WI0700178_GEO THERMAL_20100615

Permit Number WI0700178
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
David Sawyer SFR
Location Address
113 Hope Dr
Ahoskie
Owner
Owner Name
David
Dates/Events
NC 27910
Sawyer
Central Files: APS_ SWP_
06/15/10
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
David Sawyer
Owner
17908 Garner Dr
Accokeek
Major/Minor
Minor
MD
Region
Washington
County
Hertford
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
David Sawyer
Owner
17908 Garner Dr
Accokeek MD
20607
20607
Orig Issue
06/15/10
App Received Draft Initiated
Scheduled
Issuance Public Notice Issue
06/15/10
Effective
06/15/10
Expiration
05/21/10
Re g ulated Activities
Heat Pump Injection
Private residence, single family
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin
g
NA
NCD ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
David Sawyer
Maureen Sawyer
17908 Garner Dr.
Accokeek, MD 20607
Coleen H. Sullins
Director
6/15/2010
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No, WI0700178
113 Hope Dr.
Ahoskie, NC 27910
Dear Mr. and Mrs. Sawyer:
Dee Freeman
Secretary
On 05/21/2010, the Aquifer Protection Section (APS) received notification of your intent to construct a closed-loop water-onl y
geothermal injection well system for the operation of a ground-source heat pump located at the address referenced above. An
individual permit is not required for the construction and operation of this type of geothermal injection well system as long as the
following conditions are met:
1. The injection well system contains only potable water,
2. The injection well system is constructed in accordance with well construction standards specified in North
Carolina Administrative Code Title ISA Section 2C Subchapter .0213, and
3. The required notification form and associated maps have been completely and accurately submitted.
Failure to comply with all of these conditions constitutes a violation of the North Carolina Well Construction Act and North Carolina
Administrative Code Title 15A Section 2C Subchapter .021 l(u)(2). Additionally, you should contact the Hertford County Health
Department as they may have additional requirements for this type of system. Noncompliance with applicable state, county, or
municipal rules and regulations may result in the assessment of civil penalties.
Please contact Mike Rogers at [phone] or Michael.Ro 2:ers @ncdenr.e:ov if you have any questions.
cc: Washington Regional Office -APS
APS Central Files• Permit No.~ Du: 8
Hertford County Health Dept.
~~D
for Debd-w atts
Supervisor
Charles Menefee (C & G Well Drilling, Inc., 2257 Santa Fe Arch, Virginia Beach, VA 23456)
Gary Hughes (Gary's Electrical Service, Inc., P.O. Box 312, Colerain, NC 27924)
AQUIFER PROTECTION SECTION
1636 Mail Service Cen ter, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588 : FAX 2: 919-715-6048 \ Customer Service : 1-877-623-6748
Internet: www.ncwaterqual ity.org
An Equal Opportunity I Affirmative Action Employer
Nirth Carolina
Jvaturalllf
May ,21 10 07:06a C & G Well i]rilling 7574266003 p.5
0507110 9:39 AM nary's L:trae;tr'a.t: ;EI Y-LUVJ e.ae-.t I ,.1u . ■
S b�[o I F.
;digit T H C A R OL IN k
DCPA RT'N1ENT OF !:N wl f Rr )rtiWIENITA ND N/% TCFkAL R a i0U1V•`F, [!`9iAMNR}
OTU111CATION 4F ENTVtr TO RUCT A C=.€ Q6' D-I,0QP �Ei a<`i'fi IkLti r
);`+j"..Txm s1•5 C'Z: m:
Jn Aacnrdailo- ■vleri th, pro visk4wo (pf HCAC Tiwa; = IA,: 0?C.0200. pi,zsse:
C%)ag4mw this nasiriaui011 and M11il tQ� uudleu:: Off IIIi, is mc! z p:q;u (�)laate: —P,-LLI g uC T,, ;M ill IWPAINLiO,ii.
DATE: 20 fU
Meet 7}pe Catrfrr :arion: i,► eZ; du; pIxi kN;W 5k.swvio L ir4uk:iw t}:rt oic y;guLg, �iIA (xi-i ;tdd_16i,es) in
Coillirin"Us pipi=} the fluid ff%'IJII l,i.::
OYQ4
(:ananmv i:Q uplvlikig liw; fwni-
No Do Not cAmiple:te dais :biirt. Con.,,icw vajuv UX.3ppIi"mpa films a'ur i,aa.,aIIing
t. r,![ ii:jge_ ;11 t para:ai;. ►aatci imo the uquireri orn 5Qn•1 Weil
loop wlI c&Manining urjditivs.- such t:s R-22. r tha+iul. or orh►:r antifreeze or con-urion inhibitursi.
A. �tvff % .,- D o J) S-{�`°"', a ` t1�
[.ia CatCh Property Own-_-r IWt d Ciro pi-opvn dau-k4 (IP o'. nod b _t basir!--i or WtU: PalrfV uI
entity and Q . epresentalive ►X.-MUZ4100(y for slgnanuc):
(1) MaililtgAddres5: �`� _•• +� } x f �`)►�. _�_ ___ �._
r y c firy: r! c Ci Swi :: ZIP
L_.d.� ILc►�� li ! `?tlifiC,; T=::r �'t�.: r;.x' �:,?- 5�4�__ _ _w....._.-�:i' Zlti.._►?`�C:'.��� �� ._ �� t�'~7
Load] Addre.a,��+~�
f r�
(2) P'rj-sic;%I rlddres;,s of We[l F,Ie (IeJil•[z'=w thiut above):
City �' ���Li � _ Si;ae r II- COS: ���`C C-� ..� _.C-N Wry! _L��=���_+�
f•:urn,r}t7ffic�'l'clsr Na. �.__.... _._...___. _ Y ��—._..S��4i :,-� U 17-
its :iUTl�+.]�tiLl::!: �[:E!�"(' Ulu [)79�di1~e:Ci, lt' �►.,'V� � i! :::: i�elll►il �.i�=ae.tnt u,:es >ir�c I�►•rra t'nusubj,::: ;NtijJRaiy,
rt(Wh a ttXt•r frutp Ilia prupeny Offll f alaharizing Agem to ln,tull and operate. UC: +4all)
Company Namo:
City:
Ofl ce TeJc P 1u.. — -- -- - _ - _ ...• -,� 11 iy c __ _.,_
Webs ite Address bfC u:npany. if
RECElvED r DEAR r4vuQ
AICIUPR l}Rt` pr'nm gFCTION
MAY S 1 2010

May ?1 10 07;06a C & G Well Drilling 7574266008
05/17)10 9:40 AM Gary•s Electric serviceu rae-Sao—r:�u A•6
rk
1:.. tit►EfLUALri.r..iqZ, Ii4`,i;C4tis+l A'x 1Oti!
Well OriflerContrraccor'S Ttila,+ e
NG%:curtractar Cortrticsiro::7wo._
Cd+714ei Pmon
City. L� �. Zif; Cad,: � � _ CD.
Office Tile No.: 75�� 3aa3 � - Cclt po.. ?s ?
!-i_ BEAT FUMP G '13:.CT4 ti t'tiFti _=�.�k'>E'i��R f+i:iiai ri ;i E:u� +'J:ir.r-)
rs�ntr�i F't:rs[ _��-�_.___.._��=i�,� f i_ sr��•s ;.,r�r��.��C��.�L�
City: �._— 'Zip 4 c:1,
C3ificc Tole
E. ST_ .TUS OF APr11CdUWT
Privatd; X— car+:
SCdlt:: _�w �rll7tjlCi1ii11:
evmmen: ia): -
laai'iYr;: A i}iL is s z i_:lr,[! t_ _
F. 1NJF..1M'10X rL"y' S.cnibC lio W U l.: 1 ` ti`«i`.11ili iS]/ I 'Al klw usitil?
G. Vrl]ti�,L C",ti1<�tUC7�=':1lso'i'.i
l 1] Propoia d 4-ale to be conrrructe w % 5'` tifllrYrF?cr ;r2' bO(h1;S-. _2
Approximate srt:pth of arch Lorin& (fi t): 114
(2) Type ofxubine, to he iv -a (colTme, PV(,:, dm):
(3) +l++e)l c 4-ia. TY the welf[s) eased? 6-.hcr:k, a )lh•,jr 0,- YLi r�i (t.. :tc+ :[:t►r1
(a.) Yes �_ _� i]'}'cs, [Iten lsrpvicic t:a;;xt+u tll�l3rriiililan bll�s'
T'yp,;: _,-calvanfmd StR-a-1 6gac:rc st+:ei. _ _ p]axtic . _c�`st t (s�OCI
Cb)
(4) Omw ltrfo (mritedall surrvLmding »'nil caving, andlor piplag):
(a) Grotti typt: Neat CArnmiti3Ctra'Aliv olfw tspecoy)
(b) Groin placotnew Purnpir%, K lxre?ewe Other
(C) Gr~:,ut d�ptl: of tubing (refenmkm to lwkt wrface): fim-n - 61,
If Welk 1;as ,--a:ag, indicate Ktou- d:,pu1: from _0 m

May 21 10 07:07a C & G Well Drilling 7574266008 p.7
05/17/10 9:40 AM uary-s itiecirltc tovrvtu>'Lj + s..0 ._
Fl, irti.lis'tt't joN-usi.A xD i% i.'slrlrl 'N"i
¢j{ii1tach A diagrain s7m ing the eri��rrs .ti4jnisftjj] 7 xwriirrrstcvL;ru
pipin0,4LIbirLL+__ ss*+ iated ►wFt4t the irE "i ion opar•,,tion, 'The u' u-:ttf�i:lut+rr':; br..,:h:sre imiiy provide 5�.;t;•;flvnen a
i17Tor )a&Uo
1. LO 4-TiON Off v;'>7 LL(S)
Attach t►tiocepic!, of c:i:tg 1he i.,lhewiiW it7tnr,„iafiirn
s
(l) include a Site ep1ap (cm ix drawn) :.mpwirsg; buildiw-Isr l.wujwfll lines, <_LPr `U,z wetter bodics, Wm-'tLli
runes orgroartdti Parr t:gtl=iinaUon rtnd the orianuttion ur ..crsj .tistan(v:; bef,% acts €jic pi,:pcned wall{'s) it
wiy f xi:aing or wivac di:.pu:;.tF ra-.ilides tiach ?-, ,:epiic ta)d:!; or drain Fields iocaXd wit'.tin 100 feet
tht: gemficrmal h-�--sr ptur►p wt'ii svjb--m. -.:iW I,0I einsitaTtti cleanly ivAd
(?) Tfie SILe Map Immi show rh%a in re)AL-*,i Lo ail. surrotindi;i . dreA by li::;rrt 1"* F.x4
ref venc-e pnineti C r:h L+i mad:. Sri evtr--, ar.Jlt3r hi f{bwzo it �tz'.r ss;etir r�>y.
Ci ki'1}t"l4CA'1'E0N
No Le. 111si5s Parrot AppliercLioll ►l►a4iS : ir:: sii;U06 by t:.i't1 pvAlEt'a tzi, pw-A.A1;g tell Voti:
rccta dtd IL-g*i prolverty dred,
"I is .ruby certify. under penatty otil 4t v, titm } ha►+o p,erwmslly cx*m-oissc►i and awn l:tmilit..r %vich tht• isticxnali.s
submitted ift this docunwnt Surd ail :ttttxa}ttnents thereto ssrd t11a(, L%U; J On n]v iugtriry of 1170s- iilli►aidux,
irtt511►x iatc:Ir rospunsIWt: fi- obtoini:K said in form ai'sr,n, 1 b,.-I kvr: tfiat tiw infomiation fs taste, am Limemid romplttt
18L7 3.V ae tt:at tber4 aft 9 4,111l,::tnt penalties, 41cl W 611, the j o-vs, ipbiljiv of tines and impriserraossat. fot ;vhmiuir.
faIsa irsFurmation. 1 agree to anaitvuct, opervic, maiLttrtin, r4}:uir, -Ind F appIicable, ban dun ttre injec6:;n -WJt ;t:1
aJt relatrt4 appitxtcrisuices i1) sExnrt11F1rt g wide ti7z` :t 17l avi!J s}]ceitit::stiur]! axtd r�»tditif7.ts a1-Li:c perm is. .
5i�:aaturt nfF't,L+p<ttti• i?�hru:rr��.pp!ic�1u
3'ritsl :Nxro,, aW tie e
P
rinko]1'ti Full lv:+itv rlfk% risfc
ar At cyri.:txi fit ern, iCany.., - a_r,
4-16 - A -�f
csr-t'yyjc f ui I 'Nana- end rifle
Pleifse rttjtrn two copic5 Elf tite cnrnpictcd App iy:al,an p nA.a c rV:
North Cai-oliim DFJ4R-DWQ
A40IfCrPrOttrtiun 8"tioa •UIC Pr1Fip-uIll
036 tr zA Suvicc C,crtwr
Rafe h, NC V699463. 6
i ;0ei ,otie (919) 715-6-0:Y RECEIVED I OENR i M
AQUIFm PgmTq,.TrN SFGTII*N
MAY 2 1 2010

May ,21 10 OT07a C & G Well Drilling 7574266008 p.8
(W-17110 9'40 AM uary-s kiactr1C tierviceu rc
FIRST COPY OFFICE SECOND COPY ELEGTRICAL OR BUIWINIG 1NSP THIRD {,'O!'Y HOMEOWIP
HERTFORD COUNTY PUBLIC HEALTH AUTHORMY
RO. Box 246 Construction Permift
Winton, N. C. 27986
HERTFORD COUNTY 358-7833 is
�c-d d� _3 :
�. -C ► d Phone No.
ii
Owner
L ,,Pcati%on -- a r -
r
Address
T
Sut'd%isian Name 1.3
Lat No,
Pin Number
,i
f
�
-No. Bedrooms Nob Peo*
Washing Machine
!��
Autorrtatic Dishwasher
Liquro Capacity of Tank �i R�
No. as Lines Length
J>110
�rdth ;+ t78plh�+
Source of Weter Supply rCz
C]isFance Fram Well�
f Lp1 Size
/
Date e
inspectorT�-
p
!-louse �G � �
Mobile Hams- . - -.- - -- ----
--.----
. Type of 8usiness -- -------
Comments 1) NO BUILD INGS CR ANYTHING TO BE 9UILT dR PLACED OVEFi TAWT DRAIN LINES OR REPAIR
AREA 2] ❑O NOT DRIVE OVER TANK OR DRAIN LINES. 3) THIS�PERMIT IS VALID FOR FIVE (5) YEARS.

Reports
Page 1 of I
Hertford County, NC - Tax Parcel Report
Date: May 27, 2020
PIN:6905-20-4099
Owner Name:
Site Address:
Deeded Acres:
Deed Book and Page:
Township:
Defered Value:
Total Fax Value:
Land Value:
Year Built:
PIN:6906-20-4099
Owner Name:
Site Address:
Deeded Acres:
Deed Book and Page:
Township:
Defered Value:
Total Tax Value:
Land Value:
Year Built:
Account Number: 33826
SAWYER, ❑AVID C
B/S HWY 13
13.38
631, 672
W INTON
$69463
$33453
Account Number: 33826
SAWYER, MAUREEN
B/S HWY 13
13.38
631, 672
W INTCN
$69463
$33463
i
Jr
ram.
�5\13
3
S I-
W
*WARNING: THIS IS NOT A SURVEYI*
Thursday, 5/27/2010
Thi, map is prepared for the inventory of
`
f
real property round within Hertford
County, and Is corn pIled from recorded
deeds, plats, and other public records and
data. Users of this map are hereby notified
b
that the aforementioned public primary
information sources should be consulted
for verlficadon of the Information
contained on this map, Hertford County
and the mapping and software companies
assume no legal reSponsibllity for the
information contained on this map.
Notes*
http:llmaps.roktech.netIHerifordlreportslreport.cf n?CFID=813723&CFTOKEN=29094699 512712010

11:36:30 04 MAY 2010
HERrFURD COUNTY PROPERTY RECORD CARD
ACCOUNT NU'!SER TOWNSHIP
MAP 51 lIFET PIN NUUA R ROUTE ST'£CIAL MTMTS
i
120NE
I �Irr crTv
33826 WINTON
6906_.03 690-20-4099 f 3OO A
OWNCR NkAE
P^.0PL2TY OfSCRIPTODN r PROP -RTY ADDRF C9
SAWYER, DAVID C SAWYER,
MAUREEN CLAYTOR
17908_BARNEY ❑R_
B/S HWY 13
DATE TPANS. sTf.' !-8 pUAL D= RCC'P.ENCC
_
PLAT 97PERENCE SOIL M..Al ASCCa TPl-CY NOASC.'+TPl-CT NO. DATE APPRSOI BY 'h'.-OI PRENOUS YALLES
04/O41 5.4 , a Y S31 /67 2
PC1 / 173F 838 Ol i 21 d AP I_F (39.463
OWI# RAOOR,—, S
CEI:5U51;-^3ER AMENITIES !Lots f ACREh• E LAND
111
_ACCOKEEK MD 206073234
15 '_-O I 13.38 I 0 1 33.463
LAND UsS' jVTILW'r NCIO:*ORHOOD LANDSCAPC TCPOGRAPFW ROAD CY.f-.%PT R Cl.:: NNCI S
E
A
OU,NLITY F P N 36.000
j
CRP: 1.25
WDS: 11.13
j
AMEN:6
_
1 LOUATION
APA: 1867
FR
0.9
01F: ❑
F k9t TYP ACT-FRNT G'5FF4 iWO AVC.CCPTH OPTH�AC LUIT5 1 OP.O I CLS SOIL-TYP Y: ACM APPRAISED W.L USE VALUE
II A92
1. 25 �1
80 14W RA $3 , 5❑8I $�3 , SOB
U7
2 A4
3.53
"2LN $6,810 $6,81
3 4
4. 23'..
175 I I.3C" $7 , 432E $7 , 432
4 A�4
3.27
154i *4LF $5363 $5,353
I I
51 A!1 1.OQ
$10:35a $10,350
I
I I
i i I
SMALL PINES ON PROPERTY -FRONTAGE ON OLD US 13 HWY
NIE1HOD- I DESCRIPTION
CECilON'S I71LJX.Fk1
TYPE APFS OCCIIP-I5lFLE
I ANCY +ifl
I
I �
BL'rx.Co!`.:AR EI 1 OELC R IPI1P:1
USER: t I i rrdsay APPRA I SAL GARB 1 OF 'I
j--- gU:umc OEPREcwnON '-.co;.lrTE JLc 1 WI LING CLASS BUILOIyG TA�f VALUE
I PIiYL1CR.l FVACTIONAL, EG6N0!11G I
EUILDING RLpLA:EMENTV�.wL=
FNaTM SSAiNT EXTEAIOR� RG7FIf✓S'RgVF R gg I P. TTIC IHTEF=%t ,p$NT BUILT-INS iEAT1NG �AiP
�I�pI, PLUMIINC FIREiKJSCE GRACE N1L YEAR EFF COHDt- {5EG(IDN.DEpR CTION FiEP'L CiECTiOIJ iAY_
AP.EA WALLS (TYPE RIFT �11 A WALL IS FINI I _— o .1 F%T_ STK 0PI4 ITT BUILT YEAR TION `nHyF1 RINr, I' VALJE VALUE
.R E MA R K i _ Pi N-s FNCT-L.^RI Er.ON-DPh, TYPE PAFA ISTRIFS FWY :L.AI'H IRAOE NEAR I— I— IIE JAY VALL'E T
OR HOUSE"i i' ITi V I 'a3B,QOQ
i
i
VeLI•=5!'i�`--"� [!9E V�I,UE SIJo-'•IARN
wao R11L'CI iqs LANs BL 1O' , Ts - --- TOTAL TAX VALUE
$33 46 $36 p❑
HERTFORD COUNTY LAND RECORDS -PROPERTY RECORD CARPI VAF.L'1 a��4��� � _�_ s: L 483
rnrw. vPrrT J _
Rl QQ
PCl /34g

Ro gers, Michael
From:
Sent:
To:
Subject:
[e-mail]
Wednesday, May 26, 2010 6:53 PM
Rogers, Michael
Re: Sawyer 5QW geothermal
j(f_k l<~µ
auren Sawyer-17908 Barney Drive Accokeek, MD 20607 ph#301-223-6940 cell240-423-9547 current address.
Well location new construction: 113 Hope Drive Ahoskie , NC 27910
Thank you, Criss Menefee
---~-Original Message-----
From; Ro gers . Michael
To: charlesmenefee @cox.net
Sent: Wednesday, May 26, 2010 3:10 PM
Subject: RE: Sawyer 5QW geothermal
As in previous email, we need the info for Sawyer. We could not read the names of the Permittees, mailing address,
and physical address of the well site.
Thanks
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
From: [e-mail] [mailto:[e-mail]]
Sent: Monday, May 24, 2010 5:21 PM
To: Rogers, Michael
Subject: Re: Gunnells SQW geothermal
Sorry for trouble:
Mailing address: P. 0. Box 25 Harrellsville, NC 27942
Physical address: 114 Christian Harbor Road Harrellsville, NC
Address heat pump contractor: Gary's Electrical Services Inc . P. 0. Box 312 Colerain, NC
C&G Well Drilling, Inc. mailing address: 2257 Santa Fe Arch, Va Beach, Va 23456
Sorry for the confusion , I will be more careful in future. If you have any questions, please call my cell# 757-438-3123
Loops to filled with water only with no additives .
thank you, Criss Menefee
I -----Original Message -----
1
From: Ro gers . Michael
To: charlesmenefee @cox.net
Sent: Monday, May 24, 2010 2:09 PM
Subject: Gunnells 5QW geothermal
Charles-
We could not decipher some of the information on the form was submitted for the SQW geothermal well. What is the
mailing city and physical address, city? Also, what is the address of the heat pump contractor, and your mailing
address?
Since these forms are hand written and faxed and re-faxed, please print clearly.
Thank you
Michael Rogers, P.G. (NC & FL)
Environmental Specialist
NC Div of Water Quality-Aquifer Protection Section (APS)
1636 Mail Service Center
Raleigh, NC 27699-1636
Direct Line [phone]; Fax [phone] (put to my attn on cover letter)
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties
2