Mooresville Regional Office, telephone number 704-663-1699.
(B) Written notification shall be made within five days of the occurrence and submitted to the addresses
in Item #5 below.
(C) The written notification shall contain a description of the noncompliance and its cause; the period of
noncompliance, including dates and times; if the noncompliance has not been corrected, the
anticipated time it is expected to continue; and any steps taken or planned to reduce, eliminate, and
prevent reoccurrence of the noncompliance.
4. The Permittee shall record the number and location of the wells with the register of deeds in the county in
which the facility is located. (15A NCAC 02C .0224(f)(3)].
All forms, reports, or monitoring results required by this permit shall be submitted to:
UIC Program Staff Water Quality Regional Operations Section
Division of Water Resources and DWR Mooresville Regional Office
1636 Mail Service Center 610 East Center Ave.
Raleigh, NC 27699-1636 Mooresville, NC 28115
PART VII — PERMIT RENEWAL f 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 geothennal heating and cooling system associated with this
permit.
PART VIII — CHANGE OF WELL STATUS (I SA NCAC 02C .0240]
1. Procedures for temporarily or permanently abandoning a well are the same as those specified in rule 15A
NCAC 02C .01 13. While some of those criteria are given below, the Permittee bears the responsibility of
complying with all applicable regulatory requirements.
2. If a well will no longer be used for any purpose, then it should be permanently abandoned according to rule
15A NCAC 02C .0113(b) in order to prevent the well from deteriorating and acting as a source or conduit
of contamination, which is prohibited by General Statute 87-88(c).
3. If a well is taken completely out of service temporarily, the Pertittee shall install a water -tight cap or well
seal that cannot be removed without the use of hand or power tools.
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