WI0800158_Renewal Application_20181003

DocuSign Envelope ID: 8AE53D81-C2FA-4187-AD54-50EA652A945C
North Carolina Department of Environmental Quality - Division of Water Resources
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
Permit No. WI0800158
Date: 8/9/2018 County: Caretet
To: Shristi Shrestha Permittee/Applicant: Douglas & Hilary Schultz
Central Office Reviewer Facility Name: Schultz geothermal well system
L GENERAL INFORMATION
1. This application is (check an that apply): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
a. Date of Inspection: 8/9/2018
b. Person contacted and contact information: Doug Schultz - [e-mail]
c. Site visit conducted by: Geoff Kegley
d. Inspection Report Printed from BIMS attached: ❑ Yes ® No.
e. Physical Address of Site including zip code: 175 Herring Pond Ct., Beaufort, NC 28516
a. Driving Directions if rural site and/or no physical address: From Beaufort take US 70 to Merrimon Rd to S.
River Rd to Sandy Point Dr to Herring Pond Ct.
f. Latitude: Longitude:
Source of Lat/Long & Accuracy (i.e., Google Earth, GPS, etc.):_ Google Earth
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 Wells only
a. For existing geothermal system only:
Were samples collected from Influent/Effluent sampling ports? ® Yes ❑ No.
Provide well construction information from well tag: Already accurately listed in BIMS
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?
5. Quality of drainage at site: ❑ Good ® Adequate ❑ Poor

DocuSign Envelope ID: 8AE53D81-C2FA-4187-AD54-50EA652A945C
6. Flooding potential of site: ❑ Low ❑ Moderate ® High
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.
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.
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. E VAL UA TION 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
This review was conducted for a permit renewal request for an open loop geothermal
well system for the Shultz residence. On August 9, 2018, 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.
❑ Deny. If Deny, please state reasons:

DocuSign Envelope ID: 8AE53D81-C2FA-4187-AD54-50EA652A945C
North Carolina Department of Environmental Quality - Division of Water Resources
WQROS REGIONAL STAFF REPORT FOR
UIC Program Support
❑ Hold pending receipt and review of additional information by Regional Office
❑ Issue upon receipt of needed additional information
DocuSigned by:
® Issue
Signature of Report Preparer(s): E515MB417 .
d by:
DocuSigne
Signature of WQROS Regional Supervisor: 14
8 / 10 / 2 018 E3ABA14A=C434...
Date: