Cumberland_Well Abandonment_20221028

YELL ABANDONMENT RECORD For tre rtalVwONLt-:
11is feint cart be used foe sinute ar ntunipte lulls
1.}Nett Contractor Utformaoon griL awnOMENT D6T 1k g.
Scott aunt sr. 7atVumlteraitncllbeiteT;aUandon4d 1
��ittr th�tf' s+irfa tt� s;rrrr
11Teit �m CurewrNat=(or%%Vn0%,bwP:r�HAa ubambWugU61onhktnrpfapMy r"cL' rrrfrfl�h rrl;srtiwr +u r*rncrrer arrefih
cnraataircraixi iahizrrcfr±+rrnrr'.r),rn crvr,afruar ratr�/F�rnr
4561-A 7b.Apprui:lmate volume of water remaining in well(s): (9A)
NC Wet7 Carnatclar Curl(ficatiuta NumJasr _
F"WATIRRSUOKY Wf:1,1.S MIX-
SARDACCO Inc
Czrnspatq N.aute 7c Type of dininfietant used:
2.Well Construction Fcrmit M—
l.ixt e at it:kvtfr wdlpmrmav rt.e.CVJP .Sloe,Alrumve,lnfedfou,eft)r/S'smuo 'pd,Atnotttlt of dhAnfectrlat used:
3.Wen use(cheelf'Vell wit:):
Water Sappiy Well: 7e.Scaling matetstalc used(ch"k all that apply);
IIAgrr itltutat t]htimicilnUp ablirx Neat Cement GUM 0 Bcrrfeuitc Chips or t?cllcts
❑Ci>3athcrmit{Flc:uimaC001ju-Supply) oliesidrntial.l4atcr$upper•(single) II Sand Ccrnen!GIUtu ❑ Ury CLt}
IIhrcltlstriidf(prnntcrci r1 ❑mid:nt;at 14:�itcr Supply(shared)
.II Couctetc Grout ❑Uttll Cutfltr
❑lrri� ion II Sptaeiahy Gtoul II Gravel
han Water Supphy Welh R9 Bentouite slurry t7 Qllter(explain under 7S)
13MO iterut as:ra�'tq
lajectlott c : +f.For each material selected above.prolkide amount of materials nSC(I:
MquilkaRcciLa%t MwundtiarerRemadiation Neat Cem.:941b ,Wtr:7gal. Sand Cem.:lb ,Wtr:gal.
QAquiferSloraige.and Rt.IMIMy IISalinityLanier
Miluifer Test 13sle"ntvatcr Dmirrage -
MxVeriateutal Techualbua DSubsidtoce Cowtul -7 .Prurtde a brief description of{ire allandu"mcnt PINI -durc
Meotherntat(Closed Loop) i iTracer
Pressure grouted from bottom up.
oGeothennal tt Qui eCooli. Return} 001her4ea lalaunder 7gl
a.nittcwtUCc)ahautdoned. 4fgo.4-if
S&L Well tuuttion: m r&
Chemours 022
factTtig?YhviaTNsno {ifapplicable! B.CcraiRcation: IPt•^, e , r
C:i4ntty tLtB �'•C'•i'-.:9
1248 Bill Ball Rd White Oak, NC 28399 J , 2022
Pity'sicat Addres.Cin,and 2itr Stgititrrn;orCwtiri4d 1Veti Cot motor or Wolltbvrur Daar
Cumberland fly sigluji this furor, 1 hewhG• Mar tlae w,tfl(si rt'cag ruerej uhanrfaned ttr
Coved.} Nted Wntitttatt+wtNa.{pttiT) cacconfaatcr,It,011 M ttA'02C,1)100 ter X,#100111141 CC 1381 tcfrtrp StiaM1afrfs
rand d/rid a.copy of this recar4t irm freers pnvidded to the w°e11 owner.
Sb.Latitude and bmgittx&in degrrecgltnittutcatseeoads or decimal deduces:
(ifniAl told,Oak tat:'tortyts 9031;xt t) 9.Site diagram or additional well details:
You tuay use the back of this page to piavide additional Full site details or tail
N W abaudotuueca details. You uray&0 airAelt WilitionA Ir gas if neeessaw.
Cp1gST1tiTCTlAat DE EA11.ti I3F IVEI l itil DEING ABANDONED ST T—UNIi7 AT.tTN:R't'tliliCftQNS
idle ra ueif cr+rs+rrrctiaa+rtcrtr�lsJ!a'ornit, fu For nofft+ple rngetiou or re+u.atf:rr apply
ivek_ONLY is-11 l ralu am SwIl a one pal. ip;. For All 3Wh• Submit thLS Egmt within 30 d n•*of completion of ktell
6a.Wef1[DS'•
oW-4 Aindounurtt to the folinwing:
Division of Water Resources,Infurmation Processing Unit,
1617 Mail Smite Crater,Ralcipb,hC 276r19-1617
6b.'Ehtat wed depth: 57 (ft,)
hilt.For frtit�etiRin-WAls: hi addition,to seudiug Cite feint to lite address ill lha
fie.Borehole diameter 2 tin.} short,.Aso subutit our cape of this f0m,within V dAVs of,:umptetiva►of trelt
abandonment to ten:folln«ing: .
DiAsiuu of Water Resounres,Underground i llecdon Control Program.
t►d.Water lctelh&iw•Wwad arrfasc: (ft.) 1636 Mail$cnicc('cater,Raleigh.KC 21649-1636
ltlr Fnr Wane_%only.¢a kulcethiu Well . In addition to sending the farm to
(w,Outer casing leagit(If ialowrtn); (ft.) the addresses) above. also submit otte Cep{' of this f0fM witbiu :Tel€ days of
tomptcdon ut«cil a6andarumm Co Itac County hagih&pantnew of trio cotuay
whrrc abandtit�d.
6L Innercasinw1uhiag tenigh(if[mown;): (ft.)
6R Sereca length(if known):
I
i
Faun GW-30 Nand Carohin Deturtrr o of Enr iman:cor atrl Naiwal Resm—cis—IN%ision of%oar k esouicc-i R vtscd Augusa 2oIS

WE LL BAN I4I NEN�'' RECORD rat lt.4cm1 tW�Ni.e:
This faun ran be used for sin-afe or multiple lkells
1.Well Contractor 1,4ffatrn ttion WFL ARANDMMRi4T q AUII
saott aunt Jr. 7,L Number of wefts heft abandoned-, 1
4 c1tco Itriow-Nome(,,[fcr,:tt Ins off ps'Mmtta atrumiAuin°f UU,N.2 Wait X,r opcs ry Fran Irl4dilple €11ty xton r>" w.41+reerer Vff qt "40 t],\+LY wrat! €* $00t
c atftrbctle�"l�tT2+r&�;s Nr�t at,tit!cWt s.q€I;NiM1Gvn..h"rnr,
4561-A 7b.ApnniximAft,VulumC Elf wdtcrtwnaduiugiu Cal
NC W01 Cautrwet 4,•etriiisatittta Nmailaer
SABDACCO Inc
CO"*ally Kanto 7c.Type of diaiufeetant need:
2.Wilt Cousstrutdon Pe trait -
f to di applu'aAle a tt c4mr4l�91we.t wlawe,luftra rm,de.1 rJkwwu 7d.Alan[rlf dWaf&''tuut md,
3.Well use(check Well use}.
Water Supply Well; 7e.Scaling materials used(shed..*11 brat apply):
CJrl ttttntae [�tvtsmtcip�itPutsttc M Nag ccamut Grout 0 liautenate Chips of Psll�is
❑Sant Cement Grout ❑ My CL•ty
❑Cictttltettnd(Hcatiur l"a0ling StrpplF} t7[i tttiut',tflttgr Supply(Mnjol ❑ Chill Cuttin
❑hdostciaL'Cotunwrcttl ❑Rcsidet `VaterSupplti(sham() D Cpedull GTOut
❑Specnuliy Groin ❑Gr°t+e:l
131rd r tion
a!'ctnWater Supply wa. ®8erdottitc Start}' Ci Other(explaist trtt is 7g)
❑141anitoda �liecavea'
7f.For each urtttcrtal.selecirtl above.prakidc attt0n4tt Of tttsrtrt9atu used:
Injection lYcR:
❑AquiferRcdUIgc ❑0ttlmtdtt4terftumamion Neat Cem.:941b ,Wtr:7gal. _ Sand Cem.:lb cWtr:gal.
❑Aquifer Strout a mA Rccdv3n^ 17Ssdinily Battier
❑Aquifer'Ted DStanmvvterortinage
❑ illerinte MI Ter:hnot* ❑Subsidence COMM 7g.Projide a brtcf 4ev riptitm of the abandonment pr41e4xinre:
k1GFotttennal(0mod Limp) Mcer pressure grouted from bottom up.
®Gcothawl tligatittr7r'['zoG ttettttnt 1 Other{ rain under 7gD
4,Mte%Wj(s)abandoned- 9/20/22
A3.WOU tneateion: _ 0 C T 2 S 2077 _
Chemour6 . xr rt
r•�-a'tit�-tn�4irapa►�Ne1 S.Cc�rti[lezttiOu: Itu�t,r:rt';��� i'i'.^,r,.suv.:tJ Ut'aK
Farilit)icKV erMM0 r,s'.Q/a0G
1248 Sill Hall Rd white Oak, NC 28399 '� 10/11/2022
P46ical Addis.C4,wW gig 6ia j tarn or estuled Wen Cat for or W41 t}n-teaf Date
Cumberland 13j:+Y n n d�'dtSp€t€l7n, F(fern by rtrr*tfp of trd tJ tc�tf{I trr:a{i:rr r a'wulauled aaa
lvufitp ILaxei Idattgt3catr tttAta.iPttvh air cvrrtct+din 4t ilFd 1{•1:4'.'"SIC"tl _.411(tt1 of ZC'd 1t7 tt'c1I t:tftt5ltYdtYlFrn'Wstifard.;r(ts
and dkart ra ezrypt+e€f"this rercord kats.beat l+mu ded to dire well c+txtt9r.
$b.tatitudeaod longitude in dogrccalottautarslseconds or dedinal dcgre w
{if c1t f41,rlfae kttnunS is taptr ,a 9.Site diagram or additional well deter:
You may we the back of t@is page.to pfavide additional writ site details Of UVII
W :abandomn at details- You tttkV AD Mach additicntai POVS if lac ssary
t't11AS Cittit9 ttlrT!1)�1A11.S OF WEL.ta'si,SKIN(;MA!VIDONFI) &J_%jI T^r�t —M ROtC'tUM
drf Erie vzlr csit�?rtrl€rv!rNcurii+ afa-WAw'ii. lclr m^.rfaip&ith Pi+ltc Or mw"nut i'P&
tavddsIMLYY,irlf.Vie auaat c>fas .104.Fora Wda: Submit this farm within 30 days of completion of'Aril
*andomnctlt to the r01l0wik9-
6a.Well rpg•ow-5
Uivisionof Water Remititve!c,lnformation Pruceminll[brit,
t617 Mail Service Crater.Hakho.Nc 216'3r)-1617
6b.Total"ea depth: 64 0 1
iCtb.For lstfertlrttt Wt�ttc: to additionf to sending,d►e form tiv the atidfess ill Ilia
dbatv,also subluft one.cape or this farm within 30 day,of completion of wen
6c.ltos ehule diameter:2 ---- (in.► tb n domucla,to tlaa failowing:
!llvjslott of Water Remurm,Vidergruund to jec-don Control Program-
rd.Water-leW bdxa Mmund surlac c ( ) 1636&Wit-Service(-VaU .Raleigh,MC 27fi9q-tG3b
loc.Fear Wroter Suont�.Yr laic tttttr `ells; to addition to se Wing the fO+ttrt 10
fir,Outer easinglenO(if known): (R.i the addiess(es) abotre: also-<ttttuut One copy of this form within V days of
cvmpktion of well a&andaatrmm to the coup r•h0dIh dt•Pafnmem of the e:0"r-1F
rehear ttbindo scd,
6f.Inner coin;jtabing length(if Lu aw•n): (0
ft S4tt a length(if kuaan?s ft.f
i
Fano ratWAO Dtoftta Cartttaua Dipanrafetz!of t?n4i asantesat aril Natumt R,:souces-DWL-A'a a of Watcr%c^soufc" Rented Augusa 2titz

WELL AE1ANDONNN,'1J ,T RECORD For lmcnwl Uw ONLY,-
This formranran be used for single a muttiple wells
1,Welt Contru tr information: LVUL AKANDE1N1NEN f RTi i'.Al[
Scott Hunt Jr, 7a.Number of wells being abandoned:1
Fiv rtalrlople or wws nttfer swTh' m.dhg UwL} rrrh tl +rrelir
%veil Cet�raetcr Dante(cr vvrthnvkxr p;isottall}aUct btatting Kr U on tGR71xr propettg) cMtlsfrrtettlxt abram>txrru rlr,pin aw sui`�lrrt SN1V�lrr r.
4561-A 7b.Appro%imtttc volume of water remaining inwell(AI):
NC WCO CottlramorGatitie.ation Nanrxr
6OR«:#TFit S11PPI,Y WELL ONLY.
SAEDACCO Inc
COttr(+,uty Name 7c,T�Vc of dhinttc•etant used:
2.%Veil Coustructfun Permit th.
Ld-s all,.l&oAle W411wif u ft d.C-w-wttt Shae,lbri wce.brjeruolt,erg:t tf kooky 7d.Amount of disinfecctant nst:tl:y
3.Well use(rbcrlc tteit use):
Wateruse(cWell: 7r Srallnn materials usxtl(Chtxli all that appl}):
L7 ater Supply ltttrtl ntvltaalci(rxllRt@titti M�t 4ltmcttt Grant M Bentonitc Chips or Nrllets
oc;rothennal(Hcadjt;f'oolina Suppty) OR rntiat Water S n Div Cot}+
upph'(011910 ❑Saud Cement Gmut
❑hu►ttstri tit otnmcartat mesidenti.•et Watcr Suppty t4ltared) ❑t'ouetett Greta ❑ Drill Cuttings
�1tti'.ndtlDn 0 Sp&ia€ty Gtout. ❑Graael
Non Water Supp��Wct1; ® Bentouite slaw 0 dither(explain under 7g)
P9141ottitOeing. t]Recovety
7f.
[njection Well: For each u►accrial`Clrcte+l above,provide amount of.tttatet9ats used:
❑Aquil'ctRecharge ❑GrounzinaterkenlWiaticn Neat Cem.:941b ,Wtr:7gal. i Sand Cem.:lb ,Wtr:gal.
13Acp fcrSfumj:cIIni.RCC0vert! ❑"iniir Bartiet
DAquifer Test ❑StounivaterDrainage
0Es7cndnteuM6 Ttchaolo—m Mabsideoce Control 7g,PrnvidL a brief deguiption of tiie abandonment pr%mdurc
0Gt:otltennat(Closed Loop) Mitt r Pressure grouted from bottom up.
CJCrrothett»uttitHgatiinuCaalinrlt orn) 00dwrlea laiaunder
4.Ditc,wCR(s)abantlnttcd: 9/20/22 n( 9
Well taxation:
Chemours DV1fQ/'B)t?G
F�cf fttet)wuerNamc rxility ID9(ifappliaib1c) 8.Ccraficalion:
1248 Sill Hall Rd White Oak, NC 28399 S�.dy�urtt 10/11/2022
Pky+sical Adilic-m Cft)t mid Zip $icnzlkksr 9rC<nil3erl iVF31(.�n u+rnr GlactlQ3a r U„t�
Cumberland f!v si ntrrts,•thrs/r rtn. I irelvkv cergfy duty wetifs! tress tleerel.1hewthmed!rt
County Rarecl I&Wirkstiatt No.(Plt+i) ac-cc.t fanca with t 5A NC>!C O''C.01►1t)Or?t_'V00 i ell E ons.frlt0off SCnruktryls
and that o crn9,0141ris record lim-beat ptatidedla ddre well of t:er.
Sh.ItAtituda and latigitndeIn or decimal degrem
(i1'nclt rw1d,cure tadlon2 ig i tiricicrn) 9.Site diagram or additional well detaffs:
You UjaV tale lilt hack of this paw toL provide additional well site details or well
t\ W abaWouutent detai& you tua)'also attach Ahlitional baby'-if ttecesSurY.
Ct1hS1 R1iC"ftCfAl DE'lAIt ti OF IV-ia:WSi t3MNCti -A11.�-1400 iED MWIRMIX—EAL M3 Ft$ 1 -I NQ.
lttrtnr.tailtyro.ctrvJimtnxvrdsi-tfavwlafllr lirnerrltirl it rrt+ureu rv�li*a-wa�}d�h' —
t JZrt)ULY;ritR{ltr.:atla crnrstructiiit'ca5r;mlrrm.trt.) c� s�frrl7en joimr- 10;s.For All�Vt1C�: Submit Uti�fatttt¢itttin i(l dt}a of completion of nail
.OW-9 afltandoumcnt to ttw fallonrinR;
ta.�Y¢D tD3.
Division of Water Reboot ,information Processing,Unit,
1617 Anil Stx"w Center,RatclgJ NC 27699-1617
6b.Total vivlt depth: 64
lob.P'ar lniecNttrt\+bells: fit additwn to SeWing tits forth to the address in loa
a Wxv,also sttbutit one cope of this(6nu vdihiti 30 days of compWon of toll
fie.Bombole dl;ntlttter.2 (in,) abandotmtent to the fallotiving.-
Division of Water Resources,Underground injection Control program,
Gd.Water tcvt i betow grnttn(I XttrbM } 1636 Mail Senicc-00kier,Raletgtt,Nt 17699-1tt�l.¢
Gc.Outer casing lea^ih(i6lmawn)• tft.) loc.finr Mter Sannty&iniretin�r�Ar. lot addition to sctiditig the forin to
t» �. the addresses) aboove. also sunlit Otte COPY of this fOutt trilitin 10 tiaYS of
rompletian of avf atrmtdannirrkt to the cowAY Imith depurmient o><the county
where ahatidancd.
Gt.Intereasingtubing,tertok of knouti): (D•l
6p,S► Ien length(if Imot)n):
I
Fonn City-+o Nnnit C rotin a DepAinem of Envivnntait:tni Natttr.tt P.csonucs-Division of%ater Mommes Roosed Aupuzi ZM
i
I i

WELL BANDONN-1 E I Itll_rCl.6RD For 1mcmdUscONLY:
'this Conn can be used for sing or muhiple.iivils
1.Welt Contractor InfUrmation: WFLL ARAM. DoNmENT DErA1L.t
Scott Hunt Jr. 7a.Number o(wells being,abanduuttd: 1
Welt rourivel Name(err abildollitle%bull all hisAw rJapeslt) Far am dg1te o0kilimv or mm-wafer mgyx v wells t}Z'LT wdli MV sass
cv:.aaiM tuui arr.r:lhsn:lrulAjnr�l,
4561-A
7b.Approximate volume of tsattx-remaining in%vell(x)t
NC 1Ve..11 coninslor Cstlil'tz�tficn Noutc�r ( !,)
SARDACCO Inc FOR WATER SUPPLV WCI I:S O.NLY-
Co m,paiiy Namo lc.T pe of disioratint used!
2. MAl Canstructf m Pctm1t at:.
1..lu aril el,rliraaili tr�il.Hrrtrri.'.v f%ai t:rrtnjt:5ha'r f'uriar e,.Lr_,'yrtttl.ti rtt: i11±ir�wa 7d.Amount of dWillceli tit used:e-
3.Welt Use(check w ell.use):
Water Supply Well: 7c.Scaling materials urxd(ihes(:all that apilly):
❑ttgtirtattttttt8 ❑ht(aicipauPublic ®Ncat Cemcm.Grcait Q 80140nite Chip or R.ilets,
i7Gcot114rna.•ll(llc 0q_-q'CoQling Supnl),) t7Rcsic-hilt%Watcr Suppb-(tdnglc) ❑ Solid Cement Gmut ❑Dry My
❑Industrialicomwerrial ❑Rcsidruti 1.%Vatcr Stlpiaty(shaerd) ; ❑Concrete Grout ❑ DAU Cattlup
Lllydetion ❑Specialty Gtotd ❑Gmvel
Non-Water SupplyWelt: M fletitonite.Sluttt 0 fltheftexpWn under 7g)
Dlataultocing IRReccvery
Injection Wctt: ":.E Tor-each material selected AGive,provide antountof,materws used:
13AquiferRc:dmtge ❑GroundttaterRentediation Neat Cem.:941b ,Wtr:7gal. _ Sand Cem.:lb ,Wtr:gal.
❑Aquifer Stoua_eold Recov ❑Salinity=[carrier
❑Aitutt@r Test MtonmNater Draitsage
❑ENperinwroal TvchuotoW ❑Subsidence Comrut 7g.Pmvide a brief description of the abandonment procciture
0Gevilteetuat(Closed Loop1 OTr cer
Pressure grouted from bottam�ip•.,,,,,, , ,,
C7(itwthetntal t&it ttin�tCattlin-l:ltclum) 0011::rieix laic under 7}Yb „. `t> o;.-�: " a
t,DatcrNrll(s)uhanrMncd: 9/20122 OCT 2 8 2022
5a.Weil location: s ry .
iY�sO'iit'.:,:,l�il ri'.^^;��uK;j ill`trl
Chemours .7077s
urui
F:zctlft7-rovMrNsme Fxi►ny iD1(if applk�abte) 8.Cei tifZr�a,,tcia_n:
1248 Sill Hall Rd White Oak, NC 28399 �r^idt.L 10 111/2 0 2 2
Physical AddmSs.City.mid Zip Stu�sapraprt szlUitzt then Cane. for or Wctl f-hvmv Deus
Cumberland tit'.v�vniog this_farm, 1 trEmkv eertr v An dw iveN{s} was vrerx-i a midoned in
Cauuty N.fccl-Walifi�ati�ir No.INN i arronknin,ivNi MANIUC 0.1c•0100)rat•X-4 00lfrM('41os -le olt S'tttodards
and itrat a cvpb>of tlrfv recorai t as been provided 16 tire irelt an-uer.
SU..Iaitihtdcaud kangltuctc ht dcgt+eestntinutestsecttnasnrd�cuat dgi�cs:
(f(vvcli Ciru"olm ynflnli is-AftwaD n.Site diagram or additional well details:
You tuay use litti back of this gales to ptovide additional hell site details or NMI
N W a W-adountent derails. You tiny also altach additional(saps if necessary.
('(INg t'R1lC'i UN OLTAILS OF 44ELL(tii 8>IN -ABANDONED SI)BhiETA-INST71LAC I .'.
ita'al MVP twDs fah-ia ra.exvl 3'I!t'�t�A]1i..5L.6 K'ir n•nitip"C r gittic+n,sr+:art-nu i�srppi}'
14,rils ONLY a iUi the s rmc Ltrtexxraerertrz rrh urr4urrstnt.tom::cwn vt.5mrt,xre#nm 14a. Far All.%Velb Submit this t'arm within 30 days of completion of vvrll
6a �Vcll@ . '3 abaMourli;ni.tathefiollowik
Division of Water Resourom,Information Processing Unit,
tib.'I'atat well depth: 67
1617 Mail Seabee Center,[Weigh,NC 27699-1617
(fl.)
It)b.fin Inleetlori Well In addition to seudinl;like form to ttLe address in 103
fie.Romehole diameter:.6 0113 above also saabudi one copy of this&-ml ntidtha 30 days of completion of%veil
ab;andotuma tit the rallovdikq:
6d Water level below tp otattel stirfaee� ( ) Division of WaterResourees,Underground injection Control Program,
1636 Mail Senicc Centex.IWeigh.NC 27699-1636
Gc.(later casing length(if t,noirut: (ft} tile,For� aLerr Jinnla&iaiectian MdLi: Ill addition to s aalingt the form to
the address(es) above. alsd submit one copy of this fault within 30 days of
comptctian of%veil abartdrounent to the caunly heattlt depmttmeid of the county
Cif.Inner cmingitabing ti.%Zh(if tmown): fit.) %%hcrc a indoncd.
6$.Sereva length(lf known): flit.)
Yust1G%1V-3o Nonh Carnfitra Defurtmcm of`Enbimamem ard.Natumt Resou.tcs-.131%zion of Mwr Ra5bumics R¢tted Aligns•2012A