Onslow_Well Abandonment_20231113

i
-iirELL ABANDONNIENT RECORD . D F r lmemal ilsc ONLY: 1
This form can be used for single:or multiple wells 11 wV�
•
1.Well Contractor information: \t1 �!t WELL ADANDKINMENT DETAit:S -
• Rich Lemire la.Nuttier Of wells bebt)lphandolied 1 •
Well Contractor Natae{or well ostnel* pJsinall pLiiafoithi;wellanLCgllterpropcny► For rridnpre hftutn, or rwn:li:wafer supply. sells ONLY vttll the saute
eomtrrectionvhordtvtat rari.yoticw,saiwivaleform,
2593A
7h.Approximate 4•uhune of Water remaining in well(s)PONE - (gal.)
NC Wen Contactor con ifi liairNmoba
SAEDACCO FOR WATER, ONLY: FT.'
-:' - , ^..^
CanqunvNailtc s''''-�,.<''g..s i7 a:.� , ' y'
7e.Type of disinfectant used:SHOCK CHLORINE
2.Well,Constructiun•Pertuit tl:r , NO V 1 ,i 2023
'/.4r oll whey*well permits'(i.a"Casino.Sicia,ilirihrwe:lit edict rtr)ifittnlsn 7d.Amount of dislnfectant.ustd 16 OZ
3.Well Me,(diedai'LU use)p G e`.. .„-_ i�• 7
• Water Supply Well;- . - . ' 7e.Sealing materials ttscd•(chest:all that applv)c
AAgnnultural. Ill MunicipaltPublic. • .[2 Neat Cenrcnt.Groat Cl Bcntottlic Chips or Pellet's
ElGrothenmal(Heating;CoolingSupplg) lJttcsidenrial',4'ater Supply(single) D,Solid testae Gm* 0 Dv Clay.
❑htdustrial/Comntctziat ORtithdential Water Supply:(stiattd)' El.Cons tc Grout 0 Drill Cuttings
.Dinatiou ,- ., •El'SpecialtyGrtiut d Gr.isel. .
•
Non-Water Supply Well: 0'Bentonite Slurry O'Other(explain under 7g)
OMaititiatine 'ORecovety '
injection Weil: 7E For each material selected'above,protidc amount of materials used: .
DAquifer[tec[targe OGrtimldq}allerlttnteduilimt Neat Cem.:10,3401b ,Wtr:660ga •
l.Sand Cem.:lb •,Wtr:gal..
DAlluifer Storage anti Recovery DS:dinity Darner (; ,
OAnuifer Test DStormwater dririnage
'Bentonite.:501b ,Wtr:gal: .
DEyleriutetltal Teehuotogy ESubsidetxe Control '7.g,Prdn•ide a brief ittmeription afthe.ahandanmcnt priore lure:
L Ge iIierilral(Closed Loop) CJTracer i , •
®Gcothemtal(He ttiny,'CoalinnRetum) DOIlterd plain under 7 } TREMMIE.GROUTED FROM BOTTOM-TO TOP LET.SET OVER NIGHT AND.
CAPPED.OFF NEXT DAY TO(SURFACE.
4.Datewtll(s)abandoned: 10-4-2023 I.
5a.Weil tucation: -
•
CAMP DAVIS • _ • - '
facilliy t ytxr'Nart:c • • Facility ID5(if appli ablc) -' - 8'Certificn 116"' -
Camp Davis•Rd. Holly Ridge, NC, 28445 ilt:!`• —p/J.,t.,.r� 10/12/2023
Physical Address;City.,nd ZiA scfgti
Sitni o :in 1{Veit Coon:141ot,or Well cone Patee
ONSLOW liv signitig rhLi finen, I hereby r rnfj that the well fs•}•:t.'as(were)Abandoned iar
County Panel ldentiruritinit No.(PIN) accordance tr(Ut 151 VG1C O2C;:01O0 or 2C.0200 Well Cam!rndion Strinila:ds
and Mato capeofthis retard hos been.pits trial to the well owner.
Sb•L atitude-and longitrtdein degtreestminnteslsecondsnr decimal degrees: '
(if w•elt.I ctd,tine talo g isInlii a t) 9.Site diagram or additional well details:
You may use the back of this page:to provide additional•nell site details or well
• •T` • . . W abandonment details.'You may also:attach additional.pagesifuecessary:
f`.t)NSTiRI1C1'ION OF.TAII.S OF•WELL(51 BEING ADANDt)NED 4I11FINI I'AL iNSTRIiCTIONre
Aliatir-well caattrzkibitz rrctlydts?it•nvatto r--'For nrnitiple eiij'ecdatr or raon•irotcr sL5ly
nd1 ONLY iiith the MU)JR!pi1r51YLdiaft lrj5Ullail Urrlt,ituO Celt,ilth/12 1 Ultt•J?rt 11Ra. Nor All Wells: Submit ibis'fans within 30-days of completion of well
Ga Well IDf(:PS-6 abaodonnient to'the following: •
i •
• Ilivision bf Witter Resnureu .Infot motion Processing Unit,.
Gb.Total well depth: 180 (D,) 1617•Mail Service Center,Raleigh,NC 27699-11617
1,0b.For Infection Wells: In addition to sending the form to the address in IOa
(in.) above;also submit one ropy of!this form within 30 days of completion of well
Ge.Borehole dlauteter:8
abandonuretu to the fallowing: 1
Gt1 Water level below ground�rafaccc UNKNOWN (ft.) Division of Water Resources,Underground Injection Cotitral Program.
E636 tliaii.Serviee Center,Raleigh,NC 27699-1636
Gc.Outer casing Icnrth(if lawn): 139 (ft.) IOC.For-Water So only'& miss/ion•Welt.: in addition to sending the form to
the addresses) above. also submit one copy of this fonu within'30 days of
completion of W-cll abandonment th the county lieahh department of the musty
where abondoncd,
6f.Iniaercasing/tttbing length(if lotawn): NA . (ft.)
6g.Screen length(If Wont):NA • (ft.)
ForstGW-3o NenhCarollmDepOrtin ofPnvirontncrit aril Natural-Resources-Phi-Mona Wad-Rcsources Revised Auuua2013

WELL ABANDONMENT RECORD For Internal 13seONLY: a
This font can be used let single or multiple wells
•
l
I.Well Contractor iirfptrnatiOn: WELL ABANDONMENT DETAILS •
- Rich Lemire 7a.Number of wells being-abandoned: 1 •
- WdiCa1ractorName(oraeltottauNmmaity;tbaa1oidnge.11Ontifsitiirtrapeny) Few rrnrlrple tt eeifar or noa-iiater supply wells ' ONLY with lie seta
2593A i
NC WO Conlr�UarCctllfleiUou•Naarfier 7h.ApprosLnatcvolnnte of siatt rem:+ining in w ell(s)FONE ( a0)
SAEDACCO FOR WATE.tR.SUPPLY WELLS ONLY: _ _ '_;
CQn�IxAc Name t' Y - --'v ,is ^^ �
7a•Typc of disinfectant pied:SHOCK CHLO[tINE-° ''. a L. +x.,:,'
2.WdhConstruction-Fertnit#:, , • N O V 1 ' 2023
Ltdall attiplkotrle lien penults(Le.:Crmiurr,Strut!,iriridarte;Lrec;flott,dh)i blown 7d.Amount of dLilnfectant.used:16 OZ •
3.Welt uie(diccl:mfd l use); r
Water Su
pply Well: - -- - 7 e:Sealing matetiaU used(cbeek•ill"that apple)
lJAgri ultural 181Municipal/Pubtic. IR Neat Cc Mail.Grout 0 Bcntoriitc Chips et:Pellets
AGeotltcrmml(&tracing)CoolingSupply) .,Ditesidentinl Water Supply(single) • 0 Santa Cetrtent Gmrlt - 0 Dry Clay. .
❑lvdustrial/Comiricrcial ❑ResidentialtVater'Supply_(stiared)• >?Conctete.Grout• .0 Drill.Clutintts .
❑Inigatiou : - • d Specialty Groirt ElGiavel '
Non-Water Supply Well; — -- • -- d Rentonite Slur O'Oilier(explain tinder 7g)
_ ❑Munitoring . ❑Rea oveiy .
injection Well: . 7f,For eadi material selected above,provide.amount of_materialS used:
•
- ❑AquiferRecbarge ❑Groundmt.cerRentediation 'Neat Cern.:10,3 401b. ,Wtr:660ga1.Sand Cem.:lb ,Wtr:gal. '
❑Aquifer Store a ats,I Re.overy 0Salinity Barrier
OAiluifer Test ' ❑Slocum+lerDntieugc Bentonite.:501b ,Wtr:gal
❑E.yierinteiitalTechnology DSubsiden eColruul
7(;.Pe;;riide;r brief el>=teription of fhe.nbaddonmr:trt pleviccdun:
-OGeothemral(Closed Loop) OTracer ,
®Geothermal{iie itint'Coolin>~Return} OOctxC(explain under 7g} •TREMMIE GROUTED FROM-BOTTOM TO TOP LET.SET OVER NIGHT AND.
i
CAPPED.OFF NEXT DAY TO SURFACE.
d.Date Wcll(s)abandoned: 10-5-2023
5a.Well Location:
CAMP DAVIS •
- .ractlityiel•txrNaatc Facility IDS(ifipplicablc) 8.Certification"
Camp Davis Rd. Holly Ridge,'NC 28445 . FE1L ?
•' �O yw�t.+�tr 10/12/2023
Pln•sicaFAddrvs;City;and Zip . Sign altar of l tilled Well Crrntrlctar,flr Well(hwar Pam
-
1
ONSLOW Iiv signing this form, 1 hereby ciFttfy that the u en(s).Was(Were)abandoned in
Couiitt• Pan>t kienliticalioit No.(PIN) titxltrrlttltce With 15.4:1VC..1C 02Cr.01017 or'2C.0200 INA Coiisltiteliurt Stiuttktrds
mid:haler copy of tans recnrd has;bdeiiprovided to the well ownen
ci, t atitude'and Iongitpde in degreesltntifutciiscconds or decimal degrees: '
dit elt.l'elil.itile I aitaug ts•a itrieieix) 9.Site diagram or additional well:details:
You tua}•case the back of this Ogle'provide additional-well site details.or well-
. . N- _ _ . . W abandonment details. You tnayalso;anaclt additional pages ifitecessary:
('.ONSTRliefiON DFTAIi.S OF14'CLL(Sl)WIN( AR INDONFD SIJBhii7=rAL iNSTRLTCrrONS
:[heady.well eortstrucrrert rn vrcl(;i ij available.'I,or nrultiprr injeCGmi or imo.iinter snpph.
We//:v tivf;le with the awine Oltnillefilietilithribyglevii.ieiu altiaiGmit weefunm 10:A..For All Wells: Submit this fttrttt within 30(1a}•s of completion of well
' - abandonrricnt to•thc following: ! •
-
6a.Well ID6:PS-5 •
• ' DElision.pfVi,rnterResnitrces,Information Processing Unit, -
6h.Total Well depth: 176 (It) 1617 Mail Seniec Curter;Raleigh,h,NC 27699-1617
10h.For infection Wells: In atitliliou to sending the fort:to the'address in l0a
re,t3o hole dtadtcteo .t3 abooe,also-submit one.copy of'this form within 30 days of completion Of well
(ill:) :ibatidonmettt lei the-following: 1 '
I
•
Gd.Water hive)below ground surfacet tlNlarOWN (ft.) Divistott of Water Rccourci's,Uliderarouud Injection Control Progratu.
1636 Mail•ScnicCenter,Raleigh,liC 27699-1636
Gc:Outer casing Icngt6(if Imorm q): 139 (ft.) 10c.For Water Sir mile 4c injection Wells: In addition to sanding the form to
the address(es) above. also subm one copy of this for] within 30 days of
• completion of Well abrutdaunenit t to the•county hcattli department of the county
6f.Inner easiri;ftubing.lcngth(if known):NA - (ft)
mvh:re abandoned,
•
6g.Screen length(if knomvii):NA {ft.) '
FontGW-3o Nonti Cato Lim De ante.moffliwlmoutcnteraNaturalResources-DisisionofWaterRisoarres Revised Angus20t5

WELL ABAN)ONNIENT RECORD Forlmcnutl Usv ONLY: i ,
This form can be used fur single.or=hipid Wells }
•
t,Well e:M actti.r information: WELL ABANDONMENT DFTAIL.S •
Rich Lemire 7a.Nittnber of wells bring abandoned: 1
Well Cot1rac1r Name Orwell scad0..-tsrnta11y:.iLii1onin ell Ott ItiOferimitynyl For mulnp&. •Pti.eiirue or rvirabriiiitir supply. wells ONLY efllr hl Sarno
consreuco(NL'aboirdon h71r+.141r1 ran 67ibflrt onefrir,n.
2593A
f
NC We11 Conir�gorGititftgliuu Nnit>kcr 71t.Aplitnsimate'olrrine of Outer remaining in�t•ell(s) ONE (gaL)
• 1 ,
FOR WATERSUPPi Y.WELYS ONLY:
SAEDACCO : •
Caa4+:iny Name _ Y�
7c,'Ty�peofdisinfectanttined:SHOCK CHLORINE --., ti. i,- r i
2.WeltConstnietimi.Pcrmlt ti:r I N� • 11
Lts!�l!rrppPltr161e uetl permits(Le.Cvcuirtt Siniie r°tiHhrxe.hr rrtiorr etc.} ktmisrr ld.Amount of disinfectant used 16 02 ▪ 2023 . '
"S.Wen uye(check-Well,Use): 7.)
' ` . • i-,...1
Water Snpph Well: Vic:Sa sling materiials•itscd(sliest;all that apply) i✓ -, i
- AA);iutilturnl .I»lvluniciplG'Ptthtic, IR Neat.Ccinenl.Groot . 0 Bentonite Chips or Pellets
1:10cotltcnna1(Hcating1Cuol(n Supply) pRcsideminl Water Supply(single) 0 Sand Cei tent Grout ❑Dry-Clan,
D hldust ial/Commercial ❑Residcnti+il-Water Supply:(shared) ❑Concrete Grout 0 Drill,Ctting . -
• .Dlrtio.ition. .. : 0 Specialty,Grout G U rovel
Non-Water Supply Weil: tl'BentouiteSlurry ❑'Oilier(e)ilain under 7g)
.DMunitotine •❑Recovery '
. Injection Welk • 71.For each material selected abo`•e,ptrnide amount of materials riled:
❑AguiferRechaage t3Gitiuiidttater-Rentedhition Neat Cem.:4,3241b ,Wtr:275ga1. Sand Cert.:lb ,Wtr:gal. '
❑AtiniferStanij;e and ftei'o♦'ety. PSuliuily Barrier
• ❑Aquifer Test ❑51orin iterDrtfitagc Bentonite.:211b ,Wtr:gal:
•
❑E terriniealul Technology OSnbsidet>re Cotaml 7g.Pnntde a brief description of tlie.abaadonment proctvlurc:
®Geotltemxd(Closcd.Luop) ClTracer i•• '
®Gi06ltetltiai(He ltlgtp'C06IInitReturn) . .❑Gtller(C1p101n under 7g) TREMMIE GROUTED FROM BOTTOM TO TOP LET SET OVER NIGHT AND
I'
CAPPED OFF NEXT.DAY TO!SURFACE. .
4.Date ncll(s).abandoned': 10-3-2023 i
5a.Well location: .. • ——
CAMP DAVIS
Factlilyithmi-Nape e • Facility 11)#(if pppli:ablc) S.Certification:
re t .
• Camp Davis Rd. Holly Ridge, NC 28445 • . .- "ham //n' t.. 10/12/2023
Physical'Adtttrss;Cii)r,and Zip sigtono erlti.!?:died Welt Cpntr ietnr,or,Well ghvn;r ' Usage
I t •
ONSLOW . ' .fay signitig.1110 lank,I,hereby certifv t/nrt she 1re�11(s) rib pas(were). idoned in .
Couiily Parcel ldi nlil'rntiait NO."(PIN) thawrdance With 114 NCAC Ott 1,Ol(O.ur 2C.0200 WellCaitsitatctior Shin2&ir-ds
acid:lrut h'sipper ryliris reenrd kas,be`eit,provided to the ire11 owner.
Sb.f atintdo'and iongituttein.degitcestminuter/sccondsor decimal degrees:
(ltwell.t'a td.iMetaaltiitg is•-olllcicta) -9.Site dlat rain or additional well details:
'You ivaY use the back.of this p ige'to provide additional-Well site details or well
. NT • W abandonment details..YOu:nay also attack additional pages if Iteaessary."
1,
C(INSTH11CTION.DETAILS OF WELL(5l HEIl\C ABANU()NED SITROITTAL INSTRUCTIONS'
. :ltincir Srdl trnatn a 17eri1711:41 if a ailnl lip l rir rnJtiple n/Jrc i err or t+Er,•nnter sdrpph'
ire/tiONLY.utdite+mneciursusrtlibrtrrSnuthirsienlVleuear:siibm/t.arefurarr. 10a.'For All.Wells: Submit this faint within 30 days of completion of well
Gg 'Well ID£i•PS-12 abet:dentricnt to that following:
•
©iyksiott.uf Water Rcsuurcu,Inforn atian.Prucessing Units
lib.Total Well depth: t[if.}
l00 I(t17 Stail.Seivicc tenter;Raleigh;Ng 27699,1617
lOb.For Inlecllan Wells: In addition to sending the form to the addtress in 10a .
•tie Biirellole diameter 8 (iu.) above. also"subunit one,"copy of!this foivi smithiu 30 days of completion of ts�ell .
abattdountettt tti the following:
• Divislotauf Water Rssanrri5,;Undetl;r:ound Injection Control Progratu.
6d.Water level below around surface: UNKNOWN (ft•) - Ifi36 Mail.Sen'cc Center,Raleigh,NC 27699,11636
Ge Outer casing ten 1h(if known): UNIINOWN (ft.) 10c.fn rid'"A .r sit tI' • ruin tigu Velty ill addition to sending the forte to
the addresses) aboie, also subunit one copy of this form witbiti'30 days of
completion of well abandonment tit thc-couniy!troth deptitmeni of the county
6f.Inter casing/tubing filial)(if laiown): NA (ft..) *here abh hdoncd,
•
6g.Screen length(If known): A ' (ft.)
Font OW-10 North Camara Depuruu:ni ofPnvironrcnt ani'Natural Resou.*xcs-Division of Wale rk ltisoazc s Revised Atreus*201i
4

,�,-. - WELL ABANDON NIENT RECORD For bnentnl U 'ONLY: 1
This form can be used for single.o r iuullipl2 wells - }
I.Well Contractor Infw.rmati( l: WELL ABANDONMENT DETAILS ' •
• I
Rich Lemire la.NürnIir of wells bdn .atiandoned: 1 •
Well cotrtrac(orNameOrco;11, thetNrsotiatlyatamtoidrigwellon16,01tirpropcny) For ruolnple 7rtfecton. or rwrttpwter s+rppfi'. whs. ONLY teeth ale same
c»nsfritaltN147b:0i111T1t+ilntt,.pm Dive stun+uf win for+u.
2593A '
NC Well Conlr,iorr rIific 1tiotrNntrlier 711.Apprmlmatc rnluine of�i;:itcr•rtmaining in 1ti'ell(a)o NE (giL)
• . I1.
SAEDACCO_ FOR WATER SUPPLY.WELLS ONLY:
I..
Cen4tan)Nate 7e.Tykof disinfectant used:SHOCK CHLORINE V. --.
I; • r+ r; ✓''fn . 1
2.`YeII:ConsttvMiunPet snit f(:, : 1
LLtr aoppfl able well piu•1o:il C e_Cigior.Stole.I irlryreo..li;teil�rr,etc_}ifbuwn 70.Amount of dinInfectunt:used 16 02• n �Y•
3.Well uSe(ch"eek Well OSe): • - 23
7e.Sealiri materials itscd(cheek all that a l ) '•"• '-=''
Water Sopply Well; - s . pn y , ,t',
Neat Ccmctil:Grout 0 Hentonile Chip 'di'1 licts',1 _"
❑Agtii ulhtml �Municip tbPubelG.
DGeethcnm)l tlieatingr'Coolino Suppt}•) °Residential Water Supply(single). D Saiui Cement Gmut ❑Dry Clay
❑lrtdustrialfCotnntercia1 ❑Residential WaterSupnly:(s)wtrd)• •0:ConcreteGrout D Drill„Cttings
. .:l]iniglrtion ._ . - t]•Specialty Grout' ❑Gravel
Non-Water Supply Well: 0 Hentanite Slurry ®'Other(ex-plain[rider 7g)
DManitoring . "❑Recovery. .
injettion Weil: • 71.For each material selected ahoy,-pr•as•ide amount of.matcrlals used:
• ❑AquiferRecbarge ❑Grewuhtticr'Rented'wtinn .Neat Cem.:3761b ,Wtr:50ga1. Sand Cem.:lb ,Wtr:gal.
. IJAtlulfer Storage and Reerri'ery. DSalwity°artier .
Bentonite.:31b ,Wtr:gal.•' •.
❑Aqulfet 7141 ❑Stommalet Dnilaagc .
❑Eyrerint�ntel Tis buologs ❑Subsidetree Cotitttrl 7 .Pratedc a brief di�tcription self(he.nbandonment proci''duiei
DGeothemial(Closed Loop) ,❑Tracer
TREMMIE GROUTED FROM BOTTOM TO TOP LET.SET OVER NIGHT AND
OGeathernial(HeaungICao ling Return) DOtlter(eplain under 7u) . .
CAPPED,OFF NEXT DAY TOISURFACE.
4.DatcWO(s)abandoned: 10-6-2023
5a:Well Mention:
CAMP DAVIS _ • ' •
Facilit)-//hiro,:rNargo Facility iitt(ifitpplicablc) " 8.• ,._•etidon:
,1- k �e Px
•
Camp Davis Rd. Holly Ridge, NC 28445 • • �j — /`s ue 10/12/2023
Physical City;and gig Signahin.or e_;:ifW Wen C(100;etnr or Well Owner - Date
I;
ONSLOW Ilyr.tithing this,form, I herrhy ciertif'that the trei1(8)H'ax(were)_abw:doued uz
County.' Pared IdcntirxninitNo.(PIN) ' ncxordaitce leith IS l VGrlC 02Ci.0T00 or 2C.0200 ii`ell altrislntcliort Stimiktrcds
arid thtat it cbpyofIhisrecord furs,beets.providedto The well'otrner.
Sb.Latitude•and longitude its degrcccs(nutnrteStscconds or deciintd degrees;
(If.reltPeW.one Ute7p,yis-a iltieiem) -9.Site diagrairror additional well details:
You tua}:usse the back of this page1to"provide,additional well site details or well'
- . N • . . W abandonment details. You may arse.attach tiddhionai gages if necessary.
CONSTRUCTION.DETA1LS C)B.\VELL{S}REINC:ABANDONED SURNITI FAL iNSTRLTC'TIONS
. :it ter il•dl CURSU71dr JO tit r.li)1J l2vair..!i!L For iirnThplo ttfrctunl or t+in•11Y er supply : j •
wilts ONLY u.lfli the',OnIL rrirrsureu+o t'at cuukutrneut-j ou ati+vilimlt are fu'frre i0a.'For All Wells: Submit this•farm within 30 days of completion-of well
Ga.Well IDft:PS-8 • abandonment to the following:- -
Di%isintr of Water Rcsuurcim,Information-Processiug Unit.
I617 Mil Service Center;Raleigh.NC 27699-1617
Gb.Total%tell depth: 19 (fit)
10h.For In team:Wells: In addition to sending the form to the•address in IOu•
6c.8orcltolcdiatnetcr:8 above,'also submit our.copy of!this.fona ttithii130 days of completion of swell
(In.)- abantlonincru to the-following: 11'
6d.Water level below nand surface! UNlarowN _(ftJ .D(;islottof Water Resources,'Underl;round Irijection Coat tit(Progratu,
1636111iiil.Senice Center,Raleigh,NC°27699-1636
I. ,
I, :
Outer caving Icn�th(if loess a): UNKNOWN (ft.) 10e.Ent-Water Simply& initletion Wells:. In addition to sending the form to
Gc
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
6f.Inner easing/tubing length(if Ioruwn): NA tom)
sv)rcre abandoned•
6g.Screen length(If lnronn):NA (ft.)
Form GW-lit Nonit Carolina t)cpsnnprn a1Enyirnntneot aril Natural Resources-Division of Water R,smrms Etcvised Aica in 2013