New Hanover_Well Abandonment_20240119 (3)

WELL ABANDONMENT RECORD For Internal Use ONLY: ;
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Frank Beecher 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 1 GW-30 is needed. indicate TOTAL NUMBER of
3225-A wells abandoned:-
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 7 42 (gal.)
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name
7a Type of disinfectant used: N/A
2.Well Construction Permit#: NIA
List all applicable well construction permits(i.e.WC,County,State,Yanonce,etc.)iflmown
7d.Amount of disinfectant used: NSA
3.Well use(check well use):
Water Supply Well: 7e.Scaling materials-used{check all that apply):
OAgricultuml ❑Municipal/Public ❑Neat CementGrouei Z Chips
or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement GroutJ�rl 0 06 Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout 9 eO240 Drill Cuttings
❑Uri ation ❑Specialty Griu ❑Gravel
Non-Water Supply Well: :�
❑ Rentonite Slurry �-Gte b;��;j�'f' i�t�dter(explain under 7g)
❑Monitoring eRecovery
injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Chips-122 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Water-1.0 gallons
[]Experimental Technology ❑Subsidence Control '
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Slowly added bentonite chips and ensured there was no bridging
❑Geothermal(Heating(Cooling Return) ❑Other(explain under 7g)
taking place. Then added water to hydrate bentonite chips.
4.Date well(s)abandoned: 10.17.2023 The well was abandoned in accordance with 15A NCAC
5a.Well location: 02C .0113.
River Road Terminall Kinder Morgan NONCD0001697
Facility/Owner Name Facility lD#(if applicable) 8.Certification- 17
3340 River Road, Wilmington, 28412 12.16.2023
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Dale
New Hanover R06400-001-003-000
By signing this form, I hereby certify that the tvell(s) was(were)abandoned to
County Parcel Tdentification No.(PiN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has beet:provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: i
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.1787120 N -77.9522416 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 well construction record(s)ifavailable.Formulliple injection ornon-water.supplywelk
ONLY with 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#• RW-15 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 17.9 (fw) 1617 Mail Service Center,Raleigh,NC 276994617
10b.For infection Wells: in addition to sending the form to the address in 10a
6c.Borehole diameter:4.0 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6.63 Division of Water Resources,Uddeeground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Cc tei,Raleigh,NC 276994636
6e.Outer casing length(if known): N/A Vt.) 10c.For Water Suauly&iniection Wells: in addition to sending the forth to the
address(es)above,also submit one copylof this form within 30 days of completion
of well abandonment to the county health department of the county where
611 Inner casing/tubing length(if known): N/A (ft.) abandoned.
6g.Screen length(if known): N/A
r
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

1 '
WELL ABANDONMENT RECORD For lutemal Use ONLY: !
I �
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Frank Beecher 7a.For Geoprobe/DPT or Closed-L I op Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. indicate TOTAL NUMBER of
3225-A wells abandoned:- I I�
NC Well Contractor Certification Number 7b.Approximate volume of water remaining I in well(s): 6.65 (gal.)
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name
7c Type of disinfectant used: N/A,
2.Well Construction Permit#: N/A
List all applicable well cons venon permits(r.e.UIC,County,State,Variance,etc.)rflmown N/A
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 ❑Neat Cement 91-out-, ❑ Bentonite Chips or Pellets
❑Geothenmal(Heating/Cooling Supply) El Residential Water Supply(single) ❑Sand Cement Graut�. , ;> �> f -mry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 1'Concrete Grout JAAr ...y b,6r ll Cuttings
❑irri ation ❑Specialty Grout 1024 ❑Gravel
Non-Water Supply Well: ❑ Bentonite181'11Yr8^&,<;`_' :^ �� ❑Other(explain under 7g)
❑Monitoring NRecovery �.. ».
Injection Well: 7f.For each material swcf�d'abbvc'�proac,amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Portland-142.13 pounds Bentonite-5.92 pounds
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑AquiferTest ❑StormwaterDrainage Water-10.59 gallons
❑Experimental Technology OSubsidence Control i
7g.Provide a brief description of the abandonment procedure:
❑Geothennal(Closed Loop) ❑Tracer Tremmie grouted with a Portland Mix.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
The well was abandoned iin accordance with 15A NCAC
4.Date well(s)abandoned: 10.16.2023 02C .0113.
5a.Well location:
River Road Terminal/Kinder Morgan NONCD0001697
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
i
3340 River Road, Wilmington, 28412 ;°"'�
9 12.16.2023
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
New Hanover R06400-001-003-000
By signing this form, I hereby certify that the well(s)was(were)abandoned in
County Parcel identification No.(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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I
(if well field,one lat(long is sufficient) 9.Site diagram or additional well details:
34.1786759 N -77.9524596 `,I, 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 well consiruaron record(v)iifavailahle.Tor muhiple injection or non-water supplywells
ONLY with the same construction/abandonment,you can submit are form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#• RW-14 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 17.5 (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: 4.0 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following: I
6d.Water level below ground surface: 7.30 (fit) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Ce Iter,Raleigh,NC 27699-1636
fN/A t 0c.For Water Supply&Injection evells: Tn addition to sending the form to the
6e.Outer casing length(if known): (t.) 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
6L Inner casing/tubing length(if known): N/A (ft.) abandoned.
6g.Screen length(if known): N/A (ft)
I
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-201 G
I

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Frank Beecher 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well ContractorName(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GV�- is needed. indicate TOTAL NUMBER of
3225 A wells abandoned:"" I o
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 7'4y (gal.)
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS
'ONLY:
Company Name 7c.Type of disinfectant used: '�!/A
2.Well Construction Permit#: NIA
List all applicable well construction permits(Le.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials uggd(check'all that apply):
❑Agricultural E
m Ti Be)n tonite Chips or Pellets❑Municipal/Public ❑Neat Cement Grout'
❑Geothermal(HeatingtCooling Supply) ❑Residential Water Supply(single) Sand Cement Grout 401)ry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) a Concrete Grout JA N � �, ❑Dri
2024 ll Cuttings
❑Irri ation ❑ Specialty Glut •^ ;, ❑Gravel
Non-Water Supply Well: •-^g;
❑ Bentonite Slurry ..ti,'r z IjQther(explain under 7g)
❑Monitoring eRecovery C DCi,%'104
injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Portland-142.13 pounds Bentonite-5.92 pounds
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑AquiterTest ❑StormwaterDrainage Water-10.59 gallons
❑Experimental Technology []Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Tremmie grouted with a Portland Mix.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
The well was abandoned in accordance with 15A NCAC
4.Date well(s)abandoned: 10.16.2023 02C .0113.
5a.Well location:
River Road Terminal/Kinder Morgan NONCD0001697
i
Facility/Owner Name Facility lD#(if applicable) 8.Certification*
3340 River Road, Wilmington, 28412 12.16.2023
Physical Address,City,and Zip Signature of Certified Well Contractor or'Well Owner Dale
New Hanover R06400-001-003-000 By signing this form, 1 hereby certify,that the well(s) was(were)abandoned in
County Parcel identification No.(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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one laUlong is sufficient) 9.Site diagram or additional well;details:
34.1785880 N -77.9527506 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 well construction record(.$)ifavailable.For multiple injection ornon-watersupplywells
ONLY with the same constructioWabandonment,you can submit one form.
10a. For All Wells: Submit this,form within 30 days of completion of well
6a.Well iD#: RW-13 abandonment to the following:
i
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 17.5 (ffi) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For iniection Wells: in addition to sending the form to the address in 10a
6c.Borehole diameter:4.0 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
is
6.05 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service On ter,Raleigh,NC 27699-1636
6e.Outer casing length(if known): N/A (ft.) 10c.For Water Supply&iniection Wells: 1n 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
611 Inner casing/tubing length(if known): N/A (ft.) abandoned.
6g.Screen length(if known): N/A (ft)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
1 i

f
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS j
Frank Beecher 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 1 GW-30 is�needed. Indicate TOTAL NUMBER of
3225 A wells abandon( I ,
NC well Contractor Certification Number 7b.Approximate volume of water reI lining in well(s):
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: N/A '
2.Well Construction Permit#: N/A
List all applicable well camsTructon permits(i.e.UIC,County,State,Variance,etc.)if nown p
7d.Amount of disinfectant used: N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout--,,
-° ` N...B entonite Chips or Pellets
❑Geothermal Heatin /Coolin Supply) ❑Residential Water Supply(single) ❑ S d Cement Grot=- a.? l❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout JA N r; ^❑Drill Cuttings
❑Irri ation ❑ Specialty Grout 9;�GZ4,Gravel
Non-Water Supply Well: ❑ Bentonite Slur ,Aa;.�„r;;-' ;,❑Other(explain under 7g)
❑Monitoring NRecovery l te`> ., j. "`, (in',
injection Well: 7f.For each material sdcctcd aiiovc,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Chips-152 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Water-1.0 gallons
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer Slowly added bentonite chips and ensured there was no bridging.
[]Geothermal(Heating(Cooling Return) []Other(explain under 7g)
taking place.Then added water to hydrate bentonite chips.
4.Date well(s)abandoned: 10.1 7.2023 The well was abandoned in accordance with 15A NCAC
5a.Well location: 02C .0113.
River Road Terminal/Kinder Morgan NONCD0001697
Facility/Owner Name Facility iD#(if applicable) 8.Certification:
3340 River Road, Wilmington, 28412 12.16.2023
Physical Address,City,and Zip Signature orCedified Well Contractor or Well Owner Date
New Hanover R06400-001-003-000 i
By signing this form, I hereby certify'that the well(s) was(were)abandoned in
County Parcel Identification No.(PIN) accordance with.75A NCAC 02C.0700 or 2C.0200 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 laUlong is sufficient) 9.Site diagram or additional well details:
34.1775032 N -77.9533088 You may use the back of this page t0"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 well construction record(s)ifavadable.Formulliple injection ornon-ivaiersupplywells
ONLY with the same construinonlabandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.We]]ID#- RW-11 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 22.5 (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:4.0 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
M I
6d.Water level below ground surface:
8.42 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center;Raleigh,NC 27699-1636
j I
N/A 10c.For Water Sunoly&Infection Wells: In addition to sending the form to the
6e.Outer casing length(if known): N/A address(es)above,also submit one eopy, this form within 30 days of completion
of well abandonment to the county`health department of the county where
6E Inner casing/tubing length(if known): N/A (ft.) abandoned.
6g.Screen length(if known): N/A 00
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
I

u
WELL ABANDONMENT RECORD For Internal Use ONLY:
I �
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Frank Beecher 7a.For Geoprobe/DPT or Closed-1,l op Geothermal Wells having the same
Well ContractorName(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-36 is needed. indicate TOTAL NUMBER of
3225-A wells abandoned:W^
NC Well Contractor Certification Number 7b.Approximate volume of water rem I ining in well(s): 11 (gal.)
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name qq
7c.Type of disinfectant used: N/ '�
2.Well Construction Permit#: N/A
List all applicable well construcrion permits ri.e.WC,County,State,Variance,etc.)iftmown
7d.Amount of disinfectant used:
3.Well use(check well use): r
Water Supply Well: 7e.Sealing materials used(check all that apply):
, r® Bentonite Chips or Pellets❑Agricultural ❑Municipal/Public ❑Neat Cement ow.
❑Geothermal(Heating/Cooling Coolin Supply) ❑Residential Water SuPP1Y(single) ❑Sand Cement oat�L:7 � �f 7� 'I)ty Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout 1 ❑Drill Cuttings
9
❑Ttt JAN 1 . 2024 i ation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite SlA er(explain under 7g)
❑Monitoring FIRecovery t . �'N
Injection Well: 7f.For each material selected adovc,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Chips-152 IbS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Water-1.0 gallons
❑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) Slowly added bentonite chips and ensured there was no bridging
taking place.Then added Water to hydrate bentonite chips.
4.Date well(s)abandoned: 10.17.2023 The well was abandoned in accordance with 15A NCAC
5a.Well location: 02C .0113.
River Road Terminal/Kinder Morgan NONCD0001697
I
Facility/Owner Name Facility iD#(if applicable) 8.Certification:
3340 River Road, Wilmington, 28412 12.16.2023
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
New Hanover R06400-001-003-000
By signing this form, 1 hereby certfy,,that the well(s) was(were)abandoned in
County Parcel Identification No.(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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: i
(if well field,one lattlong is sufficient) 9.Site diagram or additional well details:
34.1776865 N -77.9531968 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
Attachwellconsiructionrecord(s)ifavailable.pormultiple injection ornon-watersupplywells
ONLY with the same construction/abandonment,you can submit one form.
10a. For Ail Wells: Submit this form within 30 days of completion of well
6a.Well ID#• RW-10 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 22.5 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In additio to sending the form to the address in l0a
6c.Borehole diameter:.4.0 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
1.
6d.Water level below ground surface: 8.55 (1t) Division of Water Resources,Underground Injection Control Program,.
1636 Mail Service Center;Raleigh,NC 27699-1636
6e.Outer casing length(if known): N/A 00 l Oc.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 countyi hiealth department of the county where
611 Inner casing/tubing length(if known): N/A (ft.) abandoned.
6g.Screen length(if known): N/A
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources II Revised 2-22-2016

M '
WELL ABANDONMENT RECORD For Internal Use ONLY:
I �I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Frank Beecher 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 1 GW-30 is needed. Indicate TOTAL NUMBER of
3225-A wells abandoned:W^ i p
NC Well Contractor Certification Number 7b.Approximate volume of water rI maining in well(s): 7.89 (gal.)
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: N/A
2.Well Construction Permit#: N/A
List all applicable well construction permits(i.e.VIC,County,State,Variance,etc.)if/mown
7d.Amount of disinfectant used: N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials ut ed check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout( p-Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout "❑t I)ry),Clhy
❑lndustrial/Commercial ❑Residential Water Supply(shared) a Concrete Grout JA N Zo Drill Cuttings
❑Trri ation ❑Specialty Grout g4Gravel
151iiiri' 3
Non-Water Supply Well: t
❑ Rentonite Slurry n. ^%,gyfj' e4(explain under 7g)
❑Monitoring NRecovery �`r sc>�'1{`�f Ot
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Portland-159.56 pounds Bentonite-6.94 pounds
❑Aquifer Storage and Recovery ❑Salinity Barrier Water-11.90 gallons
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
[]Geothermal(Closed Loop) ❑Tracer Tremmie routed with a Portland Mix.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) 9
The well was abandoned in accordance with 15A NCAC
4.Date well(s)abandoned: 10.17.2023 02 C .0113.
5a.Well location:
River Road Terminal/Kinder Morgan NONCD0001697
Facility/Owner Name Facility ID€!(if applicable) 8.Certification:
3340 River Road, Wilmington, 28412 �✓ "`''�' 12.16.2023
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Dale
New Hanover R06400-001-003-000
By signing this form, I hereby certify that the well(s) was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15.4 NCAC 02C.0100 or 2C.0200 Well Construction Standards
Sb.Latitude and longitude indegrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.1776089 N -77.9532116 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 well construction record(.$)ifavailable.For multiple injection ornon-watersupplywells
ONLY with 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 m#: RW-9 abandonment to the following:
I
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 20.5 (fL) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Inieetion Wells: In addition to sending the form to the address in l0a
4 6c Borehole diameter: (in.)
above, also submit one copy of thisiform within 30 days of completion of well
abandonment to the following:
9.64 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
i ;
6e.Outer casing length(if known): N/A (ft.) 10c.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
611 Inner casing/tubing length(if known): N/A (ft-) abandoned.
6g.Screen length(if known): N/A (fk)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016