Brunswick_Well Abandonment_20240301

0°3
%WELL ABANDONMENT RECORD \X For Imolai Use ONLY:
This foiin can be used far single or nniltipte wells
1,Well Contractor iutortnatitin: WELL ABANDONMENT DETAIi!
Stefan Smith . 7a,Number of wills being abandun Id:1
Welt Coutme erNallieternL.11onntrNoonan)alismtoningtoilanItislhcrpropcny) For niulnple Injection or now:wufr I supple wells ONLY. fed t6•e some
cotarructnoi4aborfdtrniman)tire cturnihnniH'oneiirm,
3576A
iVC WeU Cenlraaort-cnlfiaiiioti Ntuil6cr 71i.Apprnximatc volume of w.flet remaining in W.ell(a)'1 (g111
SAEDACCO FOR 11rATER.SUPPLY WELLS ONLY:
Oilman).Name 7c,Type of diniureetant used:N/A'
2a Well Construction Permit 0:, , •
Lrh ell upplki hie well)rn&r(i.e.Cuijril Saul,.•!'ariarxi,.bredtinn•,e?d;t fJ,Gmrrn 7d.Amount of disinfectant used:
3.Well use(cbedtri•cll use): .
Water Supply Well: 7c.Sealing materials used(cheek all that apply): : .
fAgtfeniturtl ❑Mttnicipil/Puhlid' Cl Neat Cement Cmvt Dl Bentonitc Chips or Pellets
0.0e0liicrtnal(Hcating/Cooling Supply) °Residentiatl Water Supply(single) •D Sand Cement Grant ❑Dry Clay
❑Industrial/Commercial ❑Rcsidentianl Water Supply(sbatrd), D Concrete Grout D Drill Coniugs
Dhtination- - .. El Specialty Grunt 13 Gravel •
Non-Water SupplyWell: .et BenioniteSlurry 1 Cl Other(explain under 7g)
(19Ma»itoring , • 1:Recovery '
Injection Well: _ 7f.For each material selected aborr,provide amount Of-Materials used: •
DAquifer Recharge DGredrit reuer Reutediation
ElAquiferStortge and Recovery OSalinity Barrier
DAgniferTest . EIStonmvuterDrainage
Bentonite.:301b ,Wtr:gal.!'
❑Eipetintetitol Teclmology ❑Subsideixe Catiltnl 7g.Provide a brief description of the abandonment procedure:
. DGeotltennal(Closed Loop) CITracer
Pulled.well and filled with bentonite. ; -
.EIGeothennal(Heating/Cooling Return) DOther(eplain under 7g)
4.Date well(s).altandoned: 1-24-24 - • rli;`Viz 1 vE;r �j,J i
Sa.Welitucaflon: MAN 0 1 2024 .
Temp. Monitoring Wells
Facility/O r crNiinu Facility IDld(tl itppliwblc) 8.Certification: inter(istfen?rt c sial Wit
_ DNr'Gj-30G
2080 Enterprise Dr. Leland, NC 28451. tiT 2/8/2024
• Pla}•sical Address,City.and Zip S, alit¢ C*atll:d Well Coiuia tern or Well(hersr Dale
Brunswick lfy signing this farm,1 hereby cent&that the trr11(s1 was(Were)abandoned ur
County - Parcel libntifieetinnNo.(PIN) accutdance with ISA\CHIC 02e,010f/or 2C.0200 It'edl oast action Standards
and that a copy of this record lots been provided to lire well owner.
Sb.Latitude and longitude hi dcgrlceslminutes/sccnnds or decimal degrees:
Owen Meld,one Iat/IOng isSidlicicti) 9.Site diagram or additional well details:
• You may use the book of this page to provide additional well site details or well
. . 34-.261711 N 78..068147 W abandoinllctn-details..You turfy also attach additional pages if tiecessaty.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED ,SUn rrrAL INSTRUCTIONS
- :[:drub net/criluinwitan revordh)41aivallnfik. •Poi nrarlttplr byecrion or ren.iisur supply
neii tWLIt with the same ratiartmarogiatairdrmisent.iorr inn sirhnrit ore Anil. 103. Fur All Wills:- Submit.this fetal_.within 30 days of completion of well
6a.Well bl):TMW-1 -abandonment to-the following:
Division of Water Resourem.,Information Processing Unit,
•
14 . 1617 Mail Service Cr,enteRaleigh,NC 27699-1617
6b.Total-well depth: (ft.) r •
10b.For.tnieetIon Nuclide: In addition to sending the forum to the address in WWa .
Gc.Borehole dlanteter;2 (in.) above,:also submit one copy of this foam within 30 days of completion of well
abandonment lo'dtc following: I.
fro,Water tt vcl belowground surface: 4 3 (ft.) Divislou of Water Rrsourecs,Underground Injection Control Progratu;
1636 Mail Service Cc tcr,•Raleigti,NC 2709-1636
q 1Oe For Water Stinnly&inicrtinn Wells: In addition'to sending the form to
6ea•Outer casing lengt Jammu):(if Jarn): (R:) tite addresses)above. also submit,one copy of this fork: within 30 days of
completion of well abandonment toi the county health deplinmetrt of the county
where abandoned, r
6f.Inner easing/tnbingdength(if lamwn) (ft.)
6g.Screen length(If lwoecn):10 (ft.)
Foam GW-30. North Carothn Dcpsudinl of Environment alai Niiturat Rcsonrccs-Division of Warcr Resources Revised August 2013 '
•

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WELL ABANDONMENT RECORD For Internal Use ONLY;
This form can be used for-single or multiple wtells . •
•
1 Well Contractor information: WELL ABANDONMENT DETAIL,
Stefan smith 7a.Number of wells being abandoneil:1 •
Welt Codranor!Inure(or welt uwnex Normally ab intdrdng%toll on tit ilrrr propcny) Far en 1r pk overtrain or rvou-mn er I supply. wells ONLY with ei a sane _
catasrrtfCat?ueban6anmettr.?run car s1Jbmi.:41i IFann
3576A I i
7h.Apprn irtt:xhnate vnlu of watut cent eining in ileli(sel. (;,oL)
NE Well ConirmorG;glftirailon Nntitjri • Ii .
sAEDAcco - FOR WATER.SUPPLY WELLS ONLY:
-- 6
Company(Tame le.Tylie'tif disNrifettant used,:N/A i;
2.Well Construction Permit#:, . •
Liston applicable a ell perariae ft.e Cuanq:Stcte,-Yariatic.hyrertion;.etc[)rf Grown
?d:Amount of tllsinfecettut'atsal:
3.Well use(cheek ell eek W use):
Water Supply Well; 70.Sealing materiadsuscd(check-ally that apply): .
•
gAgrfcultnint fMunieipatt'Public ' El NeatCenieut.Grotit ;, Dl BentoniteChipsOr-Pellets
POeotlicrtnd(Hcatin Coolitig Supply) •Oftcsidetmnl Water Supply(single) 17 Sam Centenl(haul ❑Dry Clay
❑l dnstrial/Comnicrcial ❑Residential Water Supply-(stiarcd). ❑Concrete Grout. 0 Dill Cuttings
•❑Inn •lion. . . . . • . . . U Specialty Grout • 0 Gravel
Non-Water Supply Welt: d Bentonite Shiny ❑Other(explain tinder 7g)
DMaadloring... . . oRecovery. . . I
Injection Wen: .- - - 7f.For each material selscte4 above;pcnsldo amount de Materials rased:
❑Agnifer Reclurge 17Groundwaler Rentedlalio»
OAguifer Storage and Recovery OSalinily Barrier - I;
❑Agnifer Test ❑Stonmlvter.Dratiiage
• Bentonite.:301b ;t4tr:gal.'
❑E pmi,iietilul Techuolog OSudasideutct Cotuinut 7g.Provide a brief description of the abandonment procedure:
17Geothennal(Closed Loop) . ❑Tracer • •-
Pulled well and filled with bentonite.
OGcothennat(Heatin&'Coolina Return) . ®Other(explain under 7a) . . •
d.Date neQ{s).abandoneti: 1-24-24 - --__ • s:�C. E"It,,/h r)
Su.Well location: • 1.
IVIM 2029
•
Temp, Monitoring Wells • 1
Faciln r ylOi iw Nuauc Pxiiity Iron Orappliwblc) 8.Certification:
iriforrorYien rric»s`..2 UM
2080,Enterp rise,Dr. Leland, .NC 28451 "i r DW• I, Q3�/8/202-4
Plij'sical Address,City,and Zip S.. ilnr�::.Certified Well Cotuiau=ror%Vela ffi•n:r Dale
Brunswick ay signing this fiar)tn;I hereby certify that the tre11(s)11'0s(were)abandoned in
County . - Parcel ld.niiliaidiut No.(PlNj aecvrdance it'll!?15-f NC'AC 02C.0109.ar 2C.0200 We1l:Cvnstralclioci Standards
- - and that a copy of this record hat been provided to the Well owner.
Sit.,Latitude and longitude In dcgreeslntiatuteslsecondsof-decimal-degrees: iC '
Orwell r41d,one ladling is snuicictx) 9.Site diagram or additional well details: -
34.261804 71i.o6s6oi You ma);me the back of this page to*vide additional Well site details or well
N .- . W .abatidoimteiu details..You may also stgch additional,pages if-necessary.
CONSTRUCTION DETAILS OF%VELL A)REINS:ABANDONED• ,SUBMI1 TAL INSTRUCTIONS !! •
Attach%eel;ceiiae)nte'lhrt uwrd's)if aval&toile. •FeLe multiple agerrIun or ika•utttir gipply -
wt:lle ONLY unlit rlie songamstroctwtdoiaubrtxteru.iota can xrrbmli are)eyne. 10a: For All Wells: Submit•this font within 30 days of completion.of well
6a,Well1D#:Tmw-2 - abandonment to the fallowing:
Division of Water Resunlrcis,Information-Procu slug Unit,
14 1617 Mali Scivice Center;Raleigh,NC.27699-1617
Gb.Total well depth: (ft.) I, ,
10b.j:or•inlection Wells: In addition to sending the Como to the address in.l6a
Gc.Borehole diameter:2_ (iu.) above.tilso-'submit one copy of this fonn within 30 dayS of-completion of tell
ablittdot itten!to the following: I•
•
•
Gd.Water level below ground surface: 4 3 (ft) Division of Water Resources,Uumcrground Injection Contrvl•Prdgraut,
1636 Mail Service Canter,Raleigh;1\C 27619-.1636
I
6a Outer easing length(if lan`vn): 4 • (ft) 10e.Far-Water Swink.fi liniert1r)n Wells: In addition to sending the font►to
tits addresses) above.also stibmit,one copy of this fotmt within 30.days of
conviction-of well abandoianent collhccounty health depattnteid of the county
where abandoned. • 1` ,
6f.Innereasing/tnbing length(if[mown):. (fa.) I
• 6g.Screen length(if known):10 (fe)
Form GW-30 North Casolim Dcpecuuem of Environment mail Natural Resources-Dlrisian of W3terRcslatuns -Revised August 2013

*ELL L ABANDONMENT RECORD I
For Internal Use ONLY: f
1 ,
1
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Trevor Mizelle
7a.For Geoprobe/DPT or Closed-Loop p 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
wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 7.76043 (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: Chlorine Powder
2.Well Construction Permit#: 4629C I'
List all applicable well construction permits(i.e.UIC,County,State, Variance,etc.)ifknown 0.25 oz
7d.Amount of disinfectant used: 10.25
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublic ❑Neat Cement Grout IN Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout 0 Dry Clay
sIndustrial/Commercial OResidential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation ❑ Specialty Grout 0 Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
•
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite 84.5 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
,
❑Experimental Technology ❑Subsidence Control i I
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer 1, •
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Casing was left in place. Hydrated bentonite was
used to fill casing. 11 , p ,r-q, ",,,
4.Date well(s)abandoned: 2/8/2024 ;i �'�- Ls,/ V C D
5a.Well location: ! MAN 0 1 Z024
Don Stocks do Parker Randall Scott ff tta4fF�1 Pr^;
Facility/Owner Name Facility ID#(if applicable) 8.Certification: �' 1 +lOf3t
557 Seaside Road, Ocean Isle, NC 28469 G . ,-,- 2/9/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Brunswick
By signing this form, I hereby ceri,ifil 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 1at/long is sufficient) 9.Site diagram or additional well details:
33.94678858597417 N -78.50295079045564 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. 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 form within 30 days of completion of well
6a.Well ID#: WSW-1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 52.82 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
1'
10b.For Injection Wells: In addition to sending the form to the address in IOa
6c.Borehole diameter: 2 (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: 5.21 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
P
Unknown 10c.For Water Supply&Iniection Wells: In addition to sending the form to the
6e.Outer casing length(if known): . (ft.)
address(es)above,also submit onercopy 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): Unknown (ft) abandoned.
6g.Screen length(if known): Unknown (ft.)
I
I i
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
lit

•
© WSW-Somersett N
z- r O �� 4. 0
WSW-7 1 8!
O t
O c U. .
►.. Ul�:A PUlJ
47
GLENN CCl PARKER ' J
la
PROPERTY
, MW 2R FORMER ACME
CONVENIENCE
r / STORE
•- FORMER UST MW-1R ,
l FORMER UST "R r BASIN a j-!
-NO BASIN& s3' : ` ,.�- t
MW-16 ' Ak MW-13 ,' VE-1 ® .� ►j MW-5
t
ak L(CNL) - �� FORMER ® MW-3R
v. I - DISPENSER _i MW-9 ED
ISLAND MW 8 W® M -6
M is
W-15 ��
WSW-1 1�I1 ® MW 14R li' I
t
MW-14 ® --
LEGEND r pCEAN Or(W
® Monitoring Well „ _ - - . _
(Type II)
® Abandoned Monitoring ,--Well (Type II) ® MW-12
Destroyed Monitoring '
® Well (Type II)
,k Active f 1
Water Supply Well
r'�i Abandoned ` M •
Water Supply Well , 1
Approximate Location s A
of Former UST System r . _ _-
�� A I. t•t'•
ElParcel Boundary ►� .�. J
R_V a0 _..1_ SouicetEC ".'axai Eaethstar'Geograph.cs, - d the GIS User Community
NOTES:
1. Well and tank locations were obtained from previous reports 80 40 0 80 160
prepared by other consultants and are approximate. Feet
2. CNL= Could Not Locate immoommium
PROJECT T:T_E
GLENN PARKER FIGURE
IIALIN PROPERTY SITE MAP
7102 OCEAN HWY WEST
GRISSETTOWN, NC 1
Engineers and Scientists
WGDENT NO. JOB NO. DATE. SCALE DRAWN BY/CHECKED BY
5675 220302 FEB 2024 AS SHOWN KMC/SJO