Buncombe_Well Abandonment_20230315

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W ■.■.ABANDONMENT RECORD. " Faelol®s1UioONLY: : , •
L Well Contender Inf rmHomi • -•• .WELL ABANDONMENT DETML • •. •. •
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e. •C c"."1(-G—�4._ . h..S' •
7ni.For GeoprobdDPT or Cursed-Loop.Geot6srmsl wean having the same•
• Wail Cottons Name(or Wall ownwpa.e■ally•b ndomo6 well cc idsTherpmperty) well conatmetioaidepth,only I GW-30 is needed. Indicate TOTAL NUMBER of .
Wills abandoned
NC Wen Camawter Catifation Number r 7b.Approximatevolume of water renmining 1n well(s): o (gaL)
la_0_ ;,,,bem Q.4 \6‘a..12,-li D• .%\`•% r� c.yy-.Q_. . FOR WATER SUPPLY WELISO Y: - •
\
�'°yN°IDD 7c.Type of disinfectant used: (g - •
2.Well Consdroetloa Permit Or D`0 �• O D�`im ` (� • •
LW all app&cabk well eaa, tlon pen sits(Le.LUG Cou■ty,:ram we:Vwmn del tfbwsn 7d.Amoont of dldnfecfant sued: ` v C •
3.Well use(eheckwell use): • .
Water Supply Weil: • 7e.Sealing materials used(check all that apply): -
DAgel lie • • O Neat Cement Grout 0 Bentomte Gips or Pollees
' •OCieattaeral(lleatitw,/Cooling Supply) Water SSPpiy(single) 0 Groat " 0 my Clay
0Thdu tiriaVCommercial Water Supply(shared) 'I craw Cart 0 DrillCuttings
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O brigadon ' O Specialty Grout 0 Gravel
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Non-Water Supply Well: • } 0 Bentonite Slurry . O Other(explain under 7g)
['Monitoring .. ORecovery
Injection We>h • 7L For each'/ material selected above,provide amount of materials used:
' ['Groundwater i •
OAgnilisRx]mamge �� ����.
_ cAgadar Storage s d Reovary - . OSalinity Barrier w .
• • •A, Test OStoraawatsDrainage • - -
■a Tedmnology ['Subsidence Control •
70.Provide a brief desaiptioa of the abandeament procedure
a • ❑h1acat
❑Geothermal(Closed Return) OOtLer(avian under 7g)• L �- �O ►,�- C ��C�1 C� �
. . A �;A,G=-ice :., _ ?—
• M Date weil(s)abandoned: ; • .
sa.wmlocation: MAR 1 5 2023 . .
Al 01l jcv LLC ,.;-:.- ;- Pr..�•v' . Ur�Y
IDAE •
if b {Ci i -
F.nlity/OwarN.ae F�:Y C spF�► ) • s' J4'e'�;
i 0.1140-re R sAn� \\e to-c G' - $i.
Physical Address,CO,mid Tap } •
S e o all Ceatnstor or well t?wmr
(S1,.Y. e. Cri : 016 53UOtob.
C �� 8y foram,I hereby cart&that du weeR(s)was(were)abandoned in •
( gy • •Foal Identification No.(PIN) accordance vvid 1SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner. .
5b.Latitude end longitude is degreedminuteW.eooads or detest degrees: •
Orwell Sall,ale Wang I svSrdeat) 9.SIte diagram or addidonai well details:
p it Yon may nee the back of this page tin provide additional well site details or well
\ ' N °� r, / ( Rr abandonment detais. You may also ettach additional pages if recessasy. .
CONSTRUCTIOPPDETAIIS OF WELLIS1 BEING ABANDONED .
Mae/wellcomem teareecrd(s)lfamdlabls Formula*W tNa oreopmeekresechotsl+ .
MY with aisaaseeownrarlar✓abardarmrerR yen etas nib*dw fqes. - -- 10a.For Mi We : Submit this form within 30 days of completion of well
• 6a.Well IDt: . abendonment to the following: •
Division of Water Resources,Information Processing Unit,
Total will 9 e 0• ( ) 1617 Mall Service Center,Rabb,NC 27699-1617
6b. 10b.For Injection W : In addition to sending the form to the address in 10a ••
6e.Borehole diametral (0 (In.) above„also submit owe copy of this form within 30 days of completion of well
ebendomnenttothe following:
f+d.Water level below ponds dace: 4 0 (i1:) •• Division of Water Resources,Unda ground I jatioa Control Program,
1636 Mail Service Center,Raleigh,NC 2709-1636
• 6e.Outer-casing keg&(if imown): . . (R) 10e.For Water Simu1V t Infection Welb: In addition to sending the foam to the
addron(es)above,also submit one copy of this farm within 30 days of completion
of welt aliment to the county health department of the county where
6L Inner length(if known): .• (R) abandoned. . .
• 6g.screen berth(If known): (R)
Farm OW 30 Math Carolina Depu meat of Barn cal Quaality-Division of Wste<Resources Revised 2 22-2016 '•

` WELL ABANDON ENT RECORD- For Intemal use oNLY: • "
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L Well Contactor information: c • •WELL ABANDONMENT DETAILS• • .
�.�- % cc--C/K- n S 7a.For GeoprobeFDPT or Closed-Loop.Geothermal Wells having the same
Well Contractor Name(or*ell owner personally abandoning wan on biaiher property) well construction/depth,only 1 GW-30 is needed. indicate TOTAL NUMBER of
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wells abandoned:
NC Well Contractor Cation Number • 7b.Approximate volume of water remaining in well(s): ) (0,ED (gal.)
- ekb�te, ( &10\W Q. V Ul \1 I ;.v\ I n C FOR WATER SUPPLY WELLS O
oar Name 1 • 7a Type of disinfectant used: . .
2.Well Construction Permit#: aO a 3 O 8 © o�`� .
List ail applicable well conhdvchton permits(La UIC Cotor/y.saw Ya►itowe,eta)gloom
7d.Amount of disinfectant used:
3.Weil use(check well use): •
Water Supply Well: 7e.Sealing materials used(cheek ail that apply):
❑Agricultural ❑Muni lie • f i Neat Cement G�rr�oo,�o`t��=-',-^m 1, ,^� t Chips m Pellets
• •OGeathermal(Heating/Cooling Supply). tat Water Supply(single) ❑S d Cement Brunt¢-"..a C._- ' 1 4-°-Day Clay
•
olndustrial/Commercial . ❑R4sidcatial Water Supply(°haled) .crate Great MAR 1 5 2023 °Drill
Cuttings
❑hrigation • 0 Specialty Grout 0 Gravel
Non-Water Supply Well: Cl Bentonite S K T,s:,'n Pc 3•S'•!?../Cr;Other(explain under 7g)
❑Monitoring °Recovery DWQ:3OG • •
Injection Welk • 7L For eagh material selected above,provide*mount of materials used:
t °Aye RechargeOGmnndwater Rar mediation 1 \•I 'L a a:.C' I` --`..-
•°Agrafier Storage and Recovery • ❑Salinity Barrier - \ ``
■• . Test ❑StormwaterDrainage •
• ;„ Technology • ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothemnal(Closed Loop)
❑Geothermal(lieating/Cooling Return) ❑Other(explain under 7g) • O\U'i \ \t e �_ t��.
•
,) ]\ c C C c,x& e .
" 4.Date well(s)abandoned: a. ei a •� - cc- -- .
• Sa.Well location: , •
A k6 P �at rvleili 1,LC • .
Faclity/OwnerNum Facility DM(if sppliable) . S.rr.• -don:•
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1.3 6A t a r 1 o-t _.........As a. ,sad. -
Physical Address,City,and Zip S• •"Brit,W. Contractor or Well Owner
a-t;v,nCO-rv`I(I €_-- By signing this forts,I hereby cert)/y that the well(s)was(were)abandoned in
County • Parcel IdentlfiatinnNo.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
Sb.Latitude and longitude In degre s/minutes/ea:ends or dedmal degrees: •
(:foal field,one Luling is sufficient) 9.Site diagram or additional well details:
• '1 s o 31/ a.01 l/ NcicaoaArt ( /( :. W You may use the back of this page to provide additional well site details or well
alisadomnent details. You may also attach additional pages if necessary.
CONSTRUCI•ION'DE1'AJLS OF WELL(Sl BEING ABANDONED . SUBMITTAL INSTRUCTIONS • .
Attach well coos buctairecord(s)t(aralabla Forstuhlple Injection ornon-taaterarQpb'►ella .
ONLY vAth the owuanccNat/abasdomneruYou can submit oneJ"'"'. 102.For AU Wes: Submit this form within 30 days of completion of well
. abaodcomcot to the following:
• 6a.Well ID&
• /' Division of Water Resources,Information Processing Unit,
a- (IL) • 1617 Mall Service Center,Raleigh,NC 27699-1617
6b.Total well depth: CI S
10b.For Injection 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
6e.Borehole diameter: N-) / abandonment to the following:
rn1 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: d (ft.) • 1636 Mail Service Centex,Raleigh,NC 27699-1636
6e.outer easing length(N known): , • (fk) 10e.For Water Snooty&Inleetion Wells: In addition to sending the fomn to the
address(es)above,also submit one copyof this form within 30 days of completion
of well abandonment to the county health department of the county where
6L Inner caring/tubing length(if known): (R) abandoned.
6g.Screen length(if known): (ft)
Form GW-30 North Carolina Depattmeat of Environmental Quality-Division of Water Resources Revised 2-22 2016

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HELL ABANDONMENT RECORD. : Pre lmaad Use ONLY: . •;
L W Coatrador lido % - •WELL ABANDONMENT DETAILS- -
• E.i•'Sc �®�-GP` hJ 7tt.For Geoprobe/DPT or Closed-Loop.Geothermal Wells having the same
Wall CoatractarNaito(orwalloomrpasmallyabaadoaingwellauhielbarpeepety) well depth,rmlY1GW30is needed. Indicate TOTAL NUMBERof .•
. \.Gar. - .. A -
lz:Wan Coadnietcr "- Nona er l 'r.
7b.Approefmbe.volume of water remaining in well(s): ' b cD (gal,)
L_U �� i \ `,, `�� FOR WATER SUPPLY wFlis o�.i •
s `Company Name `'WA TO D t- -z
7e.Type of rot used:
2.WenConstrued°,permit#: a0aia- — 00-•'5 (o 0 -• • . .
lin all applkabk well coratr rettonpe die(Le UIC Ca dj.Slosta Pmlan4 etc.)bbrown
7d.Amount of disinfectant need: //8 : 6. t - •
3.Well use(chedkwel nee): •
Water Supply Well: 7e.Sealing materials used(cheek on that .
oA�� flli�tw:ccips/Public • 0 Neat Cement Grout _ .Bents mte Chips or Pellets
• Mlecaltetmal(A�g/�g Supply) 0Rosidentin1 Water Supply(single) CI Cement(Ira .' ,," ',— ; a_Dry Clay .
0 ial/Comme vial CR�8�1 Wean Supply(�)' Cwecrete .. 7 Fy' O'I)i liAga
Obligation ' 0�akr� MAR 1. 5 202(
Non-Water Simply Well: • , Cl Benmaite Slurry ❑Other(explain under 7g)
oMonhoring . . .. CiRecovay , iri; m-,y',:-Dn Pea,-c.,-to liri;i .
Injection Wdb . 7L For each material aelectod'bhovarpinvide amount of materials used:
Months Bedlam,: • DGramdwsterRemediation `� o'r1-S \ t 0 'I c�-
S and Recovery °Salinity Barrier C��'r,a1-eJ1 J ,ln� ., i b- Jp
. Teat OStormwaterDrainage lt42' 10..0. 1b .ar `3r`vc re- t`,
iC �l Technology OSnbeidmce Control 7g.Provide a brief description of the abandonment procedure:
OGecfhamd(Closed I cop) 014scerG J�C°�I h p�('2 C� .
OGeothetmal(- Cooling Return) OOlhet(isrplainucder 7g) .
• t
'�� i'��6hl ` P- ris(A C-L�c+ _ .
4.Dateweli(s)abandoned: a a e l . C.e)--�\G� e 1 W GV c?- }c-- . .
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Sa.Wen location: �( 0,--- p,n,15- --4-• .
,,,,cc-c o 1�61Ve.0(01PrS
PscihtylOwnerliana Facility lD#Ofapplicable)_ . e. ,:
. , '. ' Lo,y,�. C3P‘04,:-...
• . .a ri a.
r3..:
Piriad Address, y and yip - - of Wall contractor or Well Owner .
•
' l 'i Z.O vV`--1D Q ql GO I 0 o Bl, •
the form,I hereby cere that the well(s)was(woe)abandoned In
c!usiy • Parcel IdesdBamallo-(FIN) accordance with 15d NCAC 02C.0100 or 2C.0200 Well Canstrucllon Standards
and that a copy of tits record has beet provided to the well owner. • .
5b.Latitude and longttade ht detprt&minutes/seconda or decimal degrees:
(dwoll road,am Wiling is aat6el.ot)-- 9.tilts a�.or!Oedema'well details:
0 l l o 1 /I You rosy ono the back of this page to provide additional we is ll site deta or well
`j f o N oL�S �'� w sb�mm den il,. You may also attach additional pages if necessary.
CONSTRUCTTOMDETAILS OF WELLS!BEING ABANDONED . 'sauna - • .
dtlad+weilaaunerdduireaad(s)(aoallabls Far aaJtlpkWacda,ornwn-tar irappl'ndls
ONLY WAtltdisc°01 0alabiwi& 'a4youamaub"dta"'fans. - 10a.For MI Wes: Submit this ram within 30 days•of completion of well
• tie.Well Mkabandonment to the following: •
.
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 9 (I.) • 1617 Man Service Center,Rol igh,NC 27699-1617
lob.For Iuledlon wt;)ha In addition to sending the form to the address is 10a
fe.Borehole diameter: Oa.) above,also submit 0de copy of this,form within 30 days of completion of well
abandonment to the following:
•
6d.Water level below ground mane: l9 (R) Division of Water Resouraa,Underground Injection Control Program,
1636 Mali Service Center,Raleigh,NC 27699-1636
to. . ( ) 10e.For water Semnb de Inleetion Was: In addition to sending the form to the ie.Outer length(if io cnten): address(es)above,also submit one copy'•of this farm within 30 days of completion
of Well abandonment to the county health department of the county where
6L Inner casing/tubing length(if known): (IL) e
6g.Screen length(If known): (ft.)
Farm OW-30 Nadi Carolina D.pntment of Hnvaommoh1 Quality-Division of Water Raomca Revised 2 22 2016