3901_Granville_Oxford_MSWLF_Unit2_Phase2_Permit_WellAbandonment_FID1740501_20221021

•
hart hackman
SMARTER ENVIRONMENTAL SOLUTIONS
October 21, 2022
Ms. Jaclynne Drummond
Department. of Environmental Quality
Solid Waste Section
Asheville Regional Office
2090 US Highway 70
Swannanoa, North Carolina 28778
[e-mail]
GARRETT /
& MOOREE
Engineering for the Power and Waste Industries
RE: Groundwater Monitoring Well Abandonment and Replacement
Granville County Oxford Unit 2 Landfill
Oxford, North Carolina
Permit # 3901—MSWLF-2012
Dear Jackie:
As you are aware, Granville County is constructing the next phase of the Oxford MSW landfill (Unit
2, Phase 2). In support of the new landfill phase development, existing groundwater monitoring
wells and piezometers within the Phase 2 construction limits have been abandoned and one new
replacement monitoring well installed. The purpose of this letter is to document the well
abandonment and replacement was performed in accordance with the permit requirements.
A Work Plan for Well Abandonment and Replacement (FID 1642226) was submitted to the
Department and approved (FID 1642387) in February 2022. The Work Plan specified that twelve
(12) existing monitoring wells and piezometers (P-29, P-30S, P-30D, P-31, P-32, P-33S, P-33D,
P-34, P-6, MW-12, P-12, and MW-3R) be abandoned. The Work Plan also specified a new
monitoring well (MW-3RR) be installed to replace the abandoned well MW-3R.
Monitoring well and piezometer abandonment was performed by Geologic Exploration Inc. (Kenny
Sargent, NC Well Contractor 4226). Consistent with the approved Work Plan, the wells were
abandoned prior to landfill construction by overdrilling and grouting (via tremie pipe) with a
bentonite slurry to the landfill subgrade elevations. Copies of the well abandonment records are
provided in Attachment 1.
The installation of monitoring well MW-3RR was performed by SAEDACCO Inc. (John Eisenman,
NC Well Contractor 4439). The installed monitoring well was surveyed by Bateman Civil Survey
Company (Josh Davidson, PLS) to include location, ground elevation, and top of casing elevation.

Ms. Jaclynne Drummond
October 21, 2022
Page 2 of 2
A revised groundwater monitoring plan figure showing the location of MW-3RR, as well as a boring
log and well construction record form for MW-3RR are presented in Attachment 2.
All groundwater monitoring well abandonment and well replacement work was performed in
accordance with the approved Work Plan.
If you have any questions or require further assistance regarding this matter, please do not
hesitate to contact us.
Sincerely,
Hart & Hickman, PC
Jason Soban, P.G.
Geologist
Cc: Jason Falls, Granville County
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ATTACHMENT 1

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit
List all applicable well construction permits it. a County, State, Variance. em) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
Non -Water
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other(explain under 7g)
03/28/22
5a. Well location:
GRANVILLE COUNTY LANDFILL
FacilitylOwner Name Facility ]DO (ifapplicable)
6584 LAND FILL ROAD OXFORD 27565
Physical Address, City, and Zip
GRANVILLE
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one Iattiong is sufficient)
36" 22' 14.21" N 780 37' 14.54"
For Internal t'se ONL Y
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
For multiple injection or non -water supply wells ONLY with the sam.'
conrtructioWabandonmerr; you can submit one form.
7b. Approximate volume of water remaining in well(s): 2.75 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
• Bentonite Slurry
❑ Other (explain under 7g)
7f, For each material selected above, provide amount of materials used:
4.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA OVERDRILLING/GROUTED WITH TREMIE PIPE
AND BENTONITE SLURRY TO LANDFILL SUBGRADE ELEVATION
g. Certification:
'" 04/04/22
Signature ofCenifred Well Contractor or Well Owner Date
By signing lhis form, 1 hereby cer1ify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided io the well owner.
9. Site diagram or additional well details:
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 if necessary.
CONSTRUCTION DETAILS OF WELLIS) BEING ABANDONED
Attach well construction record(s) if available For multiple infection or turn -water supply
wells ONLY with the same constructianabamlonneenL you can submit one forme.
6a. Well ID#: MW-3R
6b. Total well depth: 25.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 8.0
SUBMITTAL 1NSTRUMONS
[On. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Infection Wells: In addition to sending the form to
6e. Outer casing length (if known): (D•) 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
6E Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Caroline Depanment orEnvircriment and Naitual Resources Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on hislher property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Nam
2. Well Construction Permit #:
List all applicable well construction permits (t.e. County, Stare, Variance, eia) ff known
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industriall'Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
4. Date welt(s) abandoned: 03/28/22
5a. Well location:
GRANVILLE COUNTY LANDFILL
under
Facility/Owner Name Facility IDY (ifapplicable)
6584 LAND FILL ROAD OXFORD 27565
Physical Address, City, and Zip
GRANVILLE
County
For Internal Use ONLY
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
For multiple lnjecitan or non -water supply
cantrualadabamfanmem. you can submit one form.
wells ONLY with the sam.
7b. Approximate volume of water remaining in welI(s): 1.75 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Scaling materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
* Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
3.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA OVERDRILLING/GROUTED WITH TREMIE PIPE
AND BENTONITE SLURRY TO LANDFILL SUBGRADE ELEVATION
S. Certification: AUAVIttv k,:~- 04/04/22
Signature ofCenified Well Contractor or Well Owner Date
By signing this fomi. I hereby certify that the well(s) was (were] abandoned in
Parcel Identification No. (PIN) accordance with 1 SA NCAC 02C.0100 or 2C .0200 Well Construction Slandards
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, ono latllong is sufficient)
360 22' 14.67" N 78a 37' 03.68"
►A
9. Site diagram or additional well details:
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 F WELLS BEING B ED SUBMI _ AL INSTRUCTIONS
Attach well construction record(s) if arailable. For multiple infection or non -water supply
wells ONLY with the tame comirue ion abandonment, you can submit one form. l0a For All Wells Submit this form within 30 days of completion of well
6a. Well ID#: MW-12
6b. Total well depth: 19.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 8.0 (ft.)
abandonment to the following.
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: in addition to sending the form to the address in IOa
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to
6e. Outer casing length (if known): (fL) the address(es) above, also submit one cLipy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner easing(tubing length (if known): ( fL) where abandoned.
6%. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning wall on histher property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County. State. Variance etc.) if known
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ IndustrtaVCommercial
Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
4. Date well(s) abandoned;
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Rernedkation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other(explain under
03/28/22
sa. Well location:
GRANVILLE COUNTY LANDFILL
For lutemal Use ONLY -
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: '
For multiple injection or non -water supply wells ONLY with the same
constructiowabandonment, you can subnat one farm.
7b. Approximate volume of water remaining in well(s)- 2'75 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentomte Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
4.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA OVERD RILLING/G ROUTED WITH TREMIE PIPE
AND BENTONITE SLURRY TO LANDFILL SUBGRADE ELEVATION
FacilityOwner N_me Facility IDN (ifapplicable) g• Certification:
6584 LAND FILL ROAD OXFORD 27565 'r
Phys-cal r.ddreo-:,+ sty, and 2ip
GRANVILLE
County
Signature of Cenifred Well Contractor or Welk Owner
04/04/22
Date
By signing this fort, 1 hereby certify that the well(s) was (were) abandoned in
Parcel ldentification No. (PIN) accordance with 15A NCAC 02C 0100 or 21:.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b. Latitude aad longitude in degrees/minutes/seconds or decimal degrees:
(if well field one latnong is sufficient) 9. Site diagram or additional well details:
360 22' 16.45" 780 37' 08.28" You may use the back of this page to provide additional well site details or well
N W abandonment details You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF W BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction records) if available. Far muttiple injection or non -water supply
wells ONLY with the same constructio"bandonment, you can submit one form. 109. For All Wells: Submit this form within 30 days of completion of well
6a. Well IDl1: P-6 abandonment to the following:
6b. Total well depth: 25.5 (It.)
6c. Borehole diameter: 2.0
6d. Water level below ground surface: 8.0 (ft.)
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. Fslr Injection Welts: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of we; I
abandonment to the following.
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-I636
length {if known): —(ft.) 10c. For Waterunaly & infection Welts: In addition to sending the form to
be. Outer casing g ) ) 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 abandoned
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): 00
Norm Ow -30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For lmemal1 Ise ONLY,
This form can be used for single or multiple wells
1. Well Contractor Information: WELL ABANDONMENT DETMU
KENNY SARGENT 7a. Number of wells being abandoned: 1
Well Contractor Name (or well owner personally abandoning well on hislher properly) 1-or multiple injection or non-wmer supply wells ONLY with the same
comtruction-abandonment, you can submit one form.
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, Stare, Variance. ere.) ifknawn
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
[]Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
❑Municipall'Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
03/28/22
5a. Well location:
GRANVILLE COUNTY LANDFILL
under
7b. Approximate volume of water remaining in well(s): 7.75 {gal.)
FOR WATER SUPPLY WELLS ONLY:
7e. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentomte Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specia:ty Grout ❑ Gravel
® Bentomte Slurry ❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
9.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA OVERDRILLING/GROUTED WITH TREMIE PIPE
AND BENTONITE SLURRY TO LANDFILL SUBGRADE ELEVATION
Facility/Owner Name Facility IDN (ifapplicable) g• Certification:
6584 LAND FILL ROAD OXFORD 27565 & 04/04/22
Physical Address, City, and Zip
GRANVILLE
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimsI degrees:
(if well field, one lailiong is sufficient)
36° 22' 10.40" N 780 37' 03.22"
SignetureofCenifiedWell Contractor orWell Owner Date
By signing this form, 1 hereby cerlO that the well(s) was (were) abandoned in
accordance with 15A NCAC 01C .0100 or ZC .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or we:1
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)_BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction records) if available. For multiple injection or iron -water supply
wells ONLY with the same cormiruction/abandonment. you can submit oneform 10a. For All Mils Submit this form Within 30 days of completion of well
6a. Well ID#:
P-12 abandonment to the following
6b. Total well depth: 55.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 8.0 (ft)
6e. Outer casing length or known): (ft.)
6f. Inner casing/lubing length (if known): (ft)
6g. Screen length (if known): (ft.)
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form Within 30 days of completion of well
abandonment to the following -
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & 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 county health department of the county
where abandoned
Form OW -SD Noah Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on hislher property)
A 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit M:
List all applicable well construction permits ri.e County State. Variance. etc j iflmown
3. Well use (check well use):
Water Supply Well:
❑Agriculturai
[]Geothermal (HeatinglCoolmg Supply)
❑ Industrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
M Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
[]Geothermal (Closed Loop)
4. Date well(s) abandoned:
❑Groundwater Remediation
❑Salmity Barrier
❑Stormwater Drainage
OSubsidence Control
❑Tracer
❑Other (explain under 7g)
03/28/22
5a. Well location:
GRANVILLE COUNTY LANDFILL
Facility/Owner Name Facility IDtt (ifapplicable)
6584 LAND FILL ROAD OXFORD 27565
Physical Address, City, and Zip
GRANVILLE
County
Parcel Identification No. (PIN)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
For multiple injection or non -wader supply wells ONLY with the same
construenoWabandonment, you can submit aneform.
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
El Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
4.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA OVERDRILLING/GROUTED WITH TREMIE PIPE
AND BENTONITE SLURRY TO LANDFILL SUBGRADE ELEVATION
S. Certification:
- 04/04/22
SignaturcofCertified Well Contractor or Well Owner Date
By signing this form, 1 hereby cenO that the wells) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 1C .0100 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b. Latitude and longitude in degrees/minuteslseconds or decimal degrees:
(ifwell field one lal/long is sufficient) 9. Site diagram or additional well details:
36" 22' 16.13" 78e 37' 01.06" You may use the back of this page to provide additional well site details or well
N W abandonment details You may also attach additionai pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Atiach well construction record(s) if available. For multiple injection or non -water supply
wells ONLY with the same construcrionlabandonrnrpS you can submit one form.
6a. Well IDN: P-29
6b. Total well depth: 24.0 (ft.)
6c. Borehole diameter: 2.0
6d. Water level below ground surface: 8.0 __(fL)
�VBMITTAL INSTRUCTIONS
10a. For All Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For lniection Wslls: In addition to sending the form to the address in l0a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply In a tion Wells., In addition to sending the form to
6e. Outer casing length (if known): (ft.) 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
6E Inner casing/tubing length (if known): (ft.) where abandoned
6g. Screen length (if known): YL)
Form GW-! . North Carolina Department of Environment and Natural Resources —Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on histher property)
A - 4226
NC Well Contractor Certification Number
For Internal Use ONLY
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
For multiple injection or non -water supply wells ONLY with the samr
consiructioWabandonmeni, you can submit one form.
7b. Approximate volume of water remaining in well(s): 8.25 (gal.)
GEOLOGIC EXPLORATION, I N C FOR WATER SUPPLY WELLS ONLY:
Company Name 7c. Type of disinfectant used:
2. Well Construction Permit #:
List all applicable well comtruction permits C.e. County, Stale. Variance, etc.) ifknown 7d. Amount of disinfectant used:
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal,tPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remedialion
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
4. Date well(s) abandoned: 03/28/22
under
5a. Well location:
GRANVILLE COUNTY LANDFILL
Fac;l itytlJ ., a er N: me Facility IDN (if applicable)
6584 LAND FILL ROAD OXFORD 27565
Physic-1 ,#ddress, City, and Zip
GRANVILLE
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degreeslminuteslseconds or decimal degrees:
(if wcll field, one latllong is sufficient)
36e 22' 15.04" N 780 37r 00.72°
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout El Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
El Bentonite Slurry ❑ Other (explain under 7g)
7L For each material selected above, provide amount of materials used:
9.5 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA OVERDRILLING/GROUTED WITH TREMIE PIPE
AND BENTONITE SLURRY TO LANDFILL SUBGRADE ELEVATION
S. Certification.
#WAI� 04/04/22
Signature of Certified Well Contractor or Well Owner Date
By signing this form, 1 hereby cerr6 that the wells)l was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 1C .0200 Well Construction Standards
and Thal a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
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 if necessary
CONSTRUCTION DETAILS OF WELLS BEING ABANDONED
Attach well construction records) if available. For multiple Injection or iron -wafer supply
wells ONLY with thr some comtruction/abanrivnmenr. you can submit one form.
6s. Well ID#: P-30D
6b. Total well depth: 58.5 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 8.0 00
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): {ft.)
6g. Screen length (if known): 00
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b, For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Infection_ 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 abandoned.
Fur (,W-10 North Carolina Department ofEnvironment and Natural Resources Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on histher property)
A - 4226
NC Wei I Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permitll:
List all applicable well construction pernNrs (i.e. County, Stare. Variance, etc.) ifknown
3. Well use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
OlndustriaVCommercial El Residential Water Supply (shared)
❑Irri tion
Non -Water Supply Well:
ONIonitorina ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
E10ther (explain under
4. Date well(s) abandoned: 03/28/22
58. Well location:
GRANVILLE COUNTY LANDFILL
Facility/Owner Name
For Internal L se ONLY
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
For multiple injection or non -water supply wells ONLY -Iih she sam.
constructionlabandonmew. you can submit one farm.
7b. Approximate volume of water remaining in well(s): 4.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7e. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check ail that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout 0 Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
El Bentonite Slurry 0 Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
5.75 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA OVERDRILLING/GROUTED WITH TREMIE PIPE
AND BENTONIfE SLURRY TO LANDFILL SUBGRADE ELEVATION
Facility IDN (ifapplicable) & Certification:
6584 LAND FILL ROAD OXFORD 27565-'
Physical Address, City, and Zip
GRANVILLE
County
Parcel Identification No. (PIN)
5b. Latilude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latmong is sufficient)
360 22' 15.07" N 780 37' 00.78" W
Signalure of Certified Well Contractor or Well Owner
04/04/22
Date
By signing this form, I hereby cert6 that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
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 recordr;) if available. Far multiple injection or non -water supply
urlfs ONLY wUh the same canstructionlabandonment you can submit one form. 10a. For All Weill. Submit this form Within 30 days of completion of wel I
6a. Well IDN:
P-30S abandonment to the following
6b. Total well depth: 35.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 8.0 (ft.)
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Well : In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water SUDDIY & Infection Wells: In addition to sending the form to
6e. Outer casing length (if known): (D-) 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
6E Inner casingltubing length (if known): -) where abandoned
(D
6g. Screen length (if known): (It.)
Form OW-30 North Carolina Department of Environmml and Natural Resources Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit M.
List all applicable well construction permits 0. e. County. Stare, Variance, etc.) if town
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (HeatinglCool ing Supply)
❑ IndustriallCommercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (HeatinglCooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
In
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other f explain under 7g i
4. Date well(s) abandoned: 03/28/22
52. Well location:
GRANVILLE COUNTY LANDFILL
FacilitylOwnerName Facility IDO (ifappl-cable)
6584 LAND FILL ROAD OXFORD 27565
Physical Addre!.s ('::ly. and Zip
GRANVILLE
County
Parcel Identification No. (PIN)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
Tor multiple injection or non -water supply wells ONLY with the sam,
constructloniabandamnent, you can submit one farm.
7b. Approximate volume of water remaining in well(s): 1.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
91 Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
2.75 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA OVERDRILLING/GROUTED WITH TREMIE PIPE
AND BENTONITE SLURRY TO LANDFILL SUBGRADE ELEVATION
8. Certification:
-114- A,,-=' 04/04/22
Signature of Certified Well Contractor or Well Owner Date
By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 1C .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 IatltonR is sufficient) 9. Site diagram or additional well details:
36 22 16.49 78 �� 37' 03.64 You may use the back of this page to provide additional well site details or well
i, N W abandonment details You may also attach additional pages if necessary.
NSTRUC LION DETAILS OF WELL(S) BEING ABAND
Attach well construction records) if available Tor multiple injection or non -water supply
. -ells ONLY with the sane construction- abandonment, you can submit one farm.
6a. Well ID#: P-31
6b. Total well depth: 16.5 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 8.0 (0.)
6e. Outer casing length (if known): (ft.)
6E Inner casing/tubing length (if known): {ft.)
6g. Screen length (if known): (ft)
SUBMITTAL INSTRIIC I'.IQNS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
lob. For Infection Wells: In addition to sending the form to the address in 108
above, also submit or.e copy of this form within 30 days of completion of well
abandonment to the following.
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Infection 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 abandoned.
Form OW-31i North C Lmlina Department ofEnvtronm nt and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or M�Lltiple we'Is
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on his(her property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
list al! applicable well construction perouts (i. e. County, Slate, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑IndustriaVCommercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
4. Date well(s) abandoned:
❑MunicipaMblic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
•
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
03/28/22
5a. Well location:
GRANVILLE COUNTY LANDFILL
Fac: 1 ity Owner Nm-ne Facility ID# (if applicable)
6584 LAND FILL ROAD OXFORD 27565
Physical Address, City, and Zip
GRANVILLE
Cnur.ty
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/ndoutes/seconds or decimal degrees:
,if well field, one 1WAong is sufficient)
360 22' 15.14" N 780 37' 06.26"
For Interval Use ONLY
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
f'or multiple injection or non -wafer supply wells ONLY with The some
cmcstrucriotdabandommem, you can submit one form.
7b. Approximate volume of water remaining in well(s): 2.25 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
• Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
3.5 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA OVERDRILLING/GROUTED WITH TREMIE PIPE
AND BENTONITE SLURRY TO LANDFILL SUBGRADE ELEVATION
8. Certification:
#u.. 04/04/22
Signature of Certified Well Contractor or Well Owner Date
By signing this form, 1 hereby certo that the well(s) was (were) abandoned in
accordance with I SA NCAC 02C .0100 or 2C .0100 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
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 if necessary
CONSTRUCTION DETAILS OF WELL(SI_BEING ABANDONED
Attach well construction record(s) if available For multiple injection or non -water supply
,yells ONLY with the some construction abandonment, you can submit one form.
6a. Well ID#: P-32
6b. Total well depth: 21.5 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 8.0 (ft.)
SUBMITTAL INSTRUCTIONS
10s. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following.
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in IOa
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (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 county health department of the county
where abandoned
6E Inner casingltubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
F),ih OW-30 'north C'&�d ins Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4226 _
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well ronstructian permits it. e. County, State, Variance. etc.) lfknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (HeatingJCooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remedialion
❑Salinity Barrier
❑Stonnwater Drainage
❑Subsidence Control
❑Tracer
03/28/22
under
52. Weil location:
GRANVILLE COUNTY LANDFILL
Facility; Ownti -, av ie Facility ]DO (if applicable)
6584 LAND FILL ROAD OXFORD 27565
Phyzical Address, City, and Zip
GRANVILLE
County
For Internal Use ONLY -
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
For multiple infection or non -water supply
consiructionlabamlonmenf. you can submit one farm.
wells ONLY with the some
7b. Approximate volume of water remaining in well(s): 5.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout © Gravel
El Bentonite Slurry ❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
6.75 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA OVERD RILLING/G ROUTED WITH TREMIE PIPE
AND BENTONITE SLURRY TO LANDFILL SUBGRADE ELEVATION
8. Certification: #Mllt& 4--- 04/04/22
Signature orcenified Well Contractor or Well Owner Date
By signing this form. I hereby certify that the well(s) was (were) abandoned in
Parcel Identification No. (PIN) accordance with I5A NCAC 01C.0100 or 2C.0200 Well Consuwction Standards
and that a copy of this record has been provided to the well owner.
5b. Latitude and longitude in degrees/minutestseconds or decimal degrees:
(ifwell field, one Iatflong is sufficient: 9. Site diagram or additional well details:
22' 15.18" 7$ 37 �� 10.44 You may use the back of this page to provide additional well site details or well
36
a N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Aua,-A well construction recard(s) if available. For multiple injection or non -wafer supply
we.4s ONLY with the same construction abandonment, you can submit one form.
6a. Well ID#: P-33D
6b. Total well depth: 41.5
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 8.0 (ft)
SUBMITTAL INSTRUCTIONS
10m. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in l0a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sponly & Infection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) 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
6E Inner casing/tubing length (if known): (ft.) where abandoned
6g. Screen length (if known): (ft)
Form OW-30 North Carolina Department of Environment and Natural Resources - DlvisiOn of Water Quality Revaed March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2, Well Construction Permit#:
List all applicable well construction permits (i. c. County, State, Variance, etc.) ifbwwn
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ IndustrlaVCommercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
03/28/22
SR. Well location:
GRANVILLE COUNTY LANDFILL
Facility/Owner Name
under
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
For multiple injection or non -water supply wells ONLY with the same
constructlaWabandonment, you can submit one form.
75
7b. Approximate volume of water remaining in well(s): 1.(gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
® Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7L For each material selected above, provide amount of materials used:
3.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA OVERDRILLING/GROUTED WITH TREMIE PIPE
AND BENTONITE SLURRY TO LANDFILL SUBGRADE ELEVATION
Facility IDLE (ifapplicable) S. Certification:
6584 LAND FILL ROAD OXFORD 27565
Physical Address, City, and Zip
GRANVILLE
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/aeconds or decimal degrees:
(if well field one lat/long is sufficient)
36e 22' 15.46" N 780 37' 10.36"
"r 04/04/22
Signature ofCenified Well Contractor or Well Owner Dale
By signing this form, 1 hereby cerr6 that the wells) was (were) abandoned in
accordance with 15A NCAC 01C .0100 or 1C .0100 Well Construction Standards
and that a copy of this record has been provided to the well owner,
9. Site diagram or additional well details:
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 if necessary.
NSTR CT[ N DETAILS OF WELL 5 BEING ABANDONED
Attach well construction records) if available. For multiple infection or non -water supply
wells ONLY with the same consrructionabandonmenr, you can submit ane form.
6a. Well IDN: P-33S
6b. Total well depth: 19.0 (ft.)
6c. Borehole diameter. 2.0 Sin.)
6d. Water level below ground surface: 8.0 (ft,)
6e. Outer casing length (if known): 00
6f. Inner casing/tubing length (if known): (ft)
6g. Screen length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b, For Inlection Wells: In addition to sending the form to the address in l0a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunoly & Injection Well;: 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 abandoned.
Form GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on hislher property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit N:
List all applicable well construction permits ft.e. County. State, Variance, etc.) if known
3. Well use (check well use):
❑Agricultural
❑Geothennal (Heating/Cooling Supply)
❑ Industrial/Commercial
14
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
❑ MunicipaVPublic
❑Residential Water Supply (single)
[]Residential Water Supply (shared)
❑Groundwater Remedlation
OSalinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
03/28/22
58. Well location:
GRANVILLE COUNTY LANDFILL
Facility/Owner Name Facility [DO (ifopplicable)
6584 LANDFILL ROAD OXFORD 27565
Physical Address, City, and Zip
GRANVILLE
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one lattlong is sufficient)
36° 22' 15.75" N 780 37' 13.82"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
For multiple Injection or non -water supply wells ONLY with the same
constructionfabandanment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 3.75 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
® Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
5.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA OVERDRiLLING/GROUTED WITH TREMIE PIPE
AND BENTONITE SLURRY TO LANDFILL SUBGRADE ELEVATION
S. Certification:
.& 04/04/22
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certo that the well(s) was (were] abandoned fn
accordance with ISR NCRC 02C .0100 or 2C' .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well sate details or wel I
W abandonment details You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS) BEING ABANDONED
Attach well construction record(s) if available Far multiple injection or non -water supply
irells ONLY with the some construcuonabandonmem you can submit one form.
6a. Well ID1l: P-34
6b. Total well depth: 31.0 (ft,)
6e. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 8.0 (ft.)
6e. Ouler casing length (if known): (ft)
6f. Inner casing/tubing length (if known): {ft.)
6g. Screen length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completicn of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection We112: In addition to sending the form to the address :n lit.,
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following -
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For.WAler Supply & infection 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 abandoned
Form G W-30 North Carolina Department of Environment and Natural Resources Division of Water Quality Revised March N,11

ATTACHMENT 2

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EXISTING 1 V TOPOGRAPHIC CONTOUR
EXISTING 2' TOPOGRAPHIC CONTOUR
GROUNDWATER SURFACE CONTOUR (FEB 2021)
GROUNDWATER FLOW DIRECTION
GROUNDWATER MONITORING WELL LOCATION AND IDENTIFICATION
SURFACE WATER MONITORING WELL LOCATION AND IDENTIFICATION
NOTES
1. GROUNDWATER MONITORING WELL NW-3RR (NEW) LOCATION SURVEYED BY
I � I�\` �✓ l\ � /// � I � �C / \ /� � \ � /1 / / � / ! J / ^ ��" � I 1 �\ / J f� ( / / / � � GATEMAN CIVIL SURVEY COMPANY, OCTOBER 2022.
1 `�� ✓ l I I I I ��' \ r (I I I 11 \ % 1 / \ { r _ j / 2. TOPOGRAPHIC DATA REPRESENTS CONDITIONS PRIOR TO UNIT 2 PHASE 2
SOLAR FARM � �' � > `- �' I# I I � � ° � � \ I �{ I I I ) / } I 1 I t[ I � 1 r o � , CONSTRUCTION.
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FIGURE 1

Granville County
Boring
GARRETT �/
&
MOORi`E
,A
Granville Oxford MSWLF
MW-3RR
Engineering for the Power and Waste lndustrres
Unit 2 -Phase 2
Page 1of1
Date Started: 9/7/22
Logged By:
Stefan Bray, PE
Well Construction Record
Date Completed: 9/8/22
Located By:
Bateman Civil Survey
ToC Elev.:
503.37'
Drilling Method: Hollow Stem Auger
Northing:
953,933.99
Screen Int. (ft, BGS):
Sampling Method: SPT/Split Spoon
Easting:
211,630.18
Seal (ft, BGS):
Drilling Company: SAEDACCO
GS Elev.:
500.82
Completion:
Locked casing
as SPT
w
a E E or J
w o y Z RQD (%)
a`
Description
Well Diagram
Steel Casing
0
Concrete Pad
CL: Silty Clay - orange/red, medium plasticity,
500
—40-50% sand (fine), moist.
Grout
5
495
2" PVC
ML: Clayey Silt with Gravel - tan, moist, gravel
10
to 15%. Auger refusal @ 10'
Bedrock: FMVR: dacitic, fine grained, aphanitic;
extensively weathered with several sub -vertical
490
Bentonite
fractures; tan -brown -red -gray. Core recovery =
30%, RQD = 27%
Run 1
27%
30%
15
Bedrock: As above, extensively fractured with
485
predominant sub -vertical fractures with iron and
manganese staining along fracture faces; REC
= 58%, RQD = 28%
Run 2
28%
58%
Sand
20
Screen
Bedrock: As above, sub -horizontal joints at
480
20.2', 21.0' and 23.5' with staining along joint
faces; REC = 100%, RQD = 100%
Run
100%
100%
Egerrefusal @10'; water level at 20.2' at 18 hours

WELL CONSTRUCTION RECORD
Tli:s fOrnw S-0n be used FK 5i ngk 9r m0l iuk wells
1. Well Contractor Infurmallon:
For flKrntiil 4rsc ONI.Y:
John Eisenman
W01 C0P4rjj;jDT t+iAFM
4439
NC Well ConividorCerlifneLionNimber
SAEDACCO Inc
UO]I PUIu r'ranmC
#, Wjil fgn5#rWti0H PCI Mit ff
List lrUd7ppei aWr i6ellplair lfi 0-'. Cfwjlh'-.52dw, Yariunre, ffWGR rjr.0
3, Wv1l Use (chcck w 0l u ney
ElAlgmulturrtl DMIMicipaVFtkiic
DGealhemtal tHealiltg,ICocling Apply) DResidenfial WaluSupph, (single)
011KfUS fialfColnmercial DRcsiden(ial Walu 5upph: (shared)
❑lrri tion
Nom-;' stRf` SU ppy Well:
phlpniloriikLz ❑RCc€r3 Ca}'
QAgtrifcr RCcha%g
13AquikF Slorage aMd Rcca; ,
❑AgllifQF T
❑ExivEim ffiml TrxhnQLpg.%-
❑Geodrernml lClosed Limp)
❑Gmdbemnal McAn neCboline Rewnsl
4.DateWM(s)Conlple1ed; 9/8/22
so- %'tell 1.Iacat6nn_
❑GroUndvr'AICF RCrrmCrlialian
❑Salinity Harrier
❑540r1M3;'atCr E"Lnagc
❑Tray T
❑0ilier 4mlain ultder #21 1
Well 1D+f MW-3RR
Granville County Landfill
Fyciliir' I',. r Monte Fncilf y TDN (if 3IplkHblel
6584 Landfill Rd., Oxford, NC, 27565
Physical Address_ City- and Zip
FRQ.M I
T4
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OR LIFTER {iF
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16. MER LASI NG Ok I 'RING { jln lk-FANAl du�-d4miir
FROM To DEiti1ETF.H ­ 7iif€kK4. HATERIAL
ft,
fR
Ft. IfF.
R
14 FL 24 f1• 2" ia. .010 rSCH-40 PVC
R ft in.
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FROM TO KATERIAL EM 7 ACEMLNT SILT1101P d AMOUNT
0 fL 9 ri Portland pump
4. it
VR4111
wE
m4-rEkUl.
E:Mra.ac'}'ME-41-MYTHEM
12
Or
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ft.
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lAG Ogyaeh
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FROM
TU
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10
ft.
25
fi
bedrock
fl,
rL
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fi.
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li.
fr.
Tx,
rt,
Bentonite seal from 9-12ft I
COORI}' PARCl IdCsilsf ylivri Na fP1^t}
ib, l.pllituds ylrul 1.nngitaliv in tlavgmrdmirrlrU*1wCrintls nr dcCimnl degrocs: 22, Crrtifiextian:
Ormr,11 fidd. mnmi hublimg is zlrlikk:nll
T1 w
9/19/2022 _
6. Is heel the welllsk 5UPer-manent o r ❑Tern ra
{as
LLF ST�IIGi� LIraT �w �R �I+' !n fir """ 1�.d'.s+ dYrRYFFYd'rCdt ur �dY�Pr�@oi Y'
; rh U4 NCAC OTC . ;r - i � Z; ;� C .02M Wrff £bmfrwrf r Standards seta AWi a
7. Is thin a repairfe an exisvtn%wrell. --J'Ycx err ® Nu
crpyafrhir rrmFdhm . rm wmi" r� Aw nrli!.mwn
1f 0fs rx rr woNlrr, f U 4,or trei,ww i-di o, t+ fan riche eirlorY+wWai 4md expfabi rAe ownbire of Me
repair under All Finadw.ya-iiaR m em fhe r5cu � of dire f Hui.
y y 1 y i �y 1
23, She d iawh o rt Or addMonal welldtfaik;
You rnmy ,1se t3fe back of this page to provide addifional wdl site details or well
S.1l umhcr of wills tOtleilttinctld: 1
WnsirurCion1 details. You rrla_+'also auach addilicmat pages if uecesssn .
for mtkke(JF rrtfeertwi of rorvi-isurer mph- l}efts ONLY mrh air srtmraa so%wAw. %,4 {xio
salbwlirrrur form.
SUBMITTAL INSTUCTIONS
9. Totid T.Ftll depth be&m Wid surfatt; 24 (ff.)
2da. Ftr All Wrilx: Sub nlo4 ties fame witLin xU days of compkiioo of wet I
FoFMMIlipie weth IfsrrrDdrf.0f rjdOfemrleymwpfe,- 3@ 00' awd 2@;fhf'}
Con5lnnCtign to the folLouing-
IU. Sufic weer levri below h}p. Of catsihey lly,l
Dir6iun aFVI'ater 1ke%CIUrCES, Informatiou Fruccsuing, Unit,
If nlelrrfi fir, d es f;lmul a inafrag. uu' "4 "
1617 Mail 9crsirz Center, Ral Pigh, XC 27699-1617
11. Bmrhole diameter: 8.25"/4 I}i)
tab. For Inimflos Weill ONLY: In addifiatl io sending the form 1C the address in
24a nbmwe. also subtllit a cop of this form within zO days of cDnipleiiotr of t++ell
IL Well toFMrnCtiost nlothod, hsa/coring
conSlruuLii n111)like f00CnVi1lg:
4i.e. ail--,'tr. nAar}', cable- 67a4 pushcic.L
Dh-Mon o£V4'xter RrAourcr>,.lfrtdcrQvuod lojccfiolr Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail SerYirr'Center. Raleith, NC 23699-1636
13A. Vio(I (qm) Virthnd of test'
24r- For Wj4W SR lief In-gttion W4 ft
Also submit One Copy of this forni %tiithin 30 days, ofconrplelion of
13b. bi HR-Cliqm hper Amount:
wdl cnosinnrtian to the cower; health department of the I,Cwnnay whom
-
CprE5MCtW
Farin GW-L Nonh Carol as D,pernnrilE DIEM iloiuiarlu aid Nantes] R.wurecs - Dii rs roe of Woor Ravin Rt, Iscii ALIgust 2913