WI0300380_Staff Report_20180618

Permit No. WI0300380
Date: 06/15/2018 County: Gaston
To: Mike Rogers
Central Office Reviewer Michael Rogers
Permittee/Applicant: (Gary G. and Susan D. Clark)
Facility Name: Clark SFR
L GENERAL INFORMATION
1. This application is (check all that apply): ® New ❑ Renewal
❑ Minor Modification ❑ Major Modification
a. Date of Inspection: 06/13/2018
b. Person contacted and contact information: Gary Clark geeclark59ki4mail.com / [phone]
c. Site visit conducted by: Edward Watson, Hydrogeologist
d. Inspection Report Printed from BIMS attached: ® Yes ❑ No.
e. Physical Address of Site including zip code: 8426 Catawba Cove Drive, Belmont, NC 28012
L Driving Directions if rural site and/or no physical address: Travel on I-77 South to I-485 outer to exit 10B
to enter I-85 West toward Belmont, NC. Travel — 33 mile on I-85 exiting on exit 27 Belmont/Mt. Holly.
Turn left onto NC -273. After —2 miles turn left onto S. Central Av. Take S. Central Av. for 4 miles,
then turn Right onto Lower Armstrong Rd/NC-273. Travel 2.36 miles and enter the roundabout and
take the 2nd exit onto S. New Hope Rd./NC-279 (Traveling briefly into S. Carolina). S. New Hope Rd.
becomes Pole Branch Rd/SC/279. You are only on this road for ---0.1 miles. Turn Right onto Catawba
Cove Dr. Travel for —1.5 miles. The property is on the right.
g. Latitude: 35° 09' 32.51" Longitude: -81° 04' 02.85"
Source of Lat./Long & Accuracy (i.e., Google Earth, GPS, etc.): GCS WGS 1984 to nearest 1 second.
II. DESCRIPTION OF INJECTION WELL 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) onl
a. For existing geothermal system only:
Were samples collected from Influent/Effluent sampling ports? ❑ Yes ❑ No.
Provide well construction information from well tag: Well has not been constructed.
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. The well has not been constructed. Samples will be collected after the system has been installed.
4. Quality of drainage at site: ® Good ❑ Adequate ❑ Poor
5. Flooding potential of site: ❑ Low ® Moderate ❑ High
6. 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.
III. EVALUATIONAND RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If Yes, explain.
2. 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
3. Signature of Report Preparer(s): Edward Watson 06/15/2018
DocuSigned by:
Signature of WQROS Regional Supervisor:
Date: 6/18/2018
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