WI0700157_GEO THERMAL_20091208 (2)

Permit Number
Program Category
Ground Water
Permit Type
WI0700157 /
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
James A. McMahon SFR
Location Address
3512 S Virginia Dare Tri
Nags Head
Owner
Owner Name
Charles
Dates/Events
NC 27959
C Menefee
Orig Issue
12/08/09
App Received Draft Initiated
12/03/09
Re g ulated Activities
Heat Pump Injection
Outfall NULL
Scheduled
Issuance
Central Files: APS_ SWP_
12/08/09
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
James A. McMahon
Co-owner
2536 Bridgewater Cove
Wilmington NC
Major/Minor
Minor
Region
Washington
County
Dare
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Charles C. Menefee
2257 Santa Fe Arch
Virginia Beach VA
Public Notice Issue
12/08/09
Effective
12/08/09
28411
23456
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Goleen H. Sullins
Govemor Director
1202009
James A. McMahon
Karen B. McMahon
2536 Bridgewater Cove
Wilmington, NC 28411
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. WI0700157
35I2 South Virginia Dare Trail
Nags Head, NC 27959
Dear Mr. & Mrs. McMahon:
Dee Freeman
Secretary
In accordance with the application submitted to the Underground Injection Control (UIC) Program that was received on 12/03/2009,
the Aquifer Protection Section (APS) acknowledges your intent to construct a closed -loop geothermal water-on1L injection well
system for the operation of a ground -source heat pump located at 3512 South Virginia Dare Trail, Nags Head, Dare County, NC
27959. This system is deemed permitted by rule (North Carolina Administrative Code Title 15A, Subchapter 2C, Section
.0211(u)(2)).
However, it is recommended that you contact the Dare County Health Department, as they may have additional construction or
permitting requirements for this type of system. If you modify your system at any time, including the addition of antifreeze, corrosion
inhibitors, or any other substances to the circulating fluid, you must contact the APS to verify compliance with applicable rules.
Thank you for submitting this notification. If you have any questions please call me at [phone].
S' cereiy,
for Mict Rogers
Environmental Specialist
GPU-Aquifer Protection Section
cc: Washington Regional Office - APS
APS Central Files - Permit No. WI0700157
Dare County Health Dept.
Charles Menefee, President (C & G Well Drilling, Inc., 2257 Santa Fe Arch, Va. Beach, VA 23456)
Fred Marklin (RA, Hoy A/C & Heating, 3908 North Croatan Highway, Bitty Hawk, NC 27949)
David H. Morton (Town of Nags Head. P.O. Box 99, Nags Head, NC 27959)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27599-1836
tacation, 2728 Capital Boulevard, Raleigh, North Carolina 276D4
Phone: [phone] FAX 1� 919-715 1586; FAX 2. 91�715-60481 Guswmer Service. 1-877a23-6748
Internet. m m.ncwatera�or
One
NorthCarol_ina
ki Crud Oti anuv tv s Akirmaiiw 4v'i7n Er, p"e•

Dec 03 09 09:29a G & G Well Drilling 7574266008 p,2
Ud 0 U9 07:54.8 C & G Weil Drilling ►.�rnmrknxs Fr.c
NaRTIi CAROT TNA
pfi>,ARTMENT OF F.l MR0NMlffrhZT AND NA7 ORAL USOURCES tNCDENR) j
NOTH.CATION OF )MEN T TO COMTRUCT A 5] AOP GF�-C4*E�AL ^I
INJEC ON WELL SYSTEM
IYPE 5-Ow W EL
in A� with the MvWQns dfr+CAr- T&t{c ]SA' 02C.02ao; case
caurplctc this noOeadon m d nvW to address an the bark?W (please -eiM Or BMitrf0rmwionj.
DATE:Q __7 3, .70P_L
Wail T�pc C f aeirra: 1]pes prupc td 14rycrtculnte po[sthk w r_ r Ana additives) iA
wntimms pjp B that completely isolates the fluid f-CM the envrronracmt (i,e_
closed I ?
yes --Zc❑ntinue completing this fiam
NO Do Not complete this form. C"Ap[ete c7th= MC anUcMion tarrrts fur im-Aniling
cithgr a 5A7 wdiII (ohs -loop well 4gcfing potahle warm into the aqudx) yr a 5QM vmli (closed -
loop well conulinMg addithre& vuch FA R-22, etheaoL or other awifivem or coTrvsi an LAhibitm).
PROPLRTY OWNM(S)PAFFUCANT(S)
List each P,vparty Owner listed on pvperty deed (if owrmd by a business or government avIX7, state mote of
,r,M ty sad a representative wMardmr* fer sigrta=m):
(() Mailing Address: �.', (�eAArLF-waI sz�.
Citr►: W .I M, - C, tmu State: &- Zip Code: Ai'J wr-.r
H=Qraffioc Tele No.: [o �.�r,-`�-= .E Cell�-
7
Emoil Adams iw- _ -
0, bval50"A Me-
g) P?ryrgical Address of WCC Stta (ifdiff mmw than abavC): 01
Ci-ty:.yeta;5-_-Hp stoic:&_ zip Cod 9 f County: _.
H=00ffioe T, do No.: T _ iiAU
IL AUTRORIZED AGENT OF UWMR, IF ANY (iftbe Permit Applicant comes pat awn The subject grmpmrty,
attach a 10= fi+am the pmpeM owwr audmizixrg Aft to in=kl and apomte VIC well)
Uornpan
Contort
Address;
CI*I Stm ij/ dip Codes CaUrt y:
Of ke Tele No.! � �^7 � e+ Cr 1 Ng-.:2-S- 7 !r` Y T
WebsjM Address of CamPUY. if MY-
a-�2-Sti - tisrr ,7 3� I.L -Djc�vIi Y'-I
RECEWE❑ i DENR I ❑M
Aquifef Rr(�Ieojpp 5edon
--- or3gg---
.**,CfQ

Dec 03 09 09;30a C & G Well Drilling 7574266008
L?t t9 09 07:54a C a C WON Drilling v. P.3
C. WELLDRILLEA U FORMATW
well Driller CvrrvftOr 'S Name-
NC Contrwtvr Certification No.=
Crstam 1 -rSO-- _ _ EMn_.II. Adrir s•
Address:
City: _ —� _ zip Conde: v County:
bSeo'Cek No.; _ -- — — - Cell No.: -
D. MAT PUMP CONTRACTOR EffO1 MT)Oi (ir*Premt than drrllar)
CoMPimyNane: R 4A . too
Cant=Perm7rq E&0 &Q<L-T _MALI, Adel-si:
city. �"7~rY„ F� zip Cade: cM_L._ Cotntty: _ it S A
d#lice Tide Na.: c�-?-fv!-onS Cal] ?�io.: _i �� cI g•� ^{3
F STA fus OF A "CAW
Private: 1� Fodcrai: Comznesekd-
State. - Municipal: Natsvc AmericFm Lands:
F. TMECTIUN ZROCEOURE (baef�v damribe how the in3mbou weti(s)aeiil be used)
�V f
G Wl~LL CDNSMUC TON DATA, _
(1 j Psopowd dam to be ranq•usv*d: Number niborin�ts: _ _
Appomdrnmte depth of each baring (feet):- _ Woo
(2) 7j" oftvbing to be used (copper PVC.. etc): Zar
(3) Wdl cash. 1s the wcE(s) cursed? (etwtk cither (a.) Yes M: (b.) No below}
(ll) Yea ifM then providc casivg kf*u=ftn below
7"ypc: �galvsrri d stee f black steel, -- jlju lc— atker (specify)
Casing diepdt: Fr= ----to fcct (reference to lvx4 surface)
Casing emends to abovc gmund -inches
{L} No
(4) Grout Info (Mal surmunding well eating and/or pipinR,):
(a) Grout type: Nmt Camnt Senionite - O*er (sway)
(lt) Gt om PLicernert!_ Pumpi:lg­ Pmsure Der
(c) Grout depth of tubin; (vefascnee to laud surfaoc): from to t7 (feet)
[i well tam canine, itadRcts'e gTsrut depth: ftvzu G to

Dec 03 09 09:30a C & G Well Drilling
Oct x8 V 07:5aa C ❑rilting
7574266008 R,4
A,Ttwh a diagram slowsmg the ertginmeting layout or prepmed modfficafion of ft iajectinn equipment and WoAor
piPf"g kubkS Assodawd with t1w isijeebitnn opmdom The mamdact=e9 brmuye! may provide supplemelfty
in bn atkfL
L LOCA71ON O IF 1 d5I
Ai&Ch tWn C00CS of MOPS Si'1tJMA08 thO &i10Wing 1hfiDUT) l MCM
(1) Include a Site Map (can be dmvsra) showing: bWiditws, proparty litres, surface witer bodies. potest:ial
gpurCa9 ofgmindwaser e4ntamsctrtitstt and the• onriendatiars aiand disEeaices betweat the prvpQ^,c►3 wr�!(s) and
any existing wcU(s) ear WWte dfspasal Riddles saab a$ septic to kS ar drain t'teidh lasted widdn 2N Mel of
the geofha=u) heat pump well system. Label alt feahms alcmiy and incladea mrft ngow.
(2) TU Sine Mite 3mvst show the subject property m rclttion to the sutrouandiAg am by us1 mg m iea~9t twe law
reference points such as woad.% ins, and/ar hip; w y 4rmrscctious.
.t_ CERT114CATION
?Vote: Tbis Pervi t Applientiion � be siptteti toe
nelmdcd legal property deed.
"I hereby ctarrlfy, UOda Micky Of law, titer l hAVC pdcsorAliy =Muined and nm bmiliar with the irefomjaafou
submitted in Ods decarnoent and ail anactmenis !hereto and tltsy based on x0Y irtquiry of those irtdNduaLs
lnetrteadlatWty Mponsible %r obt 4uft said uafac mtinn, i believe that the %fb mae6m is ever ?=Tine and compictm
I am aware riser throe we sigaufieunt pertahiis, including the possib ity of fm-9 and hnprisortreerd, for submittiog
Ube infimtation. ] agme to coanruat, opm=, m a stain, repair, and if spPlieaebic sbmWon the irde a ien wtdl and
al I mlatcd appumnamm in naoardtance fhre approved spomfscaliom m4l cued flom of die Permit"
. iigrsBrilCe e: UwtxexlAppilcar�
Pefttt ar Type
Pull arise: and tirhle:
5igt-ura OurPSUPH y 0WOWAppiit; M
In- ri
Ptruti e7r T,ypc Pall Name and title
8igmh .14F ffm4 Agent, Beaty
Prim or TYPe Pal] Nmme mW TWe
Please r+etUm two copies a£ the complemd Apglicatkm package to:
North Cambiam DE"-DWQ
Agoifer PMtectiort Section -MC IN *V m
1636-Mail Service Canter
Rtrlft]P414C 27699-1636
Telepbtan a (919) 7154935
RECENED / pEUR DV4q
►4Rw�.rprotes^San Section
DEC 0 3 2009

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rr, MIRILVA. DARE T
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0nt'. e:LeVA7104 71"' RA
SURVEY FOR
JAMES A. a KAREN B. WMAHON
LO'r 276-•Ar RECOW&INATr'ON PLAT FOR
t C�re� r 04 J?z r; JAMES A. 6 kAiREN 9, W hIAHOh[
aultnrwa $Lfsr PLAT CA$. (4 , S L I DE 113
� mvrjca erewa TOWN OF NAGS HEAD
zi F= ftm x0ma Aor �1 lnr3
erae,vta!mooa-- 9-aa-ar DARE CDUNrk, NORTH GA RO L i NA
3) et-eVnr•lnws PEA N/iVD is" $U ftll &T (] ! C. 9 - 09 �
4 ! ptw # 9 99E tsa*4cess
S ]�7rtsTNUC�; IA•fF'R�v+swe�rur� rU
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6e'\Y�r.;.e11.1%� :/fR I'Lc r.. Y r^�+f`+•ra "'..11 ...• a r•-
iM+ • {�:I,. y /�j� 11 ' A £ti . }• ' 0 �� ��� it a WrL IAM S. JO S, JR.. •1. r 43., r 1.
— y . 30.1 WEST ARCHa-ktF. S R r
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(IArE' a _9 5C&LE= 1 .��w BY: Q.y4S. P(Z2)441-36?3 F 01-M2;
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- �= .3 � -�"' 1. �s.ii._ .•iT�.' -. �:: .F:ti�....F.7i�.. �!�.L ^4- _'`!��_
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Dec 03 09 09:29a C & G Well Drilling
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Cat
REC_EIVED / DENR / DWQ
Aquifer Protection Section
DEC O 3 2009
❑Be 03 09 09:31a C & G Well Drilling
7574255038 p.7
4-4
TOWN OF NAGS HEAD j
E
DAVID H. MORTON
Senior Sodding Inspector
Pion ning and Devek4mment Department
❑ept.:252-441-7016 a
P p Bvx 99 p'
Nags t-iead, NC 27959. Fax; 252-441-A28U j
smait:devld.morton�mwnoln
1:4/a clje:�wfC/ xZQ641 5 &&-� Lf/ea—
RECEIVED i ❑ENR I Dft
Apdar %ecfim Section

State of North Carolina
Department of Environment
End Natural Resources
Division of Water Quality
Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
Coleen Sullins, Director
_off
of
Division of Water Quality
Aquifer Protection Section
Location: 2728 Capital Blvd.
Raleigh, NC 27604
Mailing Address: 1636 Mail Service Center
Raleigh, N.C. 27699-1636
FAX: (919 ) 715-0588
(919) 715- 488Date:: � o� 9169
FAX TO: C hO V EZ) i�-tl� �� f FAX NUMBER:
FROM:
PHONE: f ��
I NO. OF PAGES INCLUDING THIS SHEEN. r)(
T7 -LjD& - �N)9
If you receive this fax by mistake call: Aquifer Protection Section G 919-733-3221

AWA
~CDEMR
North Carolin a Departmen t of Environment and Natural Resources
Division of Wa ter Qual ity
Beverly Eaves Perdue
Governo r
James A. McMahon
Karen B. McMahon
2536 Bridgewater Cove
Wilmington, NC 28411
Coleen H. Sullins
Director
12 /8/2009
Subject: Acknowledgement oflntent to Construct Type 5QW Injection Well System
Permit No . WI0700157
3512 South Virginia Dare Trail
Nags Head, NC 27959
Dear Mr. & Mrs. McMahon:
Dee Freeman
Secre tary
4i accordance with the application submitted to the Underground Injection Control (UIC) Program that was received on 12/03/2009,
the Aquifer Protection Section (APS) acknowledges your intent to construct a closed-loop geothermal water-onlv injection well
system for the operation of a ground-source heat pump located at 3512 South Virginia Dare Trail, Nags Head, Dare County, NC
27959. This system is deemed permitted by rule (North Carolina Administrative Code Title 15A, Subchapter 2C, Section
.021 l(u)(2)).
However, it is recommended that you contact the Dare County Health Department, as they may have additional construction or
permitting requirements for this type of system. If you modify your system at any time, including the addition of antifreeze, corrosion
· inhibitors, or any other substances to the circulating fluid, you must contact the APS to verify compliance with applicable rules .
Thank you for submitting this notification. If you have any questions please call me at [phone] .
cc: Washington Regional Office -APS
APS Central Files -Permit No. WI0700157
Dare County Health Dept.
J;ll' -lfcxJJ_wi ~
fo, Mici1 Roge,s
Environmental Specialist
GPU-Aquifer Protection Section
Charles Menefee, President (C & G Well Drilling, Inc., 2257 Santa Fe Arch, Va. Beach, VA 23456)
Fred Marklin (R.A. Hoy A/C & Heating, 3908 North Croatan Highway, Kitty Hawk, NC 27949)
David H . Morton (Town of Nags Head, P .O . Box 99 , Nags Head, NC 27959)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard. Raleigh. North Carolina 27604
Phone: [phone] I FAX 1: 919-715-0588; FAX 2: 919-715-6048 I Customer Service: 1-877-623-6748
internet: www.ncwaterquality.org
t.~ Equal Opportun,:; \ Affirmative Acton Emoloye r
One
N orthCarol ina
JVaturall!f
TRANSMISSION VERIFICATION REPORT
�a g 69 y:gq�n-
TIME : 12105/2009 02:05
NAME : NCDE&NRIWATER DUAL
FAX : [phone]
TEL : [phone]
DATE,TIME
12/05 02:05
FAX NO./NAME
917574266008
DURATION
g0:00:36
PAGE(S)
02
RESULT
0K
MODE
STANDARD
ECM

State of North Carolina
Qepartment of Environment
and Natural Resources
Division of Water Quality
Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
Coleen Sullins, Director
Division of Water Quality
Aquifer Protection Section
r-1
OF
Location: 2728 Capital Blvd,
Raleigh, NC 27604
Mailing Address: 1636 Mail Service Center
Raleigh, N.C. 27699-1636
FAX: [phone]
[phone]
Date: I D L6�
IP90
FROM:
PHONE:
NO. OF PAGES INCLUDING THIS SHEET:
If you receive this fax by mistake call: Aquifer Protection Section @ 919-733-3221

~A NC6E~M-R
North Ca rolina Department of Environment and Natural Resources
Divis ion of Water Qualit y
Beverly Eaves Perdue
Governo r
James A. McMahon
Karen B. McMahon
2536 Bridgewater Cove
Wilmington, NC 28411
Coleen H. Suliin s
Director
12 /8/2009
Subject: Acknowledgement oflntent to Construct Type 5QW Injection Well System
PermitNo. WI0700157
3512 South Virginia Dare Trail
Nags Head, NC 27959
Dear Mr. & Mrs. McMahon:
Dee Freeman
Secre tary
In accordance with the application submitteo to the Underground Injection Control (UIC) Program that was received on 12/03/2009 ,
the Aquifer Protection Section (APS) acknowledges your intent to construct a closed-loop geothermal water-on! injection well
system for the operation of a ground-source heat pump located at 3512 South Virginia Dare Trail, Nags Head, Dare County, NC
27959. This system is deemed permitted by rule (North Carolina Administrative Code Title 15A, Subchapter 2C, Section
.021 l(u)(2)).
However, it is recommended that you contact the Dare County Health Department, as they may have additional construction or
permitting requirements for this type of system. If you modify your system at any time, including the addition of antifreeze, corrosion
inhibitors, or any other substances to the circulating fluid , you must contact the APS to verify compliance with applicable rules .
Thank you for submitting this notification. If you have any questions please call me at [phone].
cc: Washington Regional Office -APS
APS Central Files -Permit No. WI0700157
Dare County Health Dept.
S~cerely, . 0 ()
,_;ftil-~~ -J:Jo<Y-GJL D
for MichU Rogers
Environmental Specialist
GPU-Aquifer Protection Section
Charles Menefee, President (C & G Well Drilling, Inc., 2257 Santa Fe Arch, Va. Beach, VA 23456)
Fred Marklin (R.A. Hoy A/C & Heating, 3908 North Croatan Highway, Kitty Hawk , NC 27949)
David H. Morton (Town ofNags Head, P .O . Box 99, Nags Head, NC 27959)
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699 -1636
Location : 2728 Capital Boulevard , Raleigh. North Carolina 27604
Phone: [phone] I FAX 1: 919-715-0588; F.A.X 2: 919-715-6048 \ Customer Service: 1-877-623-6748
iniernet: www.ncwaterquality.org
An Equal Opportuniiy \ Affi rmative /\ct:Jn Em ployer
NOnel C 1· ort1 aroma
)Vatural~I/
TRANSMISSION VERIFICATION REPORT
TIME 12/05/2©69 02:10
NAME NCDE&NR/WATER QUAL
FAX [phone]
TEL [phone]
DATE,TIME
12/05 02:10
FAX NO./NAME
912524414290
DURATION
0 0 : 0 0 : 41
PAGE(S)
02
RESULT
OK
MODE
STANDARD