Nash_Well Abandonment_20230905

WELL ABANDONMENT RECORD For Internal Use ONLY: p
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Scott M. Werley 7a.For Geoprobe/DPT or Closed-L lop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only l GW i30 is needed. Indicate TOTAL NUMBER of
3344-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water1remaining in well(s): 2.10 (gal.)
ECS Southeast, LLP FOR WATER SUPPLY WELLSIONLY:
Company Name
2.Well Construction Permit#:
MW0701277 7c.Type of disinfectant used:
List all applicable well construction permits(I.e.VIC,County,State,Variance,etc.)ifknoun
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materi'illru mod' tfec I�,t�ia ppl�s
❑Agricultural ❑Municipal/Public a Neat Cement GrIuti C llg9 onite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout p !� 4 ! Dry Clay
❑Industrial/Comtmercial El Residential Water Supply(shared) ❑Concrete Grout r V �O� Drill Cuttings
❑Irrigation ❑ Specialty Grot fi;rjgiwD i f,l ►^,n`s'. gRel
Non-Water Supply Well: ❑ Ben_tonite Slurry DVOE7trNGG ❑_ Other(explain under 7g)
eMonitc nng ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite —25 lbs.
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stonmwater Drainage Neat Cement�35 lbs.
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothennal(Closed Loop) ❑Tracer ,
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Gravity feed bentonite chips from 20 to 5 bgs
Pour neat cement from'F bgs to ground surface
4.Date well(s)abandoned: 08/16/2023
i
5a.Well location:
Frontier Development, LLC NA
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
North Wesleyan Boulevard at Bishop Road,Rocky Mount,NC 27804 -2 z—Z3
Physical Address,City,and Zip Signature of Certified W Co ctor or Well Owner Date
Nash 386206484507 By signing this form, I hereby cert that the wells) was(were) abandoned in
County Parcel Identification No.(PIN) accordance with/SA NCAC 02C.0100 or 2C.0200 Well Constniction 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: I
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well!details:
36.02182008 N -77.7688283 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- - SUBMITTAL INSTRUCTIONS
Attach a ell construction record(s)ifm,ailable. For multiple injection or non-u atersupply wells
ONLY irith the same construction/abandonment,you can submit one form.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: M WO2 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 20 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: (in.)
2 above, also submit one copy of this form within 30 days of completion of well
I
abandonment to the following:
I I
7.09 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 10c.For Water Suaaly&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
6f.Inner casing/tubing length(if known): 5 (ft.) abandoned.
I
6g.Screen length(if known): 15 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Scott M. Werley 7a.For Geoprobe/DPT or Closed-L lop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW L30 is needed. Indicate TOTAL NUMBER of
3344-A wells abandoned:0-
i
NC Well Contractor Certification Number 7b.Approximate volume of water'remaining in well(s): 2.15 (gal.)
ECS Southeast, LLP FOR WATER SUPPLY WELLS ONLY:
Company Name
2.Well Construction Permit#:
M W0701277 7c.Type of disinfectant used:
List all applicable hell construction permits(i.e.UIC,County,State,Variance,etc.)ifknonn
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
i
❑Agricultural ❑Municipal/Public a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑lndustrial/Com mercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
El Irrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g)
mmonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite -25 lbs.
❑Aquifer Storage and Recovery ❑Salinity Barrier Neat Cement -35 lbs.
❑Aquifer Test ❑Stonnwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ]'
[]Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Gravity feed bentonite chips from 20 to 5' bgs
Pour neat cement from,5' bgs to ground surface
4.Date well(s)abandoned: 08/1 6/2023
5a.Well location: t A�.i../E:I V t=U
Frontier Development, LLC NA SEP -0 5
Facility/Owner Name Facility ID#(if applicable) 8.Certification: 2U23
North,Wesleyan Boulevard at Bishop Road,Rocky Mount,NC 27804 In Lr7f72:?ti.71 Nt'• 3
Physical Address,City,and Zip Signature of Certified We ontractor of Well Owner J Date
Nash 386206484507 By signing this form, I hereby certify, that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with I5A 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 beeh provided to the well owner.I I
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well'details:
36.02170048 N -77.76845084 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 SUBMITTAL INSTRUCTIONS
Atiachu•ellconsiructionrecord(s)ifm,ailable. Formultiple injection al-non-n-atersupplynells
ONLY with the same construction/abandonment,you can submit oneform. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#• M W03 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: (ft.)
20 1617 Mail Service Center,Raleigh,NC 27699-1617
i
10b. For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter 2 (in.) above, also subunit one copy of this form within 30 days of completion of well
abandonment to the following:
i
I
6d.Water level below ground surface• 6.82 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service tenter,Raleigh,NC 27699-1636
NA 10c.For Water Supply&Iniection W
6e.Outer casing length(if known): (ft.) ells: 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 abandomnent to the county' health department of the county where
6f.Inner casing/tubing length(if known): 5 (ft.) abandoned. I i
I
6g.Screen length(if known): 15 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-20I6

i,
WELL ABANDONMENT RECORD For Internal Use ONLY:
i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Scott M. Werley 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,3 i is needed. Indicate TOTAL NUMBER of
3344-A wells abandoned:0-
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 2.22 (gal.)
ECS Southeast, LLP FOR WATER SUPPLY WELLSONLY:
ConTimy Name
2.Well Construction Permit#:
M W0701277 7c.Type of disinfectant used:
List all applicable e•ell construction permits(i.e.UIC,County,State,Variance,etc.)ifloroen
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Ivlunicipal/Public a Neat Cement Grout S Bentonite 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
❑Irrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: _❑_Bentonite Slurry ❑Other(explain under 7g)
mmonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRernediation Bentonite -25 lbs.
❑Aquifer Storage and Recovery ❑Salinity Barrier Neat Cement-35 lbs..
❑Aquifer Test ❑Stonnwater Drainage
❑Experimental Technology ❑Subsidence Control i
7g.Provide a brief description of the abandonment procedure:
❑Geothennal(Closed Loop) ❑Tracer � �
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Gravity feed bentonite chips from 20 to 5 bgs
Pour neat cement from '-b%",gro nd-su-face
4.Date well(s)abandoned:
08/16/2023 �t M.._ , V t
5a.Well location: SEFeti
Frontier Development, LLC NA
(ft�`{'ifiY•,2�:fS1 t f:rSCdn�-`�' Lf;S:
Facility/Owner Name Facility ID#(if applicable) 8.Certification: p
North Wesleyan Boulevard at Bishop Road,Rocky Mount,NC 27804clvcau 0-22-Z
Physical Address,City,and Zip Signature of Certified Well Contract of We Owner Date
Nash 386206484507 By signing this form, I hereby cet,tify that the wells) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Constnuction Standards
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(if well field,one lattlong is sufficient) 9.Site diagram or additional well'de'tails:
36.02191484 N -77.76807831 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 WELLS)-BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attache•ellconsiructionrecord(s)ifavailable. For multiple injection or non-watersupplyirel/s.
ONLY e•ith the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW04 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 20 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
i
10b. For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter 2 (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: 6.37 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft) 10c.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 couny health department of the county where
6f.Inner casing/tubing length(if known): 5 (ft.) abandoned. I
6g.Screen length(if known): 15 (ft.)
I
Form G W-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016