09042 Fmr Scott Aviation MWA_20200904

ab
Resolve Environmental SeMcef, PIR
September 4, 2020
Ms. Carolyn Minnich
Brownfields Project Manager
NCDEQ
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Re: Monitoring Well Abandonment Report #2
Fmr. Scott Aviation
309 & 310 W. Crowell Street
Monroe, Union County, NC
Project ID: 09042-05-090
Dear Ms. Minnich:
On behalf of the City of Monroe, property owner of the Former Scott Aviation site, located at 309 and
310 West Crowell Street in Monroe, North Carolina, Resolve Environmental Services, PLLC (Resolve) has
attached Monitoring Well Abandonment Records for MW-1, MW-9, MW-10, MW-11, P-4, P-5, P-6, W-2A
and W-3A, for your records. Please note that P-3 could not be located and therefore was not
abandoned.
The monitoring wells were abandoned by a NC licensed well driller on August 15, 2020, due to ongoing
site development. Per the NCDEQ's request, monitoring wells MW-6, MW-7 and MW-8 remain intact at
the site.
This information will also be included in the Annual Summary Redevelopment Report.
Please contact me at 704-289-5881 with any questions.
Sincerely,
Laura Minor, Project Manager
cc: Mr. Brian Borne, City of Monroe
Ms. Fern Paterson, Parker Poe
Ms. Evelyn Rogers, AECOM
file

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Corey Buchanan
Well Contractor Name (or well owner personally abandoning well on his/her property)
4417-B
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitorine ❑Recovery
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned. 8/15/2020
5a. Well location:
Former Scott Aviation Facility NA
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 0.4 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
S Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
35 I bs
7g. Provide a brief description of the abandonment procedure:
Well abandoned with bentonite from
total depth to surface and plug reinstalled.
Manhole and pad could not be removed.
Facility/Owner Name Facility ID# (if applicable) S. Certification:
310 West Crowell Street, Monroe, 28112 Coy., , 08/26/2020
Physical Address, City, and Zip Signature 4 Certified Well Contractor or Well Owner Date
Union 0923-2260 By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No. (PIN) accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field, one lat/long is sufficient) 9. Site diagram or additional well details:
34.983873 N 80.552304 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: M W-1
6b. Total well depth: 18 (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: 15.13 (ft.)
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Corey Buchanan
Well Contractor Name (or well owner personally abandoning well on his/her property)
4417-B
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitorine ❑Recovery
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned. 8/15/2020
5a. Well location:
Former Scott Aviation Facility NA
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 0 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
S Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
20 Ibs
7g. Provide a brief description of the abandonment procedure:
Well abandoned with bentonite from
total depth to surface and plug reinstalled.
Manhole and pad could not be removed.
Facility/Owner Name Facility ID# (if applicable) S. Certification:
310 West Crowell Street, Monroe, 28112 Coy., , 08/26/2020
Physical Address, City, and Zip Signature 4 Certified Well Contractor or Well Owner Date
Union 0923-2260 By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No. (PIN) accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field, one lat/long is sufficient) 9. Site diagram or additional well details:
34.983873 N 80.552304 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: M W-9
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: Dry (ft.)
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Corey Buchanan
Well Contractor Name (or well owner personally abandoning well on his/her property)
4417-B
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitorine ❑Recovery
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned. 8/15/2020
5a. Well location:
Former Scott Aviation Facility NA
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 0 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
S Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
20 Ibs
7g. Provide a brief description of the abandonment procedure:
Well abandoned with bentonite from
total depth to surface and plug reinstalled.
Manhole and pad could not be removed.
Facility/Owner Name Facility ID# (if applicable) S. Certification:
310 West Crowell Street, Monroe, 28112 Coy., , 08/26/2020
Physical Address, City, and Zip Signature 4 Certified Well Contractor or Well Owner Date
Union 0923-2260 By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No. (PIN) accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field, one lat/long is sufficient) 9. Site diagram or additional well details:
34.983873 N 80.552304 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: M W-1 0
6b. Total well depth: 10 (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: Dry (ft.)
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Corey Buchanan
Well Contractor Name (or well owner personally abandoning well on his/her property)
4417-B
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitorine ❑Recovery
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned. 8/15/2020
5a. Well location:
Former Scott Aviation Facility NA
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 0 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
S Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
20 Ibs
7g. Provide a brief description of the abandonment procedure:
Well abandoned with bentonite from
total depth to surface and plug reinstalled.
Manhole and pad could not be removed.
Facility/Owner Name Facility ID# (if applicable) S. Certification:
310 West Crowell Street, Monroe, 28112 Coy., , 08/26/2020
Physical Address, City, and Zip Signature 4 Certified Well Contractor or Well Owner Date
Union 0923-2260 By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No. (PIN) accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field, one lat/long is sufficient) 9. Site diagram or additional well details:
34.983873 N 80.552304 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: M W-1 1
6b. Total well depth: 12 (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: Dry (ft.)
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Corey Buchanan
Well Contractor Name (or well owner personally abandoning well on his/her property)
4417-B
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitorine ❑Recovery
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned. 8/15/2020
5a. Well location:
Former Scott Aviation Facility NA
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned: (�
7b. Approximate volume of water remaining in well(s): 2.9 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
S Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
40 I bs
7g. Provide a brief description of the abandonment procedure:
Well abandoned with bentonite from
total depth to surface.
Manhole and pad removed.
Facility/Owner Name Facility ID# (if applicable) S. Certification:
310 West Crowell Street, Monroe, 28112 Coy., , 08/26/2020
Physical Address, City, and Zip Signature 4 Certified Well Contractor or Well Owner Date
Union 0923-2260 By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No. (PIN) accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field, one lat/long is sufficient) 9. Site diagram or additional well details:
34.983873 N 80.552304 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: r —4
6b. Total well depth: 33 (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: 14.41
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Corey Buchanan
Well Contractor Name (or well owner personally abandoning well on his/her property)
4417-B
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitorine ❑Recovery
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned. 8/15/2020
5a. Well location:
Former Scott Aviation Facility NA
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 4.0 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
S Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
50 I bs
7g. Provide a brief description of the abandonment procedure:
Well abandoned with bentonite from
total depth to surface.
Manhole and pad removed.
Facility/Owner Name Facility ID# (if applicable) S. Certification:
310 West Crowell Street, Monroe, 28112 Coy., , 08/26/2020
Physical Address, City, and Zip Signature 4 Certified Well Contractor or Well Owner Date
Union 0923-2260 By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No. (PIN) accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field, one lat/long is sufficient) 9. Site diagram or additional well details:
34.983873 N 80.552304 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: r -5
6b. Total well depth: 44 (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: 1 8. 82
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Corey Buchanan
Well Contractor Name (or well owner personally abandoning well on his/her property)
4417-B
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitorine ❑Recovery
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned. 8/15/2020
5a. Well location:
Former Scott Aviation Facility NA
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned: (� (�
7b. Approximate volume of water remaining in well(s): 6.9 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
S Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
90 I bs
7g. Provide a brief description of the abandonment procedure:
Well abandoned with bentonite from
total depth to surface and plug reinstalled.
Manhole and pad could not be removed.
Facility/Owner Name Facility ID# (if applicable) S. Certification:
310 West Crowell Street, Monroe, 28112 Coy., , 08/26/2020
Physical Address, City, and Zip Signature 4 Certified Well Contractor or Well Owner Date
Union 0923-2260 By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No. (PIN) accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field, one lat/long is sufficient) 9. Site diagram or additional well details:
34.983873 N 80.552304 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: r —6
6b. Total well depth: 69 (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: 25.73 (ft.)
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Corey Buchanan
Well Contractor Name (or well owner personally abandoning well on his/her property)
4417-B
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitorine ❑Recovery
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned. 8/15/2020
5a. Well location:
Former Scott Aviation Facility NA
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 4.0 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
S Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
75 I bs
7g. Provide a brief description of the abandonment procedure:
Well abandoned with bentonite from
total depth to surface.
Manhole and pad removed.
Facility/Owner Name Facility ID# (if applicable) S. Certification:
310 West Crowell Street, Monroe, 28112 Coy., , 08/26/2020
Physical Address, City, and Zip Signature 4 Certified Well Contractor or Well Owner Date
Union 0923-2260 By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No. (PIN) accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field, one lat/long is sufficient) 9. Site diagram or additional well details:
34.983873 N 80.552304 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: W-2A
6b. Total well depth: 43 (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: 1 7. 86 (ft.)
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Corey Buchanan
Well Contractor Name (or well owner personally abandoning well on his/her property)
4417-B
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitorine ❑Recovery
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned. 8/15/2020
5a. Well location:
Former Scott Aviation Facility NA
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 1 ' 1 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
S Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
50 I bs
7g. Provide a brief description of the abandonment procedure:
Well abandoned with bentonite from
total depth to surface.
Manhole and pad removed.
Facility/Owner Name Facility ID# (if applicable) S. Certification:
310 West Crowell Street, Monroe, 28112 Coy., , 08/26/2020
Physical Address, City, and Zip Signature 4 Certified Well Contractor or Well Owner Date
Union 0923-2260 By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No. (PIN) accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field, one lat/long is sufficient) 9. Site diagram or additional well details:
34.983873 N 80.552304 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: W-3A
6b. Total well depth: 40 (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: 33.16 (ft.)
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016