Caldwell_Well Abandonment_20230406

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Cascade Remediation Services 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
Daniel Ferrell wells abandoned: -4H
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gaL)
3221-13 FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public IN Neat Cement Grout ❑ Bcntonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
ElIrrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g)
RMonitoring ❑Recovery,
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 350 gal. Neat Cement
❑Aquifer Storage and Recovery ❑Salinity Barrier
[]Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
Pressure grout/bottom up using a Chemgrout piston pump
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
1 inch- 1560ft
4.Date well(s)abandoned, 3/6/23-3/7/23 2 inch- 1500ft
5a.Well location: CMT- 950ft 44 wells total
Former Paxar Corp NONCD0001597
Facility/Owner Name Facility ID#(if applicable) 8.Certifies•On:
950 German St.NW, Lenoir, NC 28645 4/3/2023
Physical Address,City,and Zip Signature of Certified Well Contracror or Well Owner Date
Caldwell 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 01C.0100 or 1C.0100 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.9196343 N 81.5591235 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(SI BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction records)ifavailable. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this fora within 30 days of completion of well
6a.Well ID#: abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 20 thru 172 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in IOa
6c.Borehole diameter: (in,) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface 15 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) Ik.For Water Supply&Injection 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
61 Inner casing/tubing length(if known): (ft,) abandoned
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department o£Environmental Quality-Division of Water Resources Revised 2-22-2016

Physically Bottom of Well
�
Parent ID: Location ID Install Date Nested Screen Diameter Abandon.
ft BGS inches
Groundwater Monitoring Wells
MW-1 MW-1 10/25/2007 21.3 2 Y
MW-2 MW-2 10/25/2007 23.5 2 Y
MW-3 MW-3 10/25/2007 19.5 2 Y
MW-5S 8/28/2009 24.9 2 Y
MW-5 MW-5D 8/27/2009 Y 69.8 2 Y
M W-6S 8/30/2009 29.7 2 Y
MW-6 MW-6D 8/29/2009 Y 69.8 2 Y
MW-7S 9/11/2009 31.7 2 Y
MW 7 MW-7D 9/11/2009 Y 69.7 2 Y
MW8-1 8/31/2009 Y 33.7 2 Y
M W 8-3 8/31/2009 69.6 2 Y
M W-8
MW8-2 1/11/2014 54.8 1 Y
Y
MW8-4 1/11/2014 77.8 1
MW9-1 9/9/2009 Y 28.7 2 Y
MW9-3 9/9/2009 69.7 2 Y
M W-9
MW9-2 1/15/2014 49.6 1 Y
Y
M W 9-4 1/15/2014 78.6 1 l'
M W 10-B RO I 8/31/2015 115.0 2 l'
MW-10 Y
M W I O-B RO2 8/31/2015 169.0 2 Y
MW-11 MW 1 1-1 2/4/2013 30.0 2 Y
M W 12-1 2/4/2013 Y 13.9 2 Y
MW-12 MW12-2 1/19/2014 40.6 1 Y
Y
M W 12-3 1/19/2014 69.6 1 1'
MW14-1 1/12/2014 28.8 1
Y
MW-14 MW14-3 1/12/2014 68.8 1 Y
M W 14-2 1/12/2014 48.8 1 Y'
MW15-1 1/13/2014 29.8 1 Y
MW-15 Y
MW15-2 1/12/2014 49.8 1 Y
M W 16-1 1/22/2015 20.6 I Y
Y
M W 16-2 1/22/2015 49.6 1 Y
MW-16
M W 16-3 1/22/2015 77.6 1 Y
Y
MW16-4 1/21/2015 109.6 1 Y
MW17-13ROI 8/30/2015 117.7 2 Y
MW-17
M W 17-BRO2 8/30/2015 159.7 2 Y
MW-18 MW18-1 2/8/2015 Y 24.6 1 Y
MW22-1 3/13/2016 22.5 1
Y
M W22-2 3/13/2016 45.8 1 Y
MW-22 MW22-3 3/12/2016 Y 63.3 1 Y
MW22-4 3/12/2016 84.6 1
MW22-BRO1 8/30/2015 120.5 2 1'
Y
MW22-BRO2 8/31/2015 172.0 2 Y
ins
J01-1 8/11/2016 v 25.2 1 Y

J1 JO1-2 8/11/2016 1 37.0 1 }'
J02 J02-1 8/12/2016 Y 21.0 1 Y
J02-2 8/12/2016 31.0 1
J03-1 8/13/2016 25.5 CMT4 }'
J03 J03-2 8/13/2016 Y 45.5 CMT4 Y
103-3 8/13/2016 66.5 CMT4 Y
J034 8/13/2016 80.2 CMT4 }
J04-1 8/23/2016 25.5 CMT4
J04 J04-2 8/23/2016 Y 44.5 CMT4 Y
J04-3 8/23/2016 63.5 CMT4 }
J05-1 8/24/2016 25.0 CMT4 Y
J05 J05-2 8/24/2016 } 40.0 CMT4 }'
J05-3 8/24/2016 55.0 CMT4 }'
J054 8/24/2016 66.7 CMT4 Y
J06-1 8/26/2016 25.0 CMT4 Y
J06 J06-2 8/26/2016 Y 39.0 CMT4 }'
J06-3 8/26/2016 53.0 CMT4 }
J06-4 8/26/2016 65.8 CMT4
J07-1 8/30/2016 28.0 CMT4 }"
J07-2 8/30/2016 43.0 CMT4 }
J07 J07-3 8/30/2016 Y 55.0 CMT4 }
J07-4 8/30/2016 67.5 CMT4 }
J07-5 8/30/2016 80.8 CMT4 }
J08-1 8/28/2016 27.3 CMT4 }'
J08-2 8/28/2016 41.3 CMT4 }
J08 J08-3 8/28/2016 Y 54.3 CMT4 }
308-4 8/28/2016 66.3 CMT4 Y
J08-5 8/28/2016 80.0 CMT4 y
J09-1 9/9/2016 29.0 CMT4 y
J09-2 9/9/2016 39.0 CMT4 Y
J09 J09-3 9/9/2016 Y 55.5 CMT'' }`
J09-4 9/9/2016 74.0 CMT4 Y
J09-5 9/9/2016 90.0 CMT4 }
J09-6 9/9/2016 101.1 CMT4 y
J10-1 9/7/2016 30.0 CMT4 y
J 10 J 10-2 9/7/2016 Y 47.5 CMT4 }
J 10-3 9/7/2016 65.8 CMT4 }
J11-1 9/13/2016 31.0 CMT4 Y
J11-2 9/13/2016 44.0 CMT4 1'
J11 Y
J 1 1-3 9/13/2016 59.0 CMT4 Y
111-4 9/13/2016 75.8 CMT4 Y
J 12-1 9/12/2016 3 LO CMT4

J 12-2 9/12/2016 44.0 CMT4 Y
J12 J 12-3 9/12/2016 Y 55.5 CMT4 }'
J 124 9/12/2016 69.0 CMT4 Y
J 12-5 9/12/2016 84.7 CMT4 y
J 13-1 9/10/2016 31.0 CMT4 Y
J 13-2 9/10/2016 43.5 CMT4 }'
J13 J13-3 9/10/2016 Y 55.5 CMT4 }'
.1134 9/10/2016 68.0 CMT4 Y
J 13-5 9/10/2016 82.8 CMT4 y
J14-1 9/15/2016 30.5 CMT4 Y
J 14-2 9/15/2016 41.5 CMT4 Y
J14 J14-3 9/15/2016 Y 56.5 CMT4 Y
J 144 9/15/2016 71.0 CMT4 }'
J 14-5 9/15/2016 85.2 CMT4 y
J15 J 15-1 9/16/2016 Y 26.9 1 Y
J16 J16-1 9/15/2016 Y 30.0 1 Y
J 16-2 9/15/2016 43.0 1 Y
J 17 J 17-1 9/20/2016 Y 22.9 1
J 17-2 9/20/2016 31.9 1 Y
OW-1 5/3/2016 95.9 1 Y
OW-2 5/4/2016 95.9 1 Y
SV Points-filled with concrete fill depth(ft)Jiameter(in) PUQI
SV-1 S 0.51 4.25 (�
SV-2S 0.45 4.25 �! g\
SV-3S 0.47 4.25
SV-6S 0.33 4.25 ' I\yl- N 0 NE � t7 I�o jSg7
SV-6D 0.33 4.25 U t[ I
SV-7S 0.30 4.25
SV-7D 0.50 4.25
SV-8S 0.40 4.25
SV-8D 0.42 4.25
SV-9S 0.34 4.25
SV-10S 0.40 4.25
SV-11S 0.39 4.25
SV-12S 0.36 4.25
SV-13S 0.40 4.25
SV-14S 0.35 4.25
SV-14D 0.66 4.25
SV-16S 0.40 4.25
SV-17S 0.34 4.25
SV-17D 0.50 4.25
SV-18S 0.38 4.25