New Hanover_Well Abandonment_20230807

WELL ABANDONMENT RECORD for)c¢rr+IUseONI.Y
1.VVcf1 ConLrncttsr infncmalion: WILL ARAINDONMEN r DF TAII S +
William Ewing i
7a.For Geoprobc/DPT or Closed-Loop Geothermal f1'clls having die same !
%Veil Canoeac Name for cell owner pctsara8 j ebandonina pall on hfsRxr prpcm) well consuuctioNdepth,only I G11'-30 is needed. Indicate TOTAL NUMBER of I
3.110 wells abandoned: !
NC Well CI L"Lei9r CC11111C24Qa NV Icr 7b.Approximate volume of w'nter remaining in well(s): Cr' (gal.)
Crawford Environmental Services FOR WATER SUPPLY WELLS ONLY-
7c.Type of disinfectant used: �'I•.- j
2.Well Construction Permit N: Unknown
t�v:J ccaurructir-n remis ti.e U(C.County.Srnre.tbriance.ere.)if lmn,n
7d.Amount or disinfectant used:
3.Well u-Ge(check sell use):
Water Supply Well: 7c.Scaling materials used(cheek all that apply):"r'7
t
GAgrcultural ❑MunicipaVPublic T Neat Cement Grout O Bcnioni(e Ch :$ 41fmt f
CGeothrrm:l(Heating/Cooling Supply) ORcsidenua)Water Supply(single) O Sand Cement Grout O Dry Clay
OlndusuiaUComm=ial ORtxidcntial Water Supply(shared) ❑Concrete Grout O Drill Cuttings
❑Imeation ❑Specialty Grout ❑Gravel
Non-Plater Supply Well- ❑Bcntonite Slurry ❑Other(explain under 7g)
MMDnitcring ORccovery
Injection Well: 7f.For each material selected aboyc,provide amount of materials used:
OAquifer Recharge ❑Groardwater Remeliation
OAquifer Storage and Recovery OSalinityBarrier I et
l39�� f/•�� -e J
❑Aquifer Test OStormwater Drainage II
CExpuri'mental Technology ❑Subsidence Control 7S.provide a brief description of the abandonment procedure: i
CGeothrnnal(Closed Loop) ❑Tracer
CGeothermal(lleatin 'Cooling Return) OOther(explain under 7 ) J C r `'tom't �•-irf r=9u-- /�/r.—
i
4.Date well(s)abandoned:
Sn.Well location:
Scotchman 9181 (GPM 3181) UST 0-020306
F2.6tity;0nrrr Nairn: Facility IDn(if appliabk) 8.Certification:
5302 Carolina Beach Road, Wilmington, NC ���
Pliyueal Address,City."- %ip Signature of Certified.\Yell ntmctor or 1ve11 Owner Date
New Hanover R07600-006-045-000
By signing this jorm. I hereby certify r/rnr the ircq(s)eras(were)abandoned in
Cwray Parcel Idcraifration No.(PIN) accordance whh.15A NCAC 01C.0100 or 2C.0200 Well Construction Standards
and that a rapy ojthis record lots been provided to the it-ell owner.
Sb.Latitude and longitude in degrecs/minutcs/seconds or decimal degrees:
(if well field.one In/'iong is t,fr;ryert) 9.Site diagram or additional well details:
34.142396 N 77.896205 `ti You may use die back of Otis page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DFTAU,S OF WFLL(S).BIi1NG ABANDONED SUIIMITTAL INS"rRUCHON5
Vtarh+:rlfcwvretr:ivnrttar,�.ls1 Jmailatilt For malnplNnject(nnormin-nuier supply xellr
0,v1 y wtrh the rams canvructiorva�bundonmcm.you can ruFmit arx form 10a. For All Wells: Submit this fora! within 30 days of completion of well
6a.Well II3)I:y" ` abandonment to the following:
Division or Water Resources,Information Processing.Unit,.
6b.Total well depth: • (f6) 1617 MA Service Center,Raleigh,NC 27699.1617
IOb.For Infection Wells: In addition to sending the form to the address in 10a
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:- -i (rL) Division of Water Resuurccs,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699.1(+.36
6c.Outer casing length fit known). (ft.) 10c.For Water Supply&Infection Wells: In addition to sending the form to the
address(cs)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health d:p:utment of the county where
617.Inner c sing1tubing length(if known): ((l,) abandoned.
6g.Screen length(if known): (ft.)
Lq-nGW-y1) Nm:h Cirohng Dcpanmcnt of"—ronurnial Quaht).-Div,tion of Wan•r Resources Rcsi,zJ:=12-2016
k - J

WELL ABANDONMENT RECORD For tramral Use ONLY
1.Well Contractor Information: WELL ABANDONME\T-DEfAIIS
William Ewing 7a.For GeoprohdDPT or Closcd-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on hislhcr property) well core mction/depih,only 1 G W-30 is needed. Indicate TOTAL NUMBER of 11
3110 wells abandoned:
7b.Approximate volume of water remaining in wcll(s):
I
NC Well ConuacmrC nification Number I
I
Crawford Environmental Services FOR WATER SUPPLYWELLS:ONLY:
Conmany Name
,7c.Type of disinfectant used:
Unknown
2.Well Construction Permit 8: C7 �� �►J
Elm att app6cahk well r I,ircoan Permits(Lt UIC.counly,slave.Variance,tic.)if tnona
7d.Amount of disinfectant used: Y 4 D
3.Well use(check well use):
7e.Sealing materials used(check all that apply):
Water Sdpply Well:
❑Agricultural GltunicipaUPoblic IQNeat Cement Grout G Demnnile Chips or Pellets`
GGeothemtal(Heating/Cooling Supply) GRcsidenGal Water Supply(single) ❑Sand Cement Grout O Dry Clay
i
❑IndustriaUCommcrcial GResidential Water Supply(shared) ❑Concrete Grout G Drill Cuttings
Glrrieatian O Specialty Grout G Gravel
Non-Water Supply Well: ❑Hrmonite Slurry G Other(explain under 7g) j
RNIonitcring GRecovery !
Injection Well: 7f.For each rnuteiial selected above,provide amount of materials used:
GAgaiferRecharge ❑Gmtlndwater'Remcdialion 1)3T02a,,J -'«
GAquifer Stlsragc and Recovery GSalinity Barrier
GAquifer Test GStormwater Drainage _
GExpericts:ntal Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure!
GGecthermal(Classed Leap) GTracer ' �^
GGeod:rms!(Heating/Cooling Return) Collier(explain under 7 ) fie..ed- re. rasuo4rr+a- S r�//1 a
4.Date well(s)abandoned:
So.Well location:
Scotchman#181 (GPM 3181) UST 0-020306 I I D �
F-=iU1y/O,vW Nar::e Facihly IUd(if applicable) 9,,Certification: 3
5302 Carolina Beach Road, Wilmington, NC Z >w G
Ph)sical Addres9 Cay rsd%p Signature of Ccaificd Well Corr t�r or Well0wner Date
New Hanover R07600-006-045-000
Qy.rigning this farm,I hereby certify that the well(s)was(were)abandoned in
Couray Parcel Itlenliftcation No,(('IN)' accordance with 15A NCAC 02C.0100'or 2C.0200 Well Construction Standards
and that a copy of this record has been jirovide.d to the icetl owner.
Sb.Catituds and longitude in degrers/ridnutts/scrnntls or dcc)mal degrees:
(irwell fold,one h.7ioag is suffmianl) 9.Site diagram or additional well dehiils:
34.142398 N 77.896205 W You may use the back or this page to provide additional well site details.or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DFTAII 4 OF WELL$)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Aaachv�ellr•onururtioarcrord(s)ifavallable rormufapletnjecftonornon.ealer,iupplyNrlls
ONLY w.rh fluu,saj r ccmirucrtonleba❑donment,you can rubmit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
62.Well IDA: /+rti a^r L abandonment in the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: r 2. 1 (fQ 1617 Hail Service Center,Raleigh,NC 27699-1617
lob.For Infection Wells: In addition to sending the form to the address in 104
6c.Borehole diameter: N✓1 (in.) above,also submit Vita copy of this form within 30 days of completion of ss411
abandonment to the following:
6d.Water level frtlow ground surface: (� ' f' (fL) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699.1636
/1 10c.For Witter Supply&Iniection Wells: In addition to sending the form to the
be.Outer casing length(if known): N (fL) Lddress(cs)above,also submit and copy of this fort within 30 days of completion
of well abandonment to the county health department of the county wheta
617.Inner casing/tubing length(ir known): N/) (ft.) obanduncd.
I
I

WELL ABANDONMENT RECORD
1.Weil Contractor Infornmfi3n: Sim'!I,..i$
William Ewing F.:: = x •i-a- ,tom,- _ _-� -
'A ell Cortra=Wit=to mzD c� . '�,+-,.•.,.— COL"..'•s• e _`.=:.'s`-=a=- -•- -'��'s —_ �..'� �
��,�- �new - ;^Z�:,
3110 �l^
u-wa c
Crawford Environmental Services
Well Cetntructien Permit a: Unknown ce Lry cl (i.e.G;
411,
c y"�`_fJ nx3�w c:�s�t aca C• snn.�.vz .c {`z+a [i r
3.Well ace(check well use): ^'\' — �
Water Supphi Well: W�+?`_
GAgrtal:azl _\!mv fp P r. 1C \w cr-c>-G_=i `t"��3, O
Cl,eotlxr..:..�t(EL..t:as:Caolirz5::pplcl GCcs+sr_ua1�5':..•��.�'r (si-g:e?. C S�?Cz:-__.w..s _ i-= "t�� ;,Y,,Gf
CIn3t; Ca^. tccici QRcs dcrt a Was ,—Su,-ply l���? ^_Cc` -z =
�.L�riE1I:W7 ��ti_.:.'-,Cart- �.�•'x�c:
Nan-Watcr Supply ivcu-
LO Mcru',anne ORcZC%aV
Inicctmn Well: :L For cTv cc:, cc cat m,mt—
C-xg='fcr Rshsge 0Gmc -at:r Rer_%-X ticm
115
O�ufff Stxna ttti''Rmrc:•y CSa!^sty P.!ni±r
0.4gtrfcrTan ❑smrrluu^=cTaj sw
0Ex1 ri-q-;=iul Tc:aw!egy ❑Sub,; -nc:Cerzml Pnrid.a Cti:f idrsrsi;z a�titlao cCsL +` . atir,: tx
CGcz:ir._i(Cl:--cd l.oep) OTra-Ir
cGz+-a)jM-a ^.g.'Coc;i-,Rcmm-) OCrsc:Yc,.S i a urw';r 7e1 �� } C�••a,t r c "c. c},� 'y '- — -- -
4.Qnte HcWs)axmdancd:
ca.lvelI oration:
Scc:chman �181 (GPM 3181) UST 0-020306
f :rr::- Fi;, i,fGasJ. i':tit) S.l'rctit'i.nlice: a<t I� h4
5302 Carolina Beach Road, Wilmington, NC
r..y 'Ac:L _,.C,.a_:IZ,,)
New Hanover R07600-006-045-000
H,' ;c:-�t:: P::=?. °A:r.\; N,�,t,., f2•i:Wit:, 'a.. tisr^.�-_�-�:�'�.,t
!N�,I A-' i',i:,t) w,-
1:ci
5b.Latitude and lang;iDdr in drgrtrJminalc..'.:rcondc or ticrinud degrze'.
jd.tea fc:W us It,".�^sd c+�:.• - �) Q.Site,tliaglwto er lRdol iitut nr!1 ei,�taitij
34.142398 77.896205 i), 1 w tIQV«•,:tv t k,`s t,*. tu,.�r"t.';lc _•:,)n -`a: .
a1•u:danr :r:aril; \cu wm..t:"`c;txh sa':-si4t�l\">
CO�irRl'Cl'Ir)�l I1E"I'•111 C(ll"tii'f•.I,Litii fililNl::Ut 11U11VI'ft ;1"15111"PC.`_L I\31`S�l.'C`'�ll?\
et�!1 S!iI:_Iurh'[-3��'!=.--fi{JI NC J1 (:!fWl',�id tr�f�::J'[•f N�w..`TJ-• 'Il b�-..1 ^.•�'.^•••sue.-�S.
any.t N c`r rra u�:.rs.:•.:r.::.'::r-::r x+ct 7>_..�,c' a,yf C=•rv.
it'd. 1'nc All Sui:a.l due r:c'•m wah.n tp wc'l
6n.R'cIl II)�:
M lr•'" // �� a!:_indrrt:a^U h,0 140—'ir, ,
hi,i5i�n of 1\-ntec Re,i�a:�'\`,,IitR'ft�wli:a I't.:��in�1"ice;,
''-13. 3 It�l'\lad�crrt.r t'c?lrr,llilc fit,G' +�,lt•h
0.1'otnl nrll ttepth:
lLlr,try Ift(scti n )t(1,J 1n tkki;laut ta..cr„!L tRa.na l;,t-,.a?,rei:y•,S.a
01,1,c„ 41vo'111imii @w l C$q`t rf 11ni(:vin i\ishi:l 'tl�
i 6c,Ilorehalc dinmcrcr: N`- IinJ -
( ;l!>.u,de�sx^.,1 to 11ty iallictin�;
6d.1i'ntcr irrcl brlt,w gmutul\urfucc: r 1 ([U Iti,i.i„n nP 1Yalcr Nc:i:unl.cy l ndetgwmul l,,,jcvlt.,u t`:ett,•!t\c• ,v„y
104,M-il Srr,ii.4cytcc,Rahc; h,i\i'
6e_Outrr casing length(if{,non nt; w __llt,t tile.tSC��I1lC!'_e9iil�!_\=1!sCitlSLl itt•Il,i t i..'.! ,,>h• t',t;t`a,:;c•,:;•;^,-
r_lth—j,70 ul\•,:,41,;,cul,uet\v i.,;`)•c!tpi,1:,.,i.;;hill Q S,•>:i.
s.l .ell atvalnn,a,'tU to ittc, ,iunh frilth :1„a,ti�t--�:S cJ it:..' „<it,{,r•�„`_.,
6f.lung ta,ingJluhinl;IrnFlh fif kttm,u):_ !V,1 ___^(R.I .t•:u„'•crc,i
� I '

WELL ABANDONMENT RECORD Far Iturriml Use ONLY,
1.Well Contractor Information-. WIs1.I.ABANDONMFN-r D", All-;
William,Ewing 7a.For Gcoprobc/DPT or dosed-Loop Geothermal Wells having the same
Well Contractor Noric(or well owner personally abandoning evil on hisAicir property) well constructiontricrith,only I GW-30:is needed. Indicate TOTAL NUMBER of
311,0 wells abandoned:
NC Well Contractor Cerullc2tion Number 7b.Approximate volume of outer remaining in well(s): (gal.)
A-1
Crawford Environmental Services FOR WATER SUPPLY WELLS ONLY:
Company Nanae 7Q Type of disinfectant used:
2.Well Construction Permit Unknown
Lur cillapplirable%v11 orrmonn:lion pemits fix.UIC.C"ruy.State.Vafictltce.etc.)0�11
7d.Amount of disinfectant used., "C'
3.Well use(check well use):
Water Supply Well: 7e.Scaling materials used(check oil that-apply):
CAgricultural CINfuniciparliPublic N Neat Cement Gmut 0 Bentanite Chips or Pelle
OG;;otherarral(I Icating/Cooling Supply) 011csitirmial Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
01ndustliallcommercial 011csillcintial Water Supply(shared) 0 Concrete Grout O.Drill Cuttings
C31irrigation 0 Specialty Grout 0 Gravel
N,'on-Wutcr Supply WcM 0 Bentoraile Slurry 0 Other(explain under 7g)
IffManitoring 011ccovery
Injection Well; X For each material selected'above,provide amount of materials used:
GAquifcr Recharge CGroundwater Remediation
OAquiler Storage and Recovery OSalinity Barrier
OAquifer`rcst CIStormwaicir Drainage
EIE,xperirmnW Technology OSubsidence Control 7g.Provide a brief description of the abandonment procedure:
CGLwhienma(ClascA Loop) OT(acer
CGcoth-c-mal(11cafingfCooling Return) C]Othcr(explain under 7g)
A.Date%viciffs)abandoned.,
F2.Well IOC21illn:
Sco,chmarl#181 (GPM 3181) UST 0>020306
YfG.a.-Narry Facility IDS(if op plicblo) S.Certification: 3
5302 Carolina Beach Road,Wilmington, NC
FLjical A_�Ilrcii,Uy."Lp Signature ofCcrtificd Wall Capiriacior or Well Owr= Date
Nevi Hanover R07600-006-045-000 By signing thin fonit. I herebJil Certify Mat the well(s)evens(irere)abandoned in
cc=q parcel licralfl-ation No,(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Wet]Construction Standards
Sh.Latiludc,and longitude in degirt-mliatirtuirsJwconds an decimal degrees: and that a copy of this record fins been provided to the,%rctl owner.
(;j ce bvl=z 6.sUfriic:afI 9.Site dhigrom or additional well details-
34.142398 77,896205 You may use the back of this page to provide additional well,site details or well
W abandonment details. You may also attach additional pages ifnecessary-
CO\i;Tft1JCi*I0-.'DKI-All-S OF WELI-6)BEING ARANDO-NED SUBMITTAL INSTRUCTIONS
Vo,mlft,pL,qJeNM,ot wii-air, krply ivfll
ONLY-:4­a.ra� JV.I GA
10a.Fill.All.Wells: Submit this form within 30 days of completion of well
idwdonnicra to the fallowing:
Divisioni or Water Resourec!sJufornaltion Processing Uniti
6b.Toul well depth: 1 2'_ -..(fL) 1617 Mail Service Center,Raleigh,NC Z7699.161*7
101).For Iniection Wells: In addition to scmding the form to the address in l0a
6c.Bamba!e'dLirrieter. in.) above,also submit one copy of this C.t=within 30 days of completion of well
abandonment to dic following:
6d.Water level Woe ground surface: s 7 fh.j Division of Winter Resources,Underground Injection Control Program,
1636 Mail Service Center,Ruleigh,NC 27699-16.46
6e.Outer casing length(it known)* _(fL) 10c-For Water Supply&Inieclion tVellsi In addition W Sending the form to the
T &Wrcss1cs)above,also submit one copy of this form wiLhat.30 days of comptc-Lion
of well abandolillmnL to the county health dcrcirtnumt or the coiray where
6f.Inner casingaubing length 6f known): 1`61- (n.) alixylonrd.

WELL ASANDOMMENT RECORD JW Intaral Vsc ONLY,
1.Well Contractor Information: 1VF.1,1.AIiANDO\1iFti r DEFIES
William Ewing 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
j WCII Cootrsctos Nam(or well owner pusonally ahandaning til on hislhcr property) well canstntction/depth,only I GW JO Is needed. Indi:uC TOTAL NUMM of
3110 wells abandoned:
NC Weil Conacter Certification Number 7b.Approm. mate volume ofwatcr remaining in well(sh G+ ('gal.)
Crawford Environmerital Services FOR WATER SUPPLY WELLS ONLY: t
Cor:tQany Natty^'#
7e.Type of disiufcetant used: x .
L Well Construction Permit 8: Unknown AG
Llr ail eppGcebla,cell cnnrrrcttim permits(i.e.UIC County,Store,Variance,err.)tf innua (J
7d.Amount of disin[cctanl used: �► t d t,
3.Well use(check well use): ' ,�
Water Supply Well: 7c.Scaling materials used(check till that apply): (,;J,.
,
❑Agricultural OlsluttieipaMblic 19 Nett Cement Grout O Itemonite Chips or l'cllefs *ova
OGmhermal(I{eatingfCoeling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay 47 Sr Li•
Olndustrial/Commerciaf ❑Residential Water Supply(shared) O Concrete Grout O Drill Cuttings
Oirreadon ❑Specialty Grout, O Gravel
Non-R'alcr Supply Wdl: ❑Uemonite Slurry O Other(explain under 7g)
RNIanimnng ❑Recovery .
injection Well: 7[For each material selected above,provide amount or naterials used:
CAgnifcr Recharge OGroundwuter Rcmedintion
OAquifer Stomge and Recovery OSalinily[farrier
I
OAquifer Test OStonnwater Drainage
❑Ecperimental Technology ❑Subsidence Control
7g.Provide u brief description of the abandonment procedure: �
CGcothermal(Closed Loop) OTmcer
CCruthcnal(Heatin&fCooling Return) OOther(explain under 7 ) &_pr 17'd7trv— Aj S
- I
i
4.Date wcII(s)abandoned:
5a.%Veil location:
Scotchman#181 (GPM 3181) UST 0-020306
Faciiii-yfQwoer Naa-a racility IDu(if nppticable) S.Certification: �-
5302 Carolina Beach Road, Wilmington, NC
Phy%=I AAdmss.City,aH Ty signalum of Cestilied Well Coptiactiu or Wc11 Owner Data
New Hanover R07600-006-045 000 to signing this jonn, 1 hereby ccr(i)y that rise well(s)was(mere)abandoned in
County Parcel Idcn idcation No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0260 Well Cons(nretion Standards
and(liar a copy aj this record has been provided(a the well owner.
56.Latitude and longitude in dcgrceslmdnuteslsttonds or decimal degrees:
(if er17 field.cm latflonp n safricie u) .9.Site diagram or additional well details:
34.142398 N .77.896205 IV abandonment
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 DFTAII S OF MMMS),REING ABANDONED SI)111MIT'AI.INSTRUCTIONS
Aearh xd)rm3rrecvna rermdlt)r/arailaGk:For n+ulripls inJecnnn or wn-nn/nruppty nrlL
ONLY%*h the s,m comrnutiorva!nndonmeni.)ow can so6nitonefarm. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID : r"%`^' 13 abandonment to,lhe following:
Division of Water Resources,Information Processing Unit;
6b.Total w ell depth: f Z' a" 170 1617 Mail Service Center,Raleigh,NC 27699-I617
10h,For friieetiun Wells: In addition to sending the forni to the address in l0a
6a 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. s .3 (ft.) Division of Water Resources,Underground Injection Control Program,, .
1636 Mail Service Center,Raleigh,NC 27699.1636
6e.Outer casing length(if known): �� (rL) IOc Fnr Wntcr Supply&Injection Wells: In addition to sending the form to tho
address(es)above,also submit one copy of this form within 30 day3 of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(ir known): N? ([O abandoned.

WELL ABANDONMENT RECORD For Internal Use ONLY.
1.Well Contractor Information: Wlsl.l.ABANDO,%,Nl1?h"]•Df:TAl1,S
William Ewing 7a.For GeoprobcfDPT or Closcd-Loop Geothermal Wells having(ltc same
Well Cnr=C1W NJ=(or cell 0.ner Ixnonalty abandoning xell on bjantcr property) well cons truetionftlepth,only I GW•30 is needed. Indicate TOTAL.NUMBER of
3110 ,yells abandoned:
-
NC Wcll Can—,�ctor Ccshifhcatian Nurnber 71).Approximate volume of water remaining in w•ell(s): gal-)
Crawford Environmental Services FOR WATER SUPPLY WELLS ONLY:
C cc'nny nacre .
7c Type of disinfectant used:
2.Weil Construction Permit 4: Unknown y6 .
Car a/1 appfire5tr silt coaum son permitr(i C.VIC.Craws}•.5ratq vartarre,etc)if lnm,n J '
7d.Amount of disinfectant used:
3.%Veil use(check well use): �,��
Water Supply Well: 7c.Scaling materials used(check all that apply): f�tV�:• ✓ 0\`
CAgricuitural ❑MunicipaUPublic R Neat Ccmcm.Gmul ❑Bcmonitc Chips oi1�1lc �' Z013
CGLoilicrmal(Ileatng Coolin Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout O D ryClaY (rya z f
0kic s:ri'Ccr^mhe:cial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
Mnieaton ❑Specialty Grout O Gravel G!Y
Non-Water Supply R'eU: 0 Bentonite Slurry ❑Other(explain under 7g)
F.Mcnitcring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
CAgasfcr Recharge CGroundwatcr Remc-diation /J
0,14nifcr Storage and Recovery GSalinity Barrier '
0Agnifcr Tcst ❑Stormwatcr Drainage
GF_tperirrantal Technology GSubsidencr Control 7g,Provide a brief description of the abandonment procedure:
CGeaJx-road(Cla.ed loop) CTraecr
QCnD:.':.^r.al(licninp/Cnotir,,Return) OOthcr(explain under 7e)
r..�p,) fie..s.✓t F��- ttafr�- >v. 5 c/Fits
I
4.Date%cU(s)abandoned:
52.Well location:
Sccichman#181 (GPM 3181) UST 0-020306
f-•=..iup,•Oa zr?+airo racihty IDn(ifappltcAle) 8.Certification: !1
5302 Carolina Beach Road, Wilmington, NC l7
p'r.T-icil AC:ms.Ofy=d%iP SIgnalure of Certified Well Cr�,gjractor or Well Owner Date
New Hanover R07600-006-045-000
By signing this form, I hereby certify that the is-ell(s)was(were)abandoned its
Ce y Parcel tdcn9flcaNnn No.(PIN) acenrdonre with 1 SA NCAC 02C.0100 or 2C.0200 1Ve1!Cmulrrction Standards
and that a cagy of dos record has been provider)to the well ou ner.
5b.Lat)tude and longitude in dcgrm4mintdes/smonds or decimal dcgrres:
(,f sc0 rzH,Oec woag is safflc:M) 9.Site diagram or additional well details:
34.1.42398 N 77.896205 1V You may use the back of this page to provide additional well site details or well
abandonment details. You may also attiwlh additional pages.if necessary
CONSTRUCTION DF TAUS OF WELLS)Iq:INGAIIANDO\ED SURDIIT I'AI,INSTRUCTIONS
.irt�h,ocl(ca:rrreirirn rrr�r'4)iJu,�rla✓fe. 6nrmulliple mjetr/rm or non-Na7rr agrpty„•elft
4.YLY:rrd the tr'xn-e you ran nilhm;t me form, 1041. For All W011: Submit this form within 30 days of completion of well
6a.Well Mi.. '^'�N'�� abandonment la the following:
Division of Water Resources,Information Processing Unit,
Z
6b.Total welt depth: (fL)
1617 f lail Service Center,Raleigh,NC 276994617
�
lob.Far lnlectinn Wells: In addition to sending the toms to the oddre�s in loa
6c.I)orchole diameter: Nf (in.) above,alto subihit one copy of this form within 30 days.of completion of well
abandonment to the fallowing
6d.Water level below ground surface: C� L) A) Division of Wafer Resources,Underground Injection Conirnl Program,
1636 Mail Service Center,Raleigh,NC_7699-1636
6e.Outer casing length Of knossn): �� (FL) 10c.For.Water Suouly 5 Injecting Wells: In addition to sending the form to the
addtess(cs)al,nve,also submit one copy of this form within 30 d:iv<of cernpichnn
of well abandonntcnt to the county health dcpanmem of the county wLcre
6f.Inner casing/tubing length(if known): N (ro nhandoncd.

WI-JA,A 11 A N-DONMENT RECORD
7_
3 110
T­
Gravifc;rd Erriironren!ap; Se,-/if-es F(12 V A,7E,-51-nlif-=-!Z C
2.WO U Tc.T,-A-4 ii6star'-=1
# %
3,WO'.t,
411,
W w t F r S a ppl y WcEh Tr-SeaHze ap-pi,-
C_=
e_-4
We= :2
-)frr!7_­ra D S?==:y C­_-a
Nan-WaLfir Supply WED,
_y
g ra
Injection Well. 7-1,Far cacii ab—_P=-il-k =L --z
Rccl=r I
OAf,-iL-i S:=�and R- --7
0A4::;L,r Tesi S=_-.—_ D.m=zZ_-
T=LW!00 Cs::: i!.�C= I 7g.Prmide a bri-T descrlp=of d=ab2:ae--- 'DrOcVd-=TZ'
JGC�agxrinal(cl=-4�ztop) OTrzcCT
R-ILM) (txp_1"n cry 7g)
4.Date%cil(O abumd9nO.'
52.WC11 location;
Scotchman#181 (GPM 3181) UST M20306
B.CertT
F=--"ld*-ocr I%= Cfi=,kb3c)
5302 Carolina Beach Road, Wilmington, NC
AEd'--3,01Y.a 7ip si&==_dCCftir=d W.2 C_7e,=Cr NV;_l 0�.-= I)--.
New Hanover R07600-006-045-000 By r;Xrjng this form J'her67 c,,rn;y rh,=the nvil,/s)was(tvere) in
C=-ly Pwttl Idecification No(PIN) excGrdantre with 15.4 NCAC 02C.0100 or 2C.020O Will Cc=strzrcxicn S<a7_'-rtis
56.Latitude and longitude in dignes/minutes/stwilds or decimal degrees: and thata copy of this record I=been prvaded to the ucJ oi".rr
(if C!l r-=IJ Fg i3 Vsfic.CTI) 9.Site diagram or additional%irM details:
34.142398 N 77.896205 W You may use L)lc back of this page to pro%ide additional well site details or well
abandonment dcuiils. You may also attach additional pages if necessary.
COS57'RUC`f10%'DE.T,*,JI_S OF IAIFII,L(S)BEING ABANDONED SUB%InTAL INSTRUCTIONS
At, ";pj
onw
r e,nDn ;,PP13,,e1h
ONLY Rub the mm4l Y 1 0140-- 10a, For All WON, Submit this form within 30 days of completion of well
6a.Well ID41-_5`v%u. 3 abandonihern to the following:
Division of Water Resources.,InformaLion Processing Unit,
66.Total well depth: A) 1617 Mail Service Center,Raleigh,NC 27699.1617
10b.For Iniection Wells: In addition to sending the form to the address to lea
6c.Borchole diameter: n.) above,also submit one'copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground.surfiice: Division or Water Resources,Underground Injection Control Program,
1636 NIAil Service Center,Raleigh,NC 27699-16.16
6e.Outer casing length(if known): _(ft.) 10c.For Water Suvply&Iniection Wells: In addition to sending the foun to tilt!
addre;s(c'.%)above,also submit one copy of this form within 30 days of cetoplution
of well abandonment to the county health department of the county "heiv
6f.Inner casingitubing length(ir known): abandoned.
-MMMMMNJ

. �
�
willk'AIII Ewing
.1110
--'-------- 1-114esi(k Mild Willer Supply(MlMvd) 0 0111CF00 Ou'll 0 DIM Culling.,
-
mMoniloring
Illiecli'm I -If- 7C.1.*or curl%Inuivirlot%clecied illative,provide amolud of nuiterluis used:
So.Well 18-rillioll:
5302 Carolina Boach Road, Wilmington, NC
'
`
/

i
`ILL AB_NTO\1'IE\T RECORD R;: t:.ioONLY �
I '
1.1Sei1 CC,tr--ctw InfsrtrsrF;act: %VFLL W\NIX)NMI.- f t)1:r,\D
W-i.l'am.Ewing in.For Gcepaet lL?FT or CL�—ird-Lapp Geothenml\ 41s haying the.mire:
of
by .�F t 1+.1 r^__ t„�y;h .,:s•l u1V-;) a.c iael, [: :nt:TGT.\L\1`\1EtC(:
C`_�=C i•h.:\pnmci^�tc�vlunsr of++atcr mrra9nirg in++zltt:l.: J "' ((�)
Crawford Environmental Se(vices FOR\YA'l•F.F SUPPLY NVFLL ONLY:
Cam- Le
7c T%pc of dc-infeetant used: r
Uf1KE10tYnPam-21 0- n
VV
<d..\mount of di,intec(ant tz_zd:
3,%yea use ich.ck wen
\1'atC.Ship Well- 7c.Staling tmatrht6 to is d(check-all that apply): �;r,<-s
_age 1 =.\f :`sbu K Neat Ceut—'a cruet ❑Rer,tanira Chios or Pellct�lry�
t.� r
6 Ssd Cc2 ,Groat Q lh)Clay ��kit
Wa--r$�;;h ish=d) C Cer,-rc:e Greet C Mill Cuttings
-•,,.�r--��� �7 Sra::e[t.'Grout t7 Grn+cl
N,c-)\aur Sepply Well: 3 Bentanite sll:ir ❑lhhcr(explain under 7g)
[a;rc=n Well: if.For each material scicct-d above,provide amount of materials used:
p 132
.—Aq_r=S---gz M—d Tea. r' Cv t ty Bzrii--T
aktq�=r Tcsi �a n r DmIziar,
7g.Pmvidc a brief description of lltc obnndamtrcnt proeecium:
CCst=ac.^J CCnzd-f...s,-)
e-
ri.7 �,�a.1e.,..r... r,•:, r�tzrra.— ;ham
i�.)
4,Date PcZT''s)aka dot nrd:
:a.Well location:
Scotci man#i8i .(GPNI 3181-) UST 0-020306
l'w:: (Dor,:fa^.L-fit S.Certification: 311 D �'
5302 Carolina Bead Road„ Wilmington, NC ��
F-7)S:cafr t�<C. p cam:Z� S,g=um of C-cifi nt Well cev actar or Wit Ow-etr Date
New Hanover R07600-006-045-000
f3}•signing tri.r fan„L f hereby e'erti/•i�tfsar the xelfls)it-as(were)etLandcurrt1 to
C=--7 r=3 l4vc^»aaaa NO.0N) r-=-n:pre with 15A,`CAC 02C.0100 nr 2C.0200 Well CcrtStruciion Suindimis
and rhat u vopy cf this revord ltus Even provided.to the it-ell awner
tb.Latitude and Inngitudr in dcgrees/tninutes'sccnnds or decimal degrees:
o t =•;, ,L g =�==) 9,Site diagram or additional Ni ell details:
34.t 42398 N 77.696205' W You may uaeo the back of flu,page to provide additional w,il site,details or well
abandnninm dctaila. You may also attach iWitional page;if nctescury.
CONSTRUMIO`Tw GVLS OF WFLUS)REEK?ARA'NDONL•'D SURNWITAL INRTRUCTIONS
.;r---h r_lc=u2 'ter_r�Q/� (7.'_ r"a ;,�uLt.^wsnr r_n-x �sr,-Jh xc.'Y
D-\'x :&,.c:rr
10a. For All %Vclli. Submit (his fmrn tsithin 30 days of completion of well
6a.Well IDI�' N t^ '2 alto tdorttr cat to tha follaaying.
Division of Wutcr Resources,Infnrntation Procming,Unit,
6b.Total.%ell depth: ��' Y r (ft.) 1617 Mail Service Center,Raleigh,NC 27699.1617
lt)b.For Inicelian Wells! In addtfirm,io scntling the form to the addrecs in l0a
6c.I3,,rch0etintneter: N/j (in.) ahosc.also submit ono Capp of tins fomt,w•ithin 10 da),of completion of well
abandentrcat to the folln xing-
6d.Water level bc(nn ground surface: ? MA Divicinn of Watcr Resourem,Undcrgmund Injection C'unttrl Program,
1636%fail Service Center,Ralcigh,NC 7699-16,16
6c.()suer crisits„length fit krostinl: (ft.
10c.For Witter Supply&IntectianWrllst In addition to scndma the.firm to the
f
adcht.;w�)ah.3vt,also s;,httat tau:copy of thm fn:m within 30 rays of completion
of well abandsmmrm Ls the county health dcpannicot of the county whew
6f.[once ca$ngltubirrg length(if knovi nl: ((t) bnmhjre f

„'E'l.rL AB,`I,rDONNI.. W RECORD
1,Writ Contractor Infsnnat(oo: }YI;l,1 A11,1N1t(IN111:N'I'I)F:1'All`S
William Ewing 7n.For GropnhbelDI”'or Clowd-Loop Geothermal Welly hovhng file s:nua
\\;IC-=aCvXanckc�-ell etandm:ing well enbinWrpn,r.uy) well cnnsltutllntt/deplh,unlyIt1W.it)wnrtalcd. Indicalr,'f01'Al.NIIMMIRof
wells ahmulnncd;�_�
3110
NC\\c;lG a,-,xCcmli:anaf Nunntrr 76.Approxinurtc vtilmnn of tinter rcmulnin))in svcll(o)h� �*-4_„_fgnl.)
Crawford Environmental Services FOR WATFR SUPPLY 1VE'Ll.9ONLYt
7c.'1'ype ofdisinfcctunt used: r
A.•
.1YcB Cm>_ctructicn 1•fait d: Unknown r { J
L1,1 sir.:.�'•:r rs-2—%rnn-
tr:cn ix-drs e fi. UIC,Cowuyp Sratc,tar' u^nce,«c Vv.)ifAnoun
7d:Amount of disinfectant used: ��rS __�
J,Well use(check.yell use): -
Water Supply Well- 7c.Scaling materials used(check oil that apply):
^_Acricutturl CIMunicipal/Public fit Neat Cement Grout O Bunionitc Chips or['ell
CCxothrrtsal(11catinglCooling Supply) 01tesidenfial Water Supply(single) ❑Sand Cement Grout 0 Dry Clay ��s 141 y.
OL^d:rs:ral/Ccra=rcL-d CIRcsidentinl Water Supply(shared) O Concrete Grout 0 Drill Callings
.'7im5ca:son O Specialty Grout ❑Gravel
Non-Water Supply 11'ellr O Bealonile Slurry a Omer(explain under 7g)
INK-1animning _ E3Rccovcry
Injection Well: 7f.For each material selected above,provide amount or materials used:
❑Aquifer Recharge ❑Groundwater Rcmediation
GAqufer Storage and Recovay, OSalinity Barrier f TQn'?("�C
Z,!Aq--'cr Test OStormwatcr Drainage
0 'Peri"'c w Technology OSubsidence Control 7g,provide a brief description of the abandonment procedure:
r'Gccdicm.:l(Closed Swop) OTracer
OGea;'h.^ a](HcannaCoolin2 Return) ❑Other(explain under T ) ✓�pr) �e...s;? Fri r�tJfraa.— S rr�Fri.et
4.Date nc11(s)abandoned:
Sa.Well location:
Scomt-rman#.181 (GPM 3181) UST 0-020306
Facility IDe(if applicable) B.Certification: ,3 f
5302 Carolina Beach Road, Wilmington,,NC Zy�
P1-TEz=JAd"=.Cay"7i7 Signature ofCcnificd Well Centactoror Well Owner Date
New Hanover R076M006-045-000
By signing this fnm; /hereby certify that the well(s)woo(were)abandoned in
Ccety Parcel Identification No.(PIN) accordance with 15A NG%C 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of phis retard has been provided to the well nhvner.
5b.Latitude and longitude in degrces/minuics/stconds or decimal degrees:
of v cll field,cm bubcs is saffic e at) 9.Site diagram or additional well details:
34.142398 N 7.7.896205 W You may use the back of this page to provide additional well site-details or well
abandonment details. You may also attach additonal.pages if rimessary.
CONSTRUCTION DFTAi S OF WE'LL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
.ItL7h aYUconsCrdtirm r!carrt/tl iJa:vilaLfe=F—muftipleinjertlon or aon-watersupply welt
ONLY web the tame cantlrucJtarJa.RanCanmrrtL you can tuEml am farm. 10a. For All Wells: Submit this form within 30 days of completion of well
6.Well 1IJa S M�` 1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total swell depth: 2 tl 2-- (fl.) 1617 Mail Service Center,Raleigh,NC 27699.1617
10b.For Inicclion Wells: In addition to sending the form to the address in 103
6c.Borehole diameter: Nam. (in.) above,also submit one copy of this form within 30 days or completion of well
r,� abandomncni to the following:
6d.Water level below ground surface: S, �C (ft.) Division of Writer Resourccs,.Underground injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699.1636
6c.Outer casing length(if known): /vim —(ff.) 10e.For Water Supply Ar Iniection Wells: In addition ro sending the form to tilt
address(es)above,also submit one copy'of this form within 30 days of completion
of well abandonment to the county licalth department of, fire county where
6E Innercasing/tubing length(irknown); t- (rL) abandoned.

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3110
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aqu+Mra aw`4%AR'it W M.»jr MP%a ammo e w.%wow*
apt�c+�IR�iMIa��ran1'rs+�'!�w a�f+aaww
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w.'raw a,rr lot at rn.or V*p.r!Sam"me Ift 4=6 0 MA
r.r�r...rw� `Irta.q►waar�Ala�ww.C�a�r.r�ww1�.
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