AS-3759_28886_CA_WR_20230110

January 10, 2023
Ms. Maura Clark Hydrologist
Division of Waste Management, UST Section
North Carolina Department of Environmental Quality Ashville Regional Office 2090 US 70 Highway Swannanoa, North Carolina 28778-8211

RE: Monitoring Well Abandonment/ Site Closure Report Murphy USA No. 6597 Incident No. 28886
Facility ID No. 0-036216 2474 Halltown Road Spruce Pine, North Carolina PPM Project No. 250724-WASC

Dear Ms. Clark:

PPM Consultants, Inc. (PPM) is submitting this Monitoring Well Abandonment (MWA)/ Site
Closure Report summarizing well abandonment activities conducted at the above-referenced site
on December 13, 2022. A Site Location Map is included as Figure 1, Attachment A. A
summary of work is provided below.

1.0 WELL ABANDONMENT
The scope of work included the abandonment of monitoring wells MW-1 through MW-7 and deep
well DW-1. On December 13, 2022, PetraTech Environmental, a licensed State of North Carolina
Well Contractor (License No. 4426B), conducted the well abandonment activities under PPM
supervision in general accordance with the North Carolina Department of Environmental Quality
(NCDEQ) Well Standards and Regulation, 15 ANCAC 02C.0100. Type I Portland cement was
gravity fed through a tremie pipe from the bottom of each monitoring well to the top.

Monitoring wells MW-1, MW-4, MW-5, MW-6, and MW-7 had total well depths of 35 feet below
ground surface (BGS). Monitoring wells MW-2 and MW-3 were 15 feet BGS and deep well
DW-1 was 50 feet BGS. A total of 255 feet of grout was used to complete the well abandonments.
Ms. Maura Clark January 10, 2023 Page 2
The well pads located in the grassy/gravelly areas were removed removed and the ground surface
was backfilled with soil. A jackhammer was utilized to remove the metal skirting out of the
concrete pads located in the parking lot per Murphy USA. The former well locations were then
completed with neat concrete. Well abandonment debris was loaded on a trailer and removed for
proper disposal. The abandoned well locations are shown in Figure 2, Site Map, Attachment A.

Copies of Field Notes and Well Abandonment Records (Form GW-30) are included in
Attachment B. Photographs of field activities are provided in Attachment C, Photographic
Documentation.

2.0 CONCLUSIONS

Monitoring wells MW-1 through MW-7 and DW-1 have been abandoned in accordance with North
Carolina Regulations, and no additional wells remain on or off site. PPM recommends the site
qualify for No Further Action (NFA). If you have any questions or comments regarding this
submittal, please contact the undersigned at [phone].
Respectfully, PPM Consultants, Inc.

Nik Hicks Rodney Kilgore, P.G Senior Project Manager North Carolina License No. 2086
Attachments: Attachment A – Figures; Attachment B – Field Notes and Well Abandonment
GW-1 Forms; Attachment C – Photographic Documentation
ATTACHMENT A – FIGURES
SITELOCATION
DRAWN BY:
FIGURENUMBER
PROJECT NUMBER:
DRAWN DATE:
PHASE:
JCP
250724
12/15/22
WASC
SITE LOCATION MAP
MURPHY OIL USA, INC.MURPHY USA NO. 65972474 HALLTOWN ROADSPRUCE PINE, NORTH CAROLINANCDEQ FACILITY I.D. NO. 0-036216 1
P P M C O N S U L T A N T S , I N C . PPM www.ppmco.com
SCALE: 1 : 24,000
FEET
MILES
01 1.5
01000 1000 5000 10,000
0 METER
0 KILOMETER
1000
1
1000
1 2
2000
LITTLE SWITZERLANDQUADRANGLE-1979
P P M C O N S U L T A N T S , I N C . PPMwww.ppmco.comPHASE:DRAWN DATE:PROJECT NUMBER:DRAWN BY:SITE MAP2NUMBERFIGUREASPHALTWAL-MARTPARKINGLOTDISPENSERISLAND(TYP.4)0N(Approximate)50SCALE: 1"=100'100GRASSSLOPEGRASSGRASSGRASSGRASSPW-3PW-2PW-1MW-3MW-2WOODEDAREAWOODEDAREABOJANGLE'SSTORECANOPY12/15/22250724JCPWASCMURPHY OIL USA, INC.MURPHY USA NO. 65972474 HALLTOWN ROADSPRUCE PINE, NORTH CAROLINANCDEQ FACILITY I.D. NO. 0-036216INTERMITTENT CREEKOVERHEAD POWER LINEFIBER OPTIC LINEWATER LINESANITARY SEWER LINEPOWER POLEMONITORING WELL LOCATIONLEGEND:B-13/DW-1B-9/MW-4B-11/MW-6B-10/MW-5B-12/MW-7(ABANDONED)PW-4PTWATER METERSTORM DRAINOVERHEAD POWER ANDTELEPHONE LINEGAS LINESLOPE
STREAMMW-1

ATTACHMENT B – FIELD NOTES AND WELL ABANDONMENT FORMS
330&2168/7$176,1&330ZZZSSPFRFRP3+$6('5$:1'$7(352-(&7180%(5'5$:1%<6,7(0$3180%(5),*85($63+$/7:$/0$573$5.,1*/27',63(16(5,6/$1'7<31$SSUR[LPDWH6&$/( 
*5$666/23(*5$66*5$66*5$66*5$663:3:3:0:0:0::22'('$5($:22'('$5($%2-$1*/(
66725(&$123<-&3*:00853+<2,/86$,1&0853+<86$12+$//72:152$'6358&(3,1(1257+&$52/,1$1&'(4)$&,/,7<,'12,17(50,77(17&5((.29(5+($'32:(5/,1(),%(5237,&/,1(:$7(5/,1(6$1,7$5<6(:(5/,1(32:(532/(62,/%25,1*/2&$7,2162,/%25,1*021,725,1*/(*(1''((3:(///2&$7,21%':%%%%%0:%0:%0:%%0::(///2&$7,213:3 7:$7(50(7(567250'5$,129(5+($'32:(5$1'7(/(3+21(/,1(*$6/,1(6/23(675($0
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #: List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
!Agricultural !Municipal/Public
!Geothermal (Heating/Cooling Supply)!Residential Water Supply (single)
!Industrial/Commercial !Residential Water Supply (shared)
!Irrigation
Non-Water Supply Well:
!Monitoring !Recovery
Injection Well:
!Aquifer Recharge !Groundwater Remediation
!Aquifer Storage and Recovery !Salinity Barrier
!Aquifer Test !Stormwater Drainage
!Experimental Technology !Subsidence Control
!Geothermal (Closed Loop)!Tracer
!Geothermal (Heating/Cooling Return) !Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of wells abandoned:
7b. Approximate volume of water remaining in well(s): (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:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify 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 wellabandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well abandonment to the following:
Division of Water Resources, 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 Resources, 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 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.
For Internal Use ONLY:
Trever Z. Slack
NCWC 4426-B n/a
~1.8
Petra-Tech Environmental
n/a n/a
n/a
neat cement grout ~8 gallons
12/13/2022
Neat cement tremie from bottom of well to ~1 foot
below ground surface. Steel manhole lid and ring
removed, and abandonment completed using
concrete from 1-foot to ground surface.Murphy USA No. 6597 0-036216
2474 Halltown Road, Spruce Pine, 28777 12/13/22
Mitchell 0798-00-85-2032
35*52'09.32" 82*02'37.45"
MW-1
35.70
~24
15
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #: List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
!Agricultural !Municipal/Public
!Geothermal (Heating/Cooling Supply)!Residential Water Supply (single)
!Industrial/Commercial !Residential Water Supply (shared)
!Irrigation
Non-Water Supply Well:
!Monitoring !Recovery
Injection Well:
!Aquifer Recharge !Groundwater Remediation
!Aquifer Storage and Recovery !Salinity Barrier
!Aquifer Test !Stormwater Drainage
!Experimental Technology !Subsidence Control
!Geothermal (Closed Loop)!Tracer
!Geothermal (Heating/Cooling Return) !Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of wells abandoned:
7b. Approximate volume of water remaining in well(s): (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:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify 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 wellabandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well abandonment to the following:
Division of Water Resources, 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 Resources, 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 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.
For Internal Use ONLY:
Trever Z. Slack
NCWC 4426-B n/a
~0.8
Petra-Tech Environmental
n/a n/a
n/a
neat cement grout ~5 gallons
12/13/2022
Neat cement tremie from bottom of well to ~1 foot
below ground surface. Steel manhole lid and ring
removed, and abandonment completed using
concrete from 1-foot to ground surface.Murphy USA No. 6597 0-036216
2474 Halltown Road, Spruce Pine, 28777 12/13/22
Mitchell 0798-00-85-2032
35*52'09.32" 82*02'37.45"
MW-2
15.50
~10
10
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #: List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
!Agricultural !Municipal/Public
!Geothermal (Heating/Cooling Supply)!Residential Water Supply (single)
!Industrial/Commercial !Residential Water Supply (shared)
!Irrigation
Non-Water Supply Well:
!Monitoring !Recovery
Injection Well:
!Aquifer Recharge !Groundwater Remediation
!Aquifer Storage and Recovery !Salinity Barrier
!Aquifer Test !Stormwater Drainage
!Experimental Technology !Subsidence Control
!Geothermal (Closed Loop)!Tracer
!Geothermal (Heating/Cooling Return) !Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of wells abandoned:
7b. Approximate volume of water remaining in well(s): (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:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify 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 wellabandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well abandonment to the following:
Division of Water Resources, 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 Resources, 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 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.
For Internal Use ONLY:
Trever Z. Slack
NCWC 4426-B n/a
~1.6
Petra-Tech Environmental
n/a n/a
n/a
neat cement grout ~5 gallons
12/13/2022
Neat cement tremie from bottom of well to ~1 foot
below ground surface. Steel manhole lid and ring
removed, and abandonment completed using
concrete from 1-foot to ground surface.Murphy USA No. 6597 0-036216
2474 Halltown Road, Spruce Pine, 28777 12/13/22
Mitchell 0798-00-85-2032
35*52'09.32" 82*02'37.45"
MW-3
15.50
~5
10
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #: List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
!Agricultural !Municipal/Public
!Geothermal (Heating/Cooling Supply)!Residential Water Supply (single)
!Industrial/Commercial !Residential Water Supply (shared)
!Irrigation
Non-Water Supply Well:
!Monitoring !Recovery
Injection Well:
!Aquifer Recharge !Groundwater Remediation
!Aquifer Storage and Recovery !Salinity Barrier
!Aquifer Test !Stormwater Drainage
!Experimental Technology !Subsidence Control
!Geothermal (Closed Loop)!Tracer
!Geothermal (Heating/Cooling Return) !Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of wells abandoned:
7b. Approximate volume of water remaining in well(s): (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:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify 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 wellabandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well abandonment to the following:
Division of Water Resources, 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 Resources, 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 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.
For Internal Use ONLY:
Trever Z. Slack
NCWC 4426-B n/a
~1.7
Petra-Tech Environmental
n/a n/a
n/a
neat cement grout ~8 gallons
12/13/2022
Neat cement tremie from bottom of well to ~1 foot
below ground surface. Steel manhole lid and ring
removed, and abandonment completed using
concrete from 1-foot to ground surface.Murphy USA No. 6597 0-036216
2474 Halltown Road, Spruce Pine, 28777 12/13/22
Mitchell 0798-00-85-2032
35*52'09.32" 82*02'37.45"
MW-4
34.90
~24
15
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #: List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
!Agricultural !Municipal/Public
!Geothermal (Heating/Cooling Supply)!Residential Water Supply (single)
!Industrial/Commercial !Residential Water Supply (shared)
!Irrigation
Non-Water Supply Well:
!Monitoring !Recovery
Injection Well:
!Aquifer Recharge !Groundwater Remediation
!Aquifer Storage and Recovery !Salinity Barrier
!Aquifer Test !Stormwater Drainage
!Experimental Technology !Subsidence Control
!Geothermal (Closed Loop)!Tracer
!Geothermal (Heating/Cooling Return) !Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of wells abandoned:
7b. Approximate volume of water remaining in well(s): (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:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify 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 wellabandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well abandonment to the following:
Division of Water Resources, 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 Resources, 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 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.
For Internal Use ONLY:
Trever Z. Slack
NCWC 4426-B n/a
~1.9
Petra-Tech Environmental
n/a n/a
n/a
neat cement grout ~8 gallons
12/13/2022
Neat cement tremie from bottom of well to ~1 foot
below ground surface. Steel manhole lid and ring
removed, and abandonment completed using
concrete from 1-foot to ground surface.Murphy USA No. 6597 0-036216
2474 Halltown Road, Spruce Pine, 28777 12/13/22
Mitchell 0798-00-85-2032
35*52'09.32" 82*02'37.45"
MW-5
35.10
~23
15
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #: List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
!Agricultural !Municipal/Public
!Geothermal (Heating/Cooling Supply)!Residential Water Supply (single)
!Industrial/Commercial !Residential Water Supply (shared)
!Irrigation
Non-Water Supply Well:
!Monitoring !Recovery
Injection Well:
!Aquifer Recharge !Groundwater Remediation
!Aquifer Storage and Recovery !Salinity Barrier
!Aquifer Test !Stormwater Drainage
!Experimental Technology !Subsidence Control
!Geothermal (Closed Loop)!Tracer
!Geothermal (Heating/Cooling Return) !Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of wells abandoned:
7b. Approximate volume of water remaining in well(s): (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:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify 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 wellabandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well abandonment to the following:
Division of Water Resources, 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 Resources, 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 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.
For Internal Use ONLY:
Trever Z. Slack
NCWC 4426-B n/a
~1.9
Petra-Tech Environmental
n/a n/a
n/a
neat cement grout ~8 gallons
12/13/2022
Neat cement tremie from bottom of well to ~1 foot
below ground surface. Steel manhole lid and ring
removed, and abandonment completed using
concrete from 1-foot to ground surface.Murphy USA No. 6597 0-036216
2474 Halltown Road, Spruce Pine, 28777 12/13/22
Mitchell 0798-00-85-2032
35*52'09.32" 82*02'37.45"
MW-6
35.30
~23
15
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #: List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
!Agricultural !Municipal/Public
!Geothermal (Heating/Cooling Supply)!Residential Water Supply (single)
!Industrial/Commercial !Residential Water Supply (shared)
!Irrigation
Non-Water Supply Well:
!Monitoring !Recovery
Injection Well:
!Aquifer Recharge !Groundwater Remediation
!Aquifer Storage and Recovery !Salinity Barrier
!Aquifer Test !Stormwater Drainage
!Experimental Technology !Subsidence Control
!Geothermal (Closed Loop)!Tracer
!Geothermal (Heating/Cooling Return) !Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of wells abandoned:
7b. Approximate volume of water remaining in well(s): (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:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify 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 wellabandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well abandonment to the following:
Division of Water Resources, 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 Resources, 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 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.
For Internal Use ONLY:
Trever Z. Slack
NCWC 4426-B n/a
~1.9
Petra-Tech Environmental
n/a n/a
n/a
neat cement grout ~8 gallons
12/13/2022
Neat cement tremie from bottom of well to ~1 foot
below ground surface. Steel manhole lid and ring
removed, and abandonment completed using
concrete from 1-foot to ground surface.Murphy USA No. 6597 0-036216
2474 Halltown Road, Spruce Pine, 28777 12/13/22
Mitchell 0798-00-85-2032
35*52'09.32" 82*02'37.45"
MW-7
35.10
~23
15
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #: List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
!Agricultural !Municipal/Public
!Geothermal (Heating/Cooling Supply)!Residential Water Supply (single)
!Industrial/Commercial !Residential Water Supply (shared)
!Irrigation
Non-Water Supply Well:
!Monitoring !Recovery
Injection Well:
!Aquifer Recharge !Groundwater Remediation
!Aquifer Storage and Recovery !Salinity Barrier
!Aquifer Test !Stormwater Drainage
!Experimental Technology !Subsidence Control
!Geothermal (Closed Loop)!Tracer
!Geothermal (Heating/Cooling Return) !Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of wells abandoned:
7b. Approximate volume of water remaining in well(s): (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:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify 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 wellabandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well abandonment to the following:
Division of Water Resources, 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 Resources, 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 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.
For Internal Use ONLY:
Trever Z. Slack
NCWC 4426-B n/a
~4.1
Petra-Tech Environmental
n/a n/a
n/a
neat cement grout ~1 gallons
12/13/2022
Neat cement tremie from bottom of well to ~1 foot
below ground surface. Steel manhole lid and ring
removed, and abandonment completed using
concrete from 1-foot to ground surface.Murphy USA No. 6597 0-036216
2474 Halltown Road, Spruce Pine, 28777 12/13/22
Mitchell 0798-00-85-2032
35*52'09.32" 82*02'37.45"
DW-1
49.90
~24
5

ATTACHMENT C – PHOTOGRAPHIC DOCUMENTATION
SITE PHOTOGRAPHS MURPHY No 6597 SPRUCE PINE, SOUTH CAROLINA PPM PROJECT NO. 250724‐WA Photo  1Deep Well DW‐1 Before Photo  2Deep Well DW‐1 After
SITE PHOTOGRAPHS MURPHY No 6597SPRUCE PINE, SOUTH CAROLINA PPM PROJECT NO. 250724‐WA Photo  3MW‐1 BeforePhoto  4MW‐1 After 
SITE PHOTOGRAPHS MURPHY No 6597 SPRUCE PINE, SOUTH CAROLINA PPM PROJECT NO. 250724‐WA Photo  5MW‐2 BeforePhoto  6MW‐2 After
SITE PHOTOGRAPHS MURPHY No 6597SPRUCE PINE, SOUTH CAROLINA PPM PROJECT NO. 250724‐WA Photo  7MW‐3 BeforePhoto  8MW‐3 After
SITE PHOTOGRAPHS MURPHY No 6597SPRUCE PINE, SOUTH CAROLINA PPM PROJECT NO. 250724‐WA Photo 9MW‐4 BeforePhoto  10MW‐4 After
SITE PHOTOGRAPHS MURPHY No 6597SPRUCE PINE, SOUTH CAROLINA PPM PROJECT NO. 250724‐WA Photo  11MW‐5 Before Photo  12MW‐5 After 
SITE PHOTOGRAPHS MURPHY No 6597 SPRUCE PINE, SOUTH CAROLINA PPM PROJECT NO. 250724‐WA Photo  13MW‐6 Before Photo  14MW‐6 After 
SITE PHOTOGRAPHS MURPHY No 6597 SPRUCE PINE, SOUTH CAROLINA PPM PROJECT NO. 250724‐WA Photo  15MW‐7 Before Photo  16MW‐7 After