1403_Caldwell_Foothills_MSWLF_Permit_Cell6A_PiezometerAbandonment_20210714

REPORT OF PIEZOMETER AND
LANDFILL GAS MONITORING
PROBE ABANDONMENT:
HAUL ROAD TO CELL NO. 6A
FOOTHILLS REGIONAL MSW LANDFILL
CALDWELL COUNTY, NORTH CAROLINA
SOLID WASTE PERMIT No. 1403-MSWLF-1998
e*m
19
REPUBLIC
403
SERVICES
Prepared For:
Republic Services of North Carolina, LLC
1070 Riverside Drive
Asheville, North Carolina 28804
BLE Project Number J21-1235-100
BLE North Carolina Business License C-153
July 7, 2021
0 0V011111",so
•� etc o .
Z 1 1043
IM BUNNELL
LAMMONS
ENGINEERING
6004 Ponders Court I Greenville, SC 29515
864,288.1265 a 064.208.4330 ow_,i info@blecorp,com
BLECORMOM

IlIMIM I ELL
LAMM AMMON
ENGINEERING
July 7, 2021
Republic Services of North Carolina, LLC
1070 Riverside Drive
Asheville, North Carolina 28804
Attention: Mr. Derek Bouchard
Environmental Manager
Subject: Report of Piezometer and Landfill Gas Monitoring Probe Abandonment:
Haul Road to Cell No. 6A
Foothills Regional MSW Landfill
Caldwell County, North Carolina
Solid Waste Permit Number 1403-MSWLF-1998
BLE North Carolina Business License C-1538
BLE Project Number J21-1235-100
Dear Mr. Bouchard:
Bunnell-Lammons Engineering, Inc. (BLE) is pleased to provide this report of piezometer and landfill gas
monitoring probe abandonment associated with the construction of a haul road leading to the Cell No. 6A,
which is currently under construction at the Foothills Regional Municipal Solid Waste (MSW) Landfill.
Included in this report are a summary of the project information, a description of the field activities performed,
and documentation of the abandonment activities.
BACKGROUND INFORMATION
The Foothills Regional MSW Landfill is located on Cheraw Road approximately two miles northwest of
Lenoir, North Carolina (Figure 1). The landfill is owned by the Caldwell County Board of Commissioners
and operated by Republic Services of North Carolina, LLC (Republic).
Seven (7) piezometers (FR-10, PZ-99, PZ-10013, PZ-101C, PZ-102C, PZ-103C, and PZ-105C) were
abandoned ahead of the construction a haul road leading to Cell No. 6A, which is currently under construction.
In addition, one (1) landfill gas monitoring probe (GP-12) was also abandoned due to its close proximity to
cell construction activities and planned rock blasting. This report provides documentation of the abandonment
activities.
FIELD PROCEDURES AND ACTIVITIES
A North Carolina -licensed driller from SAEDACCO, Inc. of Fort Mill, South Carolina, performed the drilling
and abandonment services under the supervision of a North Carolina -licensed professional geologist from
BLE. The seven (7) piezometers and one (1) landfill gas monitoring probe were abandoned between March
31 and April 2, 2021, using a Diedrich D50 ATV -mounted drilling rig. The abandoned piezometers include
the following: FR-10, PZ-99, PZ-100B, PZ-101C, PZ-102C, PZ-103C, and PZ-105C, which were in (or near)
the footprint of Future Cell Nos. 7 and 8B. Landfill gas monitoring probe GP-12 (located in the footprint of
Future Cell No. 613) was also abandoned as a consequence of Cell 6A construction and planned rock blasting.

1t 1m 1i
Foothills Regional MSW Landfill July 7, 2021
Report of Piezometer & Methane Probe Abandonment: Haul Road to Cell No. 6A BLE Project No. J21-1235-100
The abandonment procedures for each piezometer or probe consisted of the following:
1. Locate the piezometer or probe in the field.
2. Measure the total depth and check for obstructions using a weighted tag line (each location was found
to be not obstructed prior to abandonment).
3. Tremie grout the PVC casing from the bottom of the casing to the ground surface. This is a
precautionary measure in the event the PVC casing broke during extraction and could not be
removed (none of the PVC casings broke off during extraction).
4. For the piezometers that were installed in bedrock, the bedrock portion of those piezometers was
immediately tremie grouted following PVC pipe removal.
5. Over -drill the location with hollow stem augers to the total depth of the piezometer or to the top of
bedrock.
6. Tremie grout the resulting borehole.
a. For the piezometers and probe located in future cell footprints, the borehole was tremie
grouted to within approximately ten feet below the proposed subgrade of the future cell
and the remaining portion above the grout was filled with bentonite chips that were
hydrated in lifts.
b. For the piezometers located outside of the cell footprint, the borehole was tremie grouted
to approximately five feet below the ground surface and the remaining five feet was filled
with hydrated bentonite chips.
A North Carolina well abandonment form (Form GW-30) for each piezometer and landfill gas monitoring
probe is attached to this report (Appendix A), along with a boring location plan showing the locations
abandoned (Figure 2).
SUMMARY
Seven (7) piezometers and one (1) landfill gas monitoring probe have been permanently abandoned in or near
Future Cells No. 613, 7, and 8B. The abandonment activities performed were in accordance with North
Carolina Rule Title 15A NCAC 2C.0113(b)(1) and the facility permit. There are no piezometers remaining
in the footprints of future Cell Nos. 6A, 613, and 8B.
In accordance with the facility's Environmental Monitoring Plan, Landfill Phases 1, 2, 3, 4, and 5, Foothills
Regional MSW Landfill, Foothills Regional MSW Landfill, prepared by BLE (Project Number J15-1235-
78/78A), and dated October 20, 2017, landfill gas monitoring probe GP-12 was scheduled to be abandoned
with the construction of Cell No. 6, as existing monitoring probe GP-15 is already installed at the facility
between the landfill disposal unit and the facility boundary.
'6004 Ponders Court, Greenville, SC 29615 t,864.288.1265 A.864.288.4430 [e-mail]
BLECORP.COM

1t 1m 1i
Foothills Regional MSW Landfill July 7, 2021
Report of Piezometer & Methane Probe Abandonment: Haul Road to Cell No. 6A BLE Project No. J21-1235-100
CLOSING
We appreciate the opportunity to serve as your geological and geotechnical consultant on this project and
look forward to working with you on future projects. If you have any questions, please contact us at (864)
288-1265.
Sincerely,
BUNNELL LAMMONs ENGINEERING INC.
Riley . Blais,
Staff Geologist
Mark S. Pred y, P.G.
Senior Geologist
Registered, North Carolina No. 1043
Attachments:
Figure 1— Site Location Map
Figure 2 — Site Topography and Piezometer/Landfill Gas Monitoring Probe Abandonment
Appendix A — NCDEQ Well Abandonment Records (Form GW-30)
cc: Mr. Matthew Cheek, P.E. — Hodges, Harbin, Newberry & Tribble, Inc.
s:Wegvlsvrl foothills mswlf ncW35-100 haul roadpz aban&07 repor61235-100 foothills Ifpz aband report.docx
'6004 Ponders Court, Greenville, SC 29615 t,864.288.1265 A.864.288.4430 [e-mail]
BLECORP.COM

FIGURES

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2000 1000 0 2000 4000 REFERENCE:
17— USGS TOPOGRAPHIC MAP, 7.5 MINUTE SERIES,
APPROXIMATE SCALE IN FEET LENOIR, N.C. QUADRANGLE, 2019.
DRAWN: DATE: LAMMONFIGURE
KLW 07-07-21 IM L
0 LA M M O N S SITE LOCATION MAP
CHECKED: RLB CAD: FHLF100—SLM M ENGINEERING FOOTHILLS REGIONAL MSW LANDFILL
6004 Ponders Court, Greenville, SC 29615 CALDWELL COUNTY, NORTH CAROLINA 1
APPROVED: JOB NO: J21-1235-100 Phone: [864) 288-1265 Fax: (864] 288-4430

■
a
15
s
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MIZE
MEAN PI m- WNW 91 rA PENN!
MAN
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ET DETENTION
BASIN NO. 3/7
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SW-3
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NO.
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S LES &
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MONITORING LOCATION LEGEND
PZ-42
SURVEYED LOCATION OF PIEZOMETER OR BORING
PERFORMED BY BLE
FR17
SURVEYED LOCATION OF PIEZOMETER AND BORING
PERFORMED BY FRONT ROYAL
PT-1
SURVEYED LOCATION OF PIEZOTUBE
MW-1
SURVEYED LOCATION OF GROUNDWATER MONITORING WELL
GP-1
SURVEYED LOCATION OF METHANE MONITORING PROBE
Sw-1
APPROXIMATE LOCATION OF SURFACE WATER MONITORING POINT
UD—
APPROXIMATE LOCATION OF UNDERDRAIN MONITORING POINT
PZ-63B
a
RECENTLY ABANDONED PIEZOMETER
GP-12
RECENTLY ABANDONED LANDFILL GAS MONITORING PROBE
TOPOGRAPHIC & GEOLOGIC LEGEND
TOPOGRAPHIC SURFACE CONTOUR IN FEET ABOVE MSL
CONTOUR INTERVAL = 2 FEET
STREAM OR CREEK
ROAD
-- Uo— EXISTING UNDERDRAIN
■ ■ ■ ■ PROPERTY BOUNDARY
F 300 FOOT BUFFER
3 V `'
O �
0
0
3R2
GP—
G
SW-4
■ NOTES:
1. MEAN SEA LEVEL ELEVATION (MSL) IS REFERENCED TO THE NATIONAL GEODETIC VERTICAL
DATUM OF 1929 (NGVD).
10
0
GENERAL MAP REFERENCE
Op'
200 100 0 200 400
APPROXIMATE SCALE IN FEET
REFERENCES:
1. TOPOGRAPHIC INFORMATION SHOWN FROM AN AERIAL SURVEY BY COOPER AERIAL
SURVEYS CO., DATE OF PHOTOGRAPHY DECEMBER 9, 2020. MAPPING CONTROL BASED
ON HISTORICAL LANDFILL CONTROL POINTS.
2. WETLAND AND STREAM BOUNDARIES IN LANDFILL AREA BASED ON SURVEY
BY DONALDSON, GARRETT & ASSOCIATES, INC. DATED AUGUST 28, 2002.
3. WETLAND AND STREAM BOUNDARIES IN CONSERVATION AREA BASED ON
SURVEY BY DONALDSON, GARRETT & ASSOCIATES, INC. DATED OCTOBER 7,
2002.
4. PROPERTY BOUNDARY TAKEN FROM A BOUNDARY SURVEY PREPARED BY
WRIGHT & FIELDS LAND SURVEYING, DATED AUGUST 14, 2007.
5. CELL BOUNDARIES FOR CELLS 1-8A WERE TAKEN FROM THE ENGINEERING
DRAWINGS — PHASE NO. 3 PLANS PREPARED BY HODGES, HARBIN,
NEWBERRY, & TRIBBLE, INC., DATED JULY 2008.
6. PHASE 5 WASTE LIMITS WERE TAKEN FROM PRELIMINARY (MARCH 2O17)
PERMIT TO CONSTRUCT PLANS BEING PREPARED BY HODGES, HARBIN,
NEWBERRY, & TRIBBLE, INC.
REVISIONS
No. DESCRIPTION BY
DRAWN: KLW
CHECKED: RLB
APPROVED: MSP
DATE: 07-07-21
CAD FILE: FHLF100—BLP
JOB NO: J21-1235-100
IM BUNNELL
M LAMMONS
ENGINEERING
6004 Ponders Court, Greenville, SC 29615
Phone; [864) 288-1265 Fax; [864) 288-4430
SITE TOPOGRAPHY AND PIEZOMETER/METHANE MONITORING PROBE ABANDONMENT
FOOTHILLS REGIONAL MSW LANDFILL
CALDWELL COUNTY, NORTH CAROLINA
FIGURE NO.
2

APPENDIX A
NCDEQ Well Abandonment Records

WELL ABANDONMENT RECORD
This fart can be used far single or mullipte wells
I _ Well C.patrAgin r Infomuttion_
Richy Lemire
Well.C'oorraeror Name (or YLdl onirr persmwtl, A %uwknuig, A an hK lier prapcny )
2593-A
NC Wall Cbnlnsctor Carl ifrrllian Pftunber
SAEDACCO Inc
C0111pany Kania
2. Wal Coastratction Permit 0; NA, NA, NA
1.,xr<Ni l ,irr.6lr w ?Iprrmiex r,.e. r. I „r,wxrc . LF^Y,ui?, Cie !Ikmwo
3. Wd t use (check well uae):
Winer Supply Well;
❑Agrrir.altittlrl
❑Georrt4mwt ftalinooOLing Supplyi
❑ IndusIFisIWomFrig ri;ial
❑inipliols
Non -Water SaI" Well -
❑Aquifer RecharDV
❑Aquifer Stowage and Jiecror M
❑Aquifer Teal
❑ExprAincirlal Trdicirpbe-w
DGwihenlial (ClosixdLoopi
LIC,eo(hemal (Heating,'C'ooliltg
4, DMM wgIL(l•) a¢gntlpncd: 3/31/2021
Via. T�'rii hrratiirn.
11hlrini0FMl1FVhlic
❑Rrsidrnrial Water 4upph- f-,ingle)
❑Rcsidknriat warn ��upply tsharodI
❑Gnamidualer Renkedialiour
❑Salinii; Hamer
❑Stornm,dicr Dmirwgr
❑S3llbridn3xe-'orrml
l7Tracer
LlOtlii:ftnplain under 7g)
FOT lrtlenwl Use ONLY:
W E LL A BAN DQN M ENT DETAM
7:L Numlrrr iriwdis Leio%alrandoued. 1
F,-y Irinfriple OiNiViLUr ru• WN xwter S1V1Jfr
,%M-rrrxcr M a3ibamirurrrJeru, yr,pl rxar.vb mt oar j;jrwi.
arlh MLY wig Oke satyr
lip. Appnrximatlr airlurrw of %ater remaining in wdl(x)NA (Rd.)
FOR WATER SUPPLY WEU5 ONI,V;
7a Ty
pe ur diaofeetaod uncd: NA
7d.:Artwli.nt of disinfLctamil. ubed; NA
7e, Staling mstterials weed (Cheek itll drat mpply);
Q Ned Ccmcni [rrotrl
12 Ecntonitc Chips or PCilcts
❑ Sarld C'enrem Gmut
❑ Dn C"las
❑ ConcrelrGnrui
❑ DrilJ Cuviogs
❑ 5preralry Gruui
❑ GM,;e1
n Henrouile 51utp,
❑ C)iher lexplainunder 7g)
X For each utxterial selected above, protide arnouw of maoxiials use3:
Bentonite.:551b ,Wtr:gal. Bentonite Amount:8 bags
7g. Frin•i* a Irrlef dcscrilitian of the alranilonmrot pnr4cAum:
Pulled PVC (18'), overdrilled with 4.25" augers to 191,
back -filled with bentonite chips to surface.
Republic Services -Foothills Landfill 1403-MSWLF-1998
17xH0y.kh%-rherNu31.V Ir,wiles 1DW (if aDRliraNel S. CeHifiradon:
2800 Cheraw Road, Lenoir, 28645 3/31/2021
Pin -sisal AddTcs. Cm}, and Zip .5Igm lrcrrf,...:iJ*d WCII (lpmLiGxLmr w Well om-cor Dole
Caldwell
COMM.$
NFCCl 1&0:1 6411. N0. (PIN)
5h.14r1i0j4e;md Iongitsdcin ileavcs4 irrute iwmndsordccinriA dcuccx;
{ifwk:ll I'KA0, iriw UVWLS i, uiff4Punl}
35.914897 lti
-81.595177
By .TjA7rrjg this ferrety, f fmmby certify rlhar the wLJ1fsJ was Beer• abandoned in
Tiux,rxhrlare wilh 2 i.4 ,kC'AC 02C .0100 -,r X v_w wtv conarrlcfian SGmArdz
imdfJ'mtacopyofAriNrecordhubeerypro dedfafirewei!owner.
9. Site diagram or ad4itfoilalvvell details:
You may use the bad, of this page to pom-ide additional well site details or %V11
W abartdonutertl detail,. You ma}• ulw :aMIL additional PMges if rieCr M(V_
C,ONSTRiIITIOLN DETAIN T[
OF W£LLtS) BEING ABANDONED SU11MITTA1. rNSTRUC0
. laruir civil mmvJ.raair re rrLnrxM a q7 malry,k over r,rm ear wei-Muter s Amh-
n�idr ONLY wid The= &Wet i+w Liam nr�mtfd Lore firm I Os For A31 W011SE Subnril 113k form witkun 30 dwx of comrpletFon of well
63L Weill ID#: FR-10
6h. To1*1 %v1t depth: 19 (Ft.)
Coe. Bo rehrrle d larriew: 2 flu.)
(tit. %ViAttrkeel hclnw pukindmrrfiwc- NA i:fo
abpndanm¢ry tg the fgllmsing-
Divi:tina of W ier Rcmiuren, Jurormaruro Procinsing U61,
1617 Mail Smicr C'entcr, RalriKh, Jw (' 3709-1617
14b. Four Imlettian Vriclls: tit addilion to selsding lire forth io the address in 10ik
abo;-e_ atsu sirbodl Otte cops of This Form nvidrio NP days rrf r.Umptelion of well
obandanrrteta to the follnarmg:
Ditislon of Water R(aou rces, Undlergrou ad Injection Ciral rol Program.
1.G36 Mail _Sm-igC Ccotcr, Rairig r, Nlv 276"-J63d
1flc, For Water Sumsl,y & lnlecdon Weiss: In addition io sending ibe farm io
6c. Outrr casing IcnZtb (ir loim a): NA I • l the address;es) above_ also sub -mil owe cop- of this form wilhin YU daYs of
comptetioo of nrll abardomnent to 1hr county Imtth depitrinirim of dO irounly
(it. lnncrcasingltulrinp k7r};th cif lmruwnl: NA (k,l
rr1KT4 9tMr d4nCd.
6�,Semm l4ngHh 11f hno%a):10 fft.l
Fame GM-10 NonhC'arohre Depanincri ofEm ironimni and Narutat Rcsuimccs - Diti iswn of'i uerR55ai,rCtii Rnkscd Atpeust120B

WELL ABANDONMENT RECORD
This fart can be used far single or mullipte wells
I _ Well C.patrAgin r Infomuttion:
Richy Lemire
Well.C'ooreaeror Name (or YLdl oniri persaiwtl, Aandmlulg, A an hK Irer prapcny )
2593-A
NC Wall Cbnlnsctor Carl ifrrllian Rtunber
SAEDACCO Inc
C0111pany Kamtr
.Z. Wal Coastratction Permit 0; NA, NA, NA —
1.,xr<Ji � ,ika 61r w ?Iprrmiex r,.r. - . . r. I „rjolx�. LF^Y,ui?, rlr. i1 klrorrr
& Wd t use (check well uae):
Winer Supply Well;
❑Agrir.alti,Ltlrl
❑Gee t4mwt ftalinooOLing Supplyi
❑ IndinI risIWomrmrcial
❑iripliols
Non -Water SaI" Well -
❑Aquifer RecharDV
❑Aquifer Stowage aid RecroVM
❑Aquifer Teal
❑ExprAincnl9l Trclrtlrpbe-w
DGwihenikal (ClosixdLoopt
LIC,eo(hemal (Heatingr'C'ooliug
4. DMM wgIL(f) a¢gntlpncd: 4/1/2021
Via. T�'rii hrratiirn.
11hl1lni0FMl1PVhlic
❑Rrsidrnrial Water 4upph- f-,ingle)
❑Rcsidknriat warn ��up;:ily tshanedi
❑Gnamidualer Renkedialiour
❑Salinii; Hamer
❑Stornm,dicr Dmirwgr
❑S3llbridn3xe C'oriml
l7Tracer
LlCgheftnplain under 7g)
FOT lrtlenwl Use ONLY:
W E LL A BAN DQN M ENT DETAM
7:L Numlrrr iriwdis bdogabandoued. 1
F,-y Irinfriple OiNiViLUr uP hrJ HyA1`fY 31V1JJ5-
,%M-Prrxcria, a3lbamirurrrJeru, yr,pl rxar.vb mt oar j;jra1,
ar1A MLY wig Oke satyr
lip. Appnrximatlr airlurrw of %ater remaining in wdl(x)NA (Rd.)
FOR WATER SUPPLY WEU5 ONI,V;
7a Ty
pe ur diaofeetaod uncd: NA
7d.:Artwli.nt of disinf4ctamil. ubed; NA
7c, Staling mstterials usi d (Cheek i11 heat mpply);
12 Ncat Ccmcni (train
12 Ecntonitc Chips or PCllcts
❑ Sard Cenrem Gmut
❑ Dry C"las
❑ ConcrelrGnrui
❑ DrilJ Cutliogs
❑ 5preralry Gruui
❑ GM,;e1
n Henrouile SlikM-
❑ C)iher lexplain under 7g)
717, For t;lch nkalpri;tl wlrc(pil Ahavc, provide 3molmt of Mikanials II9e3:
Neat Cem.:941b ,Wtr:7gal, Sand Cem.:lb ,Wtr:gal.
Bentonite.:551b ,Wtr:gal. Bentonite/Portland Amount:10 bags
7g, F3 FrWic a Irrlef dcscrilitian of the alranilonmrot pnr4Ydum:
Over -drilled to 22', back -filled to surface with bentonite
chips.
Republic Services -Foothills Landfill 1403-MSWLF-1998
FacH0y.kh%-rherNu31.V 1r,w ps lDW (if aDRlkaNel S. CeHi[1radon:
2800 Cheraw Road, Lenoir, 28645 4/1/2021
Pin -sisal Adkcs. Cm}, and Zip .5Igm rcirf,...:iJ*d WCII (lpmLiGxLmr p,' Well om-cor "L:
Caldwell
COMM.$
l r-ccl1&0:1 6411.N13.(PIN)
5b,141i0u4e;md 1mngitmicin dquvcs4MrwMiwmnd&ardccimal dcuccx;
{ifwk:ll E4kl, iriw UVWLS i, uiff4Punl}
35.914897 lti
-81.595177
By .sigrrrrig this farm, f fmmby certify rlhar the wLJ1fsJ was (*er0 abarrdimed in
liux,rxhrlare wilh 2 A ,kC'AC 02C .0100 -,r X v_w wtv conarrlcfian SGmArdz
imdfJ'mtacopyofAriNrecordhrubeerypro dedfafirewei!owner.
9. Site diagram or ad4itforltttvvell details:
You may use the bad, of this page to pror•ide additional well site details or %V11
W abartdonutertl detail,. You ma-v a1w :tlMIL additional pOges if rkeC M(V_
{"SINSTRIIITION DETAIN T[
OF W£LL(S) BEING ABANDONED SU11MITTA1. rNSTRUC0
. Paruir civil mmvJ.raair re rrLnrxM a q7 malrr,k over t,rm ear wei-Muter s Amh-
n�idr ONLY w id ilk &Wet i+w Liam nr�mtfd Lore firm I Os For A31 W011SE Subnril 113k form witkun 30 dwx of comrpletFon of well
63. Wrii [DO: PZ-99
6b. T61s1; 44V11 depth: 19.2 (Ft.)
Coe. Bo rehrrle d larriew: 2 flu.)
611. V4'sttgrkrcl hclnw Pukindmrrfmc- NA ;ft,)
abpndanm¢ry tg the fgllmsing'
Divi:lina of W ier Rcmiuren, Jurormarurn Procinsing U61,
1617 Mail Smicr Center, RalriRh, Iti C' 3709-1617
14b. Four Imlettian Vri'elis: tit addilion [a selsding like forth io the address in 10ik
abo;-e_ atsu strbodl Otte oop; of This Form nvidrio NP days rrf r.UmptNion of well
obandunrrtera to the tbllnarmg:
Ditislon of Water R(aou reps, Undlergrou ad Injection Ciral rol Program.
11G36 Mail _Sm-igC Ccut[r, Rairig r, Nlv 276"-J63d
Ift. For Water Sumsl,y & lnbecdon Weiss: In addi6au io sending ibe farm io
6c. Outrr casing Icngtb {if hmim a): NA I •1 the address;es) above_ also sub -mil owe cop- of this form wilhin YU daYs of
comptetioo of nrll abundlomnent to 11ir county ttcatth depitrinirim of lhr county
(i[. lnncrcasingltulrinp k7r};th cif imruwnl: NA (k,l
rr1KT4 9tMr d4nCd.
6�,Semm l4ngHh 11f hno%a):10 fft.l
Fame GM-10 NonhC'arohre Depanincri ofEm ironimnl and N,Irulat Rcsuiaccs - DIti Iswn of'i uerR55ai,rCtii Rnkscd Alpeust120B

WELL ABANDONMENT RECORD
This fart can be used far single or mullipte wells
I _ Well C.patrAgin r Infomuttion_
Richy Lemire
Well.C'ommcior Nanie (or YLdl oniri persaiwtl, AankiLhig, cW an hK Irer prapcny )
2593-A
NC Wall Cbnlnscior Carl ifrrllian Pftunber
SAEDACCO Inc
C0111pany Kamtr
.Z. Wal Caastratrtion Permit 0; NA, NA, NA —
1.,xr<r♦i w ?Iprrm,rr r,.r. -. . r. I „rjolx�. LF^Y,ui?, rlr. i1 klrorrr
& Wd t use (check well uae):
Winer Supply Well;
❑Agrir.alti,Ltlrl
❑Gee t4mwt ftalinovolftig Supplyi
❑ IndinI risIWomrmrcial
❑iripliols
Non -Water SaI" Well -
❑Aquifer RecharDV
❑Aquifer Stowage aid RecroVM
❑Aquifer Teal
❑ExprAincnl9l Trclrtlrpbe-w
DGwihenikal (ClosixdLoopt
LIC,eo(hemal (Heatingr'C'ooliug
4. DMM wgIL(f) a¢gntlpncd: 4/1/2021
Via. T�'rii hrratiirn.
11hlrini0FMl1PVhlic
❑Rrsidrnrial Water 4upph- f-,ingle)
❑Rcsidknriat warn ��upply tshanedi
❑Gnaundualer Renkedialimur
❑Salinii; Hamer
❑Stornm,dicr Dmirwgr
❑S3llbridn3xe C'orrml
l7Tracer
LlCMWT'ilnplain under 7g)
FOT lrkFrwl Use ONLY:
W E LL A BAN DQN M ENT DETAM
7:L Numlrrr 4riwdis beio%abandoued. 1
F,-y Irrnfriple OiNiViLUr uP hrJ rlxrreY 31V1JJ5-
c+ousrrxcrror3 rxar.vb mt orwe j;jrwi.
ar1A MLY wig Oke satyr
lip. Appnrximatlr airlurrw of %ater remaining in wdl(x)NA (Rd.)
FOR WATER SUPPLY WEU5 ONI,V;
7a Ty
pe ur diaofeetaut uncd: NA
7d.:Artwli.nt of disinf4ctamil. ubed; NA
7c, Staling mstterials usi d (Cheek rill heat mpply);
12 NCat Ccmcni (train
12 Ecntonitc Chips or PCllcts
❑ Sard Cenrem Gmut
❑ Dry C"las
❑ ConcrelrGruui
❑ DrilJ Cutliogs
❑ 5preralry Gruui
❑ GM,;e1
n Henrouile 5ltktp-
❑ C)iher lexplain under 7g)
717, For C;lch nkalpri;tl wlrc(pil Ahavg, provide 3mnlmt of nMtQrhA1!% nwril;
Neat Cem.:941b ,Wtr:7gal. Sand Cem.:lb ,Wtr:gal.
Bentonite.:551b ,Wtr:gal. Bentoni te /Portland Amount:19 bags
7g, F3 FrWic a Irrlef ilescrilitian of the alranilonmrot prmedum:
Over -drilled to 87', Tremie grouted (70 gallons) and
back -filled to surface with bentonite chips.
Republic Services -Foothills Landfill 1403-MSWLF-1998
FacH0y.kh%-rrerNu31.V 1r,w ps lDW (if aDRliraNel S. CeHil1radon:
2800 Cheraw Road, Lenoir, 28645 4/1/2021
Pin -sisal Adkcs. Cm}, and Zip .5Igm rcirf,...:iJ*d WCII (lpmLiGxLmr w Well om-cor "L:
Caldwell
COMM.$
Nmcl1&0:1k 6411.N13.(PIN)
5h.14r1i0u4e;md Imngitmicin ileavcafmirru#c iwmndsordccinriA dcuccx;
{ifwk:ll E441, iriw UVWLS i, uiff4Punl}
35.914897 lti
-81.595177
By .sigrrrrig this ferrety, f fmmby certify rlhar the wLJ1fsJ was (*er0 abarrdimed in
rrux,rxhr&r<v wilh 2 A ,kC'AC 02C .0100 -,r X .fl20fi wtv conarrlcfian SGmArdz
rinddivacopyofAriNrecordhrubeerypro dedfafhewei!owner.
9. Site diagram or ad4itfoilalvvell details:
You may use the bad, of this page to pror•ide additional well site details or %V11
W abartdonutertl detail,. You ma-v a1w :tlMIL additional pOges if rkeCr M(V_
{"SINSTRiIITIONDETAINT[
OF SU11MITTA1.rNSTRUC0
.lrGuir vrf1 cr,mvJrucJrare rrLnrst�u �7 �Vrul�d,k. Iru matk�,dr x�rr,rm rxr rae,a-wx.rdrr xup�
n�irx ONLY w id ilk &Wet i+w Liam nr�mtfd Lore firm I Os For A31 WO11SE Subnr[l 1]3iry form wititiu 3(! dwx of cam letion of uxll
63L Wrii [D#: PZ-100B
6b. T61s1; 44V11 depth: 85.7 (Ft.)
Coe. Bo rehrrle d larriew: 2 flu.)
(tit. V4'sttgrlr<rcl hclnw Pukind-mlrfmc- NA ;ft,)
abpndanm¢ry tg ft fgllmsing-
Divi:lina of W ier Rcmiuren, Jurormarurn Procinsing U61,
1617 Mail Smicr Center, RalriRh, Iti C' 3709-1617
14b. Four Im liertinn Vri'elis: tit addilion to sending like forth io the address in 10ik
abo;-e_ atsu strbodl Otte oop; of This Form nyidrim NP days rrf r.Umptelion of well
obandanrrtera to the tbllnarmg:
Ditislon of Water Rcaou rcies, Undlergrou ad Injection Ciral rol Program.
11G36 Mail _Sm-iKr Ccut[r, Rairig r, P(C 276"-J63d
Ift. For Water Sumsl,y & 10ecdon Weiss: In addi6au io sending ibe farm io
6c. Outrr casing Icngrb {if loim a): NA (ft• I the address;es) above_ also sub -mil one cop- of this form wilhin YU daYs of
comptetioo of nrll abundlomnent to 1hr county Imtth depitrinirim Of dO county
(it. lnncrcasingltulrinp k7r};th iif imruwnl: NA (k,l
rr1KT4 9tMr d4nCd.
6�,Semm l4ngHh;tf hno%a), 10 fft.l
Fame GM-10 NonhC'arohre Depanincri ofEm ironimnl and N,Irulat Rcsuiaccs - DIti Iswn of'i uerRL5airrRr• Rnkscd Alpeust120B

WELL ABANDONMENT RECORD
This fork can be used far single or mullipte wells
I _ Well C.patrAgin r Infomuttion:
Richy Lemire
MILC'ommcior Nanie (or vLdl onirr persaiwtl, AankiLhig, cll an hr4 Iker propcny )
2593-A
NC Wall Cbnhudor Carl ifrrllian Pfkunber
SAEDACCO Inc
C0111pany Kamtr
.Z. Wal Construction Permit 0; NA, NA, NA
1.,xr<r♦i � ,irr.6lr w ?Iprrm,rr r,.r. -. . r. I „rjolx�. LF^Y,ui?, rlr. i1 klrorrr
& Wd t use (check well uae):
Winer Supply Well;
❑Agrir.altkttlkl
❑Geoftmwt ftalinovolftig Supplyi
❑ IndinI risIWomrmrcial
❑ittiplioll
Non -Water SaI" Well -
❑Aquifer RecharDV
❑Aquifer Stmnkgr aid RecroVM
❑Aquifer Teal
❑ExprAincnl9l Trclrtlrpbe-w
DGwihenikal (ClosixdLoopt
LIC,eo(hemal (Heatingr'C'ooliug
4. DMM wgIL(t~) atgndpncd. 3/31/2021
Via. T�'rii hrrafiikn.
11hl1tni0FM11FVhlic
❑Rrsidrnrial Water 4upph- f-,ingle)
❑Rcsidknriat warn ��upply tshanedl
❑Gnaunduarer Renkedimrimur
❑Salinii; Hamer
❑Stornm,dicr D minagr
❑S3bsidn3xe Corrml
l7Tracer
LICttlki Tinplain under 7g)
FOT lrtlenwl Use ONLY:
W E LL A BAN DQN M ENT DETAM
7:L Numlrrr kkiwdis beio%abandoued. 1
F,-y Irrnfriple OiNiViLUr ru• hrJ HyA1`fY 31V1JJ5-
'%M-rrrxcriar, rxar.vb mt cwe j;jrwi.
ar1A MLY wig Oke salme
lip. Appnkximatlr airlurrw of %ater remaining in wdl(x)NA (Rd.)
FOR WATER SUPPLY WEU5 ONI,V;
7a Ty
pe ur diaofeetmit uncd: NA
7d. Arhikant of { ibinfLct:kmt ubed; NA
7c, Staling m;kfcrials usi d (Cheek ik11 that mpply)-
12 NCat CCmCnt (train
12 Ecnf4nitc Chips or PCllcts
❑ Sard Cenkwtl Gmut
❑ Dry C"las
❑ ConcrelrGroui
❑ DrilJ Cutliogs
❑ 5preralry Gruui
❑ GM';e1
n Henrouile 5lkkM-
❑ C)ther lexplain under 7g)
7f, For t;Ich nkalpri;kl wlrc(pil Ahavg, provide 3aboliDt of m;kMrhA1!% owed:
Neat Cem.:941b ,Wtr:7gal. Sand Cem.:lb ,Wtr:gal.
Bentonite.:551b ,Wtr:gal. Bentonite/Portland Amount:8 bags
%, F3 Fr W1c a Ikrlef ♦lescrilitian of the alkamionmrot pnkLYYlum:
Tremie grouted with Portland cement to 5', then over -drilled
to 18' (refusal), back -filled with bentonite chips to
surface.
Republic Services -Foothills Landfill 1403-MSWLF-1998
FacH0y.kh%-rherNu31.V 1r,w ps lDW (if aDRliraNel S. CeHil1rmdon:
2800 Cheraw Road, Lenoir, 28645 3/31/2021
Pin -sisal A411ras. Cm}, and Zip 5rcmuL_M' 4 F,...:Ll*d WCII Om L i Gx L gi y w Well pu-ror Dole
Caldwell
COMM.$
l red 1&01"6411. Na. (PIN)
5h.1�wfiojdeand longitsdcin du1uvcsAMnutmiwmnd&ardccimal dcuccx;
{ifvV.11 E441, IFIk4 LiVWLS i, wM;:p4i1}
35.914897 lti
-81.595177
By .TjA7rrjg thes)brm, f fmmby certify rlhar the wLJ1fsJ was fk►erO abandoned in
rrux,rxhr&xv wilh 2 A ,kC'AC 02C .0100 -,r X .fl20fi wtv conarrlcfian SGmArdz
rinddivacopyofAriNrecordhrubeerypro dedfafhewei!owner.
9. Site diagram or ad4itforltttvvell details:
You may use the bad, of this page to prrn•ide additional well site details or %V11
W abartdonutertl detail,. You ma-v a1w :oMIL additioral pOges if rkeCp M(V_
C'ONSTRiI{TION DETAIN OF W£LLtS) BEING ABANDONED SU11MITTA1. rNSTRUC00
.lrGuir vrf1 cr,mvJrucJrare rrLnrst�u �7 �Vrul�d,k. Iru m�k�,dr x�rr,rm rxr rae,a-wx.rdrr xup�
n�irx ONLY w id ilk &Wet i+w Liam nr�mtfd Lore firm I Os For A31 WO11SE Subnr[l 1]3iry form wititiu 3(! dwx of cam letion of uxll
63. Weil [DO: PZ-101C
6b. T&I&I %vlt depth: 52 (Ft.)
Coe. Bo rehrrle d larriew: 2 flu.)
611. V4;ktcrkrel hclnw pukindmrrfiwc- NA (ft,)
abpndanmcry tg ft fgllmsing-
Divi:lina of Wmier Rcmiuren, Jurormarukn Procinsing U61,
1617 Mail Smicr Center, RalriRh, Iti (' 3709-1617
14b. Four Im liertinn Vri'elis: rik addilion to sending dke forth io the address in 10,k
abo;-e_ atsu skrbodi Otte oops of This Form nyidrim NP days rrf r.UmptNion of well
obandanrrkera to the tbllnarmg:
Ditislon of Water Msou rcies, Underground Injection {'rkal rol Program.
11G36 Mail _Sm-igC Ccut[r, Rairig r, Ntv 276"-J63d
Ift. For Water Sumsl'y & lnliection WeUr In addition to sending The farm to
6c. Outrr casing Icngrb (ir loim a): NA (ft• I the addresses) above_ also sub -mil one cop- of this form wilhin YU daYs of
comptetioo of nrll abardomnent to 1hr county Ikeatth depmamrim of dO county
(it. lnncrcasingltulrinp k7r};th iif imruwnl: NA (k,l
rr3KT4 9tMr44nCd.
6�,Semm l4ngHh;tf hno%a), 10 (W
Fomk GM-10 Nonh Carol= Depanincri ofEm ironimnl and N,Irulat Resoiaccs - DIti Iswn of'i uerR55aikrCtii Rnkscd Aupsr 20B

WELL ABANDONMENT RECORD
This fart can be used far single or mullipte wells
I _ Well C.patrAgin r Infomuttion_
Richy Lemire
Well.C'ommcior Nanie (or YLdl oniri persaiwtl, AankiLhig, A an hK Irer prapcny )
2593-A
NC Wall Cbnlnscior Carl ifrrllian Pftunber
SAEDACCO Inc
C0111pany Kamtr
.Z. Wal Caastraction Permit 0; NA, NA, NA —
1.,xr<r♦i w ?Iprrm,rr r,.r. -. . r. I „rjolx�. LF^Y,ui?, rlr. i1 klrorrr
& Wd t use (check well uae):
Winer Supply Well;
❑Agrir.alti,Ltlrl
❑Gee t4mwt ftalinovoting Supplyi
❑ IndinI risIWomrmrcial
❑iripliols
Non -Water SaI" Well -
❑Aquifer RecharDV
❑Aquifer Stowage aid RecroVM
❑Aquifer Teal
❑ExprAincnl9l Trclrtlrpbe-w
DGwihenikal (ClosixdLoopt
LIC,eo(hemal (Heatingr'C'ooliug
4, DMM wgIL(s) a¢gntlpncd: 4/1/2021
Via. T�'rii hrratiirn.
11hlrini0FMl1PVhlic
❑Rrsidrnrial Water 4upph- f-,ingle)
❑Rcsidknriat warn ��upply tshanedi
❑Gnamidualer Renkedialimur
❑Salinii; Hamer
❑Stornm,dicr Dmirwgr
❑S3llbridn3xe C'orrml
l7Tracer
LlCtthi:rtnplain under 7g)
FOT lrkFrwl Use ONLY:
W E LL A BAN DQN M ENT DETAM
7:L Numlrrr 4riwdis beio%abandoued. 1
F,-y Irrnfriple OiNiViLUr uP hrJ rlxrreY 31V1JJ5-
c+ousrrxcrror3 rxar.vb mt cwe j;jrwi.
ar1A MLY wig Oke satyr
lip. Appnrximatlr airlurrw of %ater remaining in wdl(x)NA (Rd.)
FOR WATER SUPPLY WEU5 ONI,V;
7a Ty
pe ur diaofeetaut uncd: NA
7d.:Artwli.nt of disinf4ctamil. ubed; NA
7c, Staling mstterials usi d (Cheek rill heat mpply);
12 NCat CCmcnt (train
12 Ecntonitc Chips or PCllcts
❑ Sard Cenrem Gmut
❑ Dry C"las
❑ ConcrelrGnrui
❑ DrilJ Cutliogs
❑ 5preralry Gruui
❑ GM,;e1
n Henrouile SlikM-
❑ C)ther lexplain under 7g)
717, For each nt,txrriill wlectleil Ahavg. provide 3malmt of rnikanials ii9e3:
Neat Cem.:941b ,Wtr:7gal. Sand Cem.:lb ,Wtr:gal.
Bentonite.:551b ,Wtr:gal. Bentonite/Portland Amount:16 bags
7g, F3 FrWic a Irrlef dcscrilitian of the alranilonmrot pnr4Ydum:
Over -drilled to 42' (refusal), all well material pulled,
tremie grouted from 42-50.5 and back -filled to surface with
bentonite chips.
Republic Services -Foothills Landfill 1403-MSWLF-1998
FacH0y.kh%-rherNu31.V 1r,w ps lDW (if aDRliraNel S. CeHil1radon:
2800 Cheraw Road, Lenoir, 28645 4/1/2021
Pin -sisal Adkcs. Cm}, and Zip .5Igm lrcirf,...:iJ*d WCII (lpmLiGxLmr p,' Well om-cor "L:
Caldwell
COMM.$
Nr'mcl1&0:1k 6411.N13.(PIN)
5h.14r1i0u4ealnd IongitsdCin ileavcafmirru#c iwmndsordccinriA dcuccN
{ifwk:ll I'KA0, iriw UVWLS i, uiff4Punl}
35.914897 lti
-81.595177
By .sigrrrrig this ferrety, f fmmby certify rlhar the wLJ1fsJ was (*er0 abarrdimed in
rrux,rxhr&r<v wilh 2 A ,kC'AC 02C .0100 -,r X .fl20fi wtv conarrlcfian SGmArdz
rinddivacopyofAriNrecordhrubeerypro dedfafhewen!owner.
9. Site diagram or ad4itfoilalvvell details:
You may use the bad, of this page to pror•ide additional well site details or %V11
W abartdonutertl detail,. You ma-v a1w :tlMIL additional pOges if rkeCr M(V_
{"SINSTRiIITIONDETAINT[
OF SU11MITTA1.rNSTRUC0
.lrGuir vrf1 cr,mvJrucJrare rrLnrst�u �7 �Vrul�d,k. Iru matk�,dr x�rr,rm rxr rae,a-wx.rdrr xup�
n�irx ONLY w id ilk &Wet i+w Liam nr�mtfd Lore firm I Os For A31 WO11SE Subnr[l 1]3iry form wititiu 3(! dwx of cam letion of uxll
63. Wrii ID#: PZ-102C
6b. T61s1; 44VIt depth: 50.5 (Ft.)
Coe. Bo rehrrle d larriew: 2 flu.)
(tit. V4'sttgrlr<rcl hclnw Pukind -ml rfi4cc- NA ;ft,)
abpndanm¢ry tg ft fgllmsing-
Divi:lina of W ier Rcmiuren, Jurormarurn Prorerxziug U61,
1617 Mail Smicr Center, RalriRh, Iti C' 3709-1617
14b. Four Im liertinn Vri'elis: tit addilion to sending like forth io the address in 10ik
abo;-e_ atsu strbodl Otte oop; of This Form nyidrim NP days rrf r.Umptelion of well
obandanrrtera to the tbllnarmg:
Ditislon of Water Rcaou rti`s, Undlergrou ad Injection Ciral rol Program.
I.G36Mail _Sm-iKrCcut[r,Rairigr,P( 276"-J63d
1 flc, For Water Su msl y & In becdon Weiss: In additim to sending The farm to
6c. Outrr casing Icngrb {if loim a): NA (ft• I the address;es) above_ also sub -mil one cop- of this form wilhin YU daYs of
comptetioo of nrll abundlomnent to 1hr county Imtth depitrinirim Of dO irounly
(it. lnncrcasingltulrinp k7r};th iif imruwnl: NA (k,l
rr1KT4 9tMr d4nCd.
6�,Semm l4ngHh;tf hno%a), 10 fft.l
Fame GM-10 NonhC'arohre Depanincri ofEm ironimnl and N,Iruml. Rcsuiaccs - DIti Iswn of'i uerRL5airrRr• Rnkscd Alpeust120B

WELL ABANDONMENT RECORD
This fart can be used far single or mullipte wells
I _ Well C.patrAgin r Infomuttion_
Richy Lemire
Well.C'ommcior Nanie (or YLdl oniri persaiwtl, AankiLhig, A an hK Irer prapcny )
2593-A
NC Wall Cbnlnscior Carl ifrrllian Pftunber
SAEDACCO Inc
C0111pany Kamtr
.Z. Wal Caastratrtion Permit 0; NA, NA, NA —
1.,xr<r♦i w ?Iprrm,rr r,.r. -. . r. I „rjolx�. LF^Y,ui?, rlr. i1 klrorrr
& Wd t use (check well uae):
Winer Supply Well;
❑Agrir.alti,Ltlrl
❑Gee t4mwt ftalinovolftig Supplyi
❑ IndinI risIWomrmrcial
❑iripliois
Non -Water SaI" Well -
❑Aquifer RecharDV
❑Aquifer Stowage aid RecroVM
❑Aquifer Teal
❑ExprAincnl9l Trclrtlrpbe-w
DGwihenikal (ClosixdLoopt
LIC,eo(hemal (Healingr'C'ooliug
4, DMM wgIL(f) atgntlpncd: 4/1/2021
Via. T�'rii hrratiirn.
11hlrtni0FMl1PVhlic
❑Rrsidrnrial Water 4upph- f-,ingle)
❑Rcsidknriat warn ��upply tshanedi
❑Gnaundualer Renkedialimur
❑Salinii; Hamer
❑Stornm,dicr Dmirwgr
❑Sullbridnxe C'orrml
l7Tracer
LlCghertnplain under 7g)
FOT lrkFrwl Use ONLY:
W E LL A BAN DQN M ENT DETAM
7:L Numlrrr iriwdis beio%abandoued. 1
F,-y Irrnfriple OiNiViLUr uP hrJ rlxrrer 31V1JJ5-
c+ousrrxcrror, rxar.vb mt orwe j;jrwi.
ar1A MLY wig Oke satyr
lip. Appnrximatlr airlurrw of %ater remaining in wdl(x)NA (Rd.)
FOR WATER SUPPLY WEU5 ONI,V;
7a Ty
pe ur diaofeetaut uacd: NA
7d.:Artwli.nt of disinf4ctamil. ubed; NA
7c, Staling mstterials usi d (Cheek rill heat mpply);
12 Nu it Cumuni (train
12 Ecntonitu Chips or PClluts
❑ Sard Cenrem Gmut
❑ Dry C"las
❑ ConcrelrGruui
❑ DrilJ Cutliogs
❑ 5preralry Gruui
❑ GM,;e1
n Henrouile 5ltktp-
❑ C)iher lexplain under 7g)
717, For 1;lch nkalpri;tl wlrc(pil Ahavg, provide 3molmt of FM1tQrhA1!% 11se3:
Neat Cem.:941b ,Wtr:7gal. Sand Cem.:lb ,Wtr:gal.
Bentonite.:551b ,Wtr:gal. Bentoni te /Portland Amount:8 bags
7g, FnFrWic a Irrlef dcscrilitian of the alranilonmrot prrr4edum:
Over -drilled to 43' (refusal),tremie grouted from 12'-46.7'
and back -filled to surface with bentonite chips.
Republic Services -Foothills Landfill 1403-MSWLF-1998
FacH0y.kh%-rrerNu31.V 1r,w ps lDW (if aDRliraNel S. CeHil1radon:
2800 Cheraw Road, Lenoir, 28645 4/1/2021
Pin -sisal Adkcs. Cm}, and Zip .5Igm rcirf,...:iJ*d WCII (,m LiGxLtr w Well om-cor "L:
Caldwell
COMM.$
Nmcl1&0:1k 6411.N0.(PIN)
5h.14r1i0u4ealnd IongitsdCin dquvcafmirru#c iwmndsordccinriA dcuccN
{ifwk:ll I'KA0, iriw UVWLS i, uiff4Punl}
35.914897 lti
-81.595177
By .sigrrrrig this ferrety, f Hereby certify rlhar the wLJ1fsJ was (*er0 abarrdimed in
rrux,rxhr&r<v wilh 2 A ,kC'AC 02C .0100 -,r X .fl20fi wtv conarrlcfian SGmArdz
rinddivacopyofAriNrecordhrubeerypro dedfafhewei!owner.
9. Site diagram or ad4itfoilalvvell details:
You may use the bad, of this page to pror•ide additional well site details or %V11
W abartdonutertl detail,. You ma-v a1w :t112i;1L additional pOges if rkeCr M(V_
{"SINSTRIIITIONDETAINT[
OF SU11MITTA1.rNSTRUC0
.lrGuir vrf1 cr,mvJrucJrare rrLnrst�u �7 �Vrul�d,k. Iru matk�,dr x�rr,rm rxr rae,a-wx.rdrr xup�
n�irx ONLY w id ilk &Wet i+w Liam nr�mtfd Lore firm I Os For A31 W011SE Subnril 113k form witkun 30 dwofcomrpletFan of well
6a. Wrii [DO: PZ-103C
6b. T61s1; 44V11 depth: 39.5 (Ft.)
Coe. Bo rehrrle d larriew: 2 flu.)
(tit. V4'sttgrlr<rcl hclnw Pukind -ml rfi4cc- NA ;ft,)
abpndanm¢ry tg thu fgllmsing-
Divi:lina of W ier Rcmiuren, Jurormarurn Procinsing U61,
1617 Mail Smicr Center, RalriRh, Iti C' 3709-1617
14b. Four Itllettian Vri'elis: tit addilion [a sending like forth io the address in 10ik
abo;-e_ atsu strbodl Otte oop; of This Form nyidrim NP days rrf r.Umptelion of well
obandanrrtera to the tbllnarmg:
Ditislon of Water Rcaou rcies, Undlergrou ad Injection Ciral rol Program.
I. G36 Mail _Sm-iKr Ccut[r, Ra irig r, P(C 276"-J 63d
Ift. For Water Sumsly & 110ecdon Weiss: In addi6au io sending ibe farm io
6c. Outrr casing Icngrb {if loim a): NA (ft• I the address;es) above_ also sub -mil owe cop- of this form wilhin YU daYs of
comptetioo of nrll abundlomnent to 11ir county Imtth depmamrim of dO county
(it. lnncrcasingltulrinp k7r};th iif imruwnl: NA (k,l
rr1KT4 9tMr d4nCd.
6�,Semm l4ngHh;tf hno%a), 10 fft.l
Fame GM-10 NonhC'arohre Depanincri ofEm ironimnl and N,Iruml. Rcsuiaccs - DIti Iswn of'i uerRL5airrRr• Rnkscd Alpeust120B

WELL ABANDONMENT RECORD
This fart can be used far single or mullipte wells
I _ Well C.patrAgin r Infomuttion_
Richy Lemire
MILC'ooreaeror Name (or s,¢tl oniri perwjL%U, A %uwknulg, A an hK Irer prapcny )
2593-A
NC Wall Cbolnscror Carl ifrrllian Pftunber
SAEDACCO Inc
C0111pany Kamtr
.Z. Wal Ctastraction Permit 0; NA, NA, NA
1.,xr <Ni l ,ika 61r w ?I prrmiex r,.r. - . . r. I „rjolx�. LF^Y,ui?, rlr. i1 klrorrr
& Wd t use (check well uae):
Winer Supply Well;
❑Agrirralti,Ltlrl
❑Gee t4mwt ftalinooOLing Supplyi
❑ IndinI risIWomrmrcial
❑ittiplioll
Non -Water SaI" Well -
❑Aquifer RecharDV
❑Aquifer Stowage aid RecroVM
❑Aquifer Teal
❑Expr incirlal Trclrtlrpbe-w
DGwihenikal (ClosxtLoopt
LIC,eo(hemal (Heatingr'C'ooliug
4. DMM wgIL(l•) a¢gntlpncd: 3/31/2021
Via. T�'rii hrrafiirn.
11hlrtni0FM11FVhlic
❑Rrsidrnrial Water 4upph- f-,ingle)
❑Rcsidknriat warn ��upply tshanedl
❑Gnaunduarer Renkedialiour
❑Salinii; Hamer
❑Stornm,dicr Dmirwgr
❑Subridn3xe C'orrml
l7Tracer
LICMWT nplain under 7g)
Republic Services -Foothills Landfill
17xH0y.kh%-rher Num.V Ir,wiles 1DW (if LippR oNel
1403-MSWLF-1998
170T irkirrul Use ONLY:
W E LL A BAN DQN M ENT DETAM
7:L Numlrrr iriwdis bdogabandoued. 1
,%M-rrrxcr M a3lbamirurrrJeru, yr,pr rxar.vb mt oar j;jra1,
arlh MLY wig Oke satyr
lip. Appnrximatc airlurrw of %ater remaining in wdl(x)NA (RdL)
FOR WATER SUPPLY WEU5 ONI,V;
7a Ty
pe ur diaofeetaod uncd: NA
7d.:Artwli.nt of disinfLctaml ubed; NA
7c, Staling m;tfcrials urrcd (Cheek it111ha mpply);
12 NCat CCmCn1 (rraw
12 Ecnf4nitc Chips or PCllcts
❑ Sard Cenrem Gmut
❑ Dry C"las
❑ ConcrelrGroui
❑ DrilJ Cutliogs
❑ 5preralry Gruui
❑ GM,;e1
n Henrouile 5ltltr3-
❑ 01her lexpiainunder 7g)
7f, For t;Ich nkalpri;tl wlrc(pil Ahavc, provide 3malmt of m tft~rhml!� nwrrl;
Neat Cem.:941b ,Wtr:7gal. Sand Cem.:lb ,Wtr:gal.
Bentonite.:551b ,Wtr:gal. Bentonite/Portland Amount:5 bags
7g. Frin•idlc a Irrlef dcscrilitian of the alranihiinmrot prrr4cAum:
Pulled all PVC, over -drilled to 30' (refusal), tremie grout
to 16', back -filled to surface with bentonite chips.
S. Cerlifkallon:
2800 Cheraw Road, Lenoir, 28645 3/31/2021
Pltt'sical Adkcs. CtR, artd ZIri If�ridlnrR it .' r" .' ; ;lily pr Wtil 0M.Wr Dpte
Caldwell
COMM.$
Nr-ccl 1&0:1 6411. Na. (PIN)
5b,14 ti0u4e mod imngitmic in lieuvWmirru#c iwmndsordccinriA dcuccx;
{ifvk:11 I'KA0, iriw UVWLS i, uiff4Punl}
35.914897 lti
-81.595177
By sipu {g Me. �f rm, f fremby certify clue the xeJ1{sJ was f3ierO abandoned in
riux,rxhrlare wilh 2 A ,V': iC 02C .09100 -,r X v_w wtv conarrlcfian SGmArdz
imdfJ'mtacopyofAriNr-xordhosbeenpro dedfafirewee'!owner.
9. Site diagram or ad4itfonalvvell details:
You may use the bad, of this page to pror•ide additional well site details or %V11
W abartdonutertl detail,. You ma-v a1w :NMIL additional pOges if rreCr M(V_
C,ONSTRiIITION DETAIL-N OF W£LL1S) BEING ABANDONED SU11MITTA1. rNSTRUC00
. laruir civil mmvJ.raair re rrLnrxM a qb malrr,k over t,rm ear wei-Muter s Amh-
mxldr ONLY w id ilk &Wet i+w Liam nr�mva Lore firm I Os For A31 W011SE Subnril 113k Form witkun 30 dwx of comrpletFon of well
63. Weil [Did,: PZ-105C
6b. T6i3rt %vlt depth: 53 (Ft.)
Coe. Bo rehrrle d larriew: 2 flu.)
611. %ViAttrkrel hclnw pukindmrrfmc- NA ;ft,)
abpndanmcry tg ft fgllmsing-
Divi:lina of W ier Rcmiuren, Jurormarurn Procinsing U61,
1617 Mail Smicr Center, RalriRh, Jw (' 3709-1617
14b. Four Imlettinn Vri'elis: tit addilion [a sending tare forrtt io the address in 10ik
abo;-e_ atsu strbodi om oops of This Form nvidrio NP days rrf r.UmptNion of well
obandanrrtera to the Follnarmg:
Ditislon of Water Msou rcies, Underground Injection Creal rol Program.
1.G36 Mail _Sm-iKr Ccut[r, Itairigh, N1w 276"-J6M
Ift. For Water Sumbly & lnliection Weiss: In additim to seceding The farm to
6c. Outrr casing Icngrb {if loim a): NA (ft• I the address;es) above_ also sub -mil owe cop- of this form wilhin Yi daYs of
comptetioo of nrll abardomnent to 11in county Imtth depitrinirim of dO county
(it. lnncrcasingltulrinp k7r};th cif imruwnl: NA (k,l
rr1KT4 9tMr d4nCd.
6�,Semm l4ngHh;tf hno%a), 10 ffi.l
Fame GM-10 Nonh Carol= Depanincri ofEm ironimnl and N,Irurat Rcsuiaccs - DIti Iswn of'i uerR55ai,rCtii Rnkscd Alpeust120B

WELL ABANDONMENT RECORD
This fart can be used far single or mullipte wells
I _ Well C.patrAgin r Infomuttion:
Richy Lemire
Well.C'ooreaeror Nanie (or YLdl oniri persaiwtl, Aanianhig, A an hK Irer prapcny )
2593-A
NC Wall Cbnlnscior Carl ifrrllian Pftunber
SAEDACCO Inc
C0111pany Kamtr
.Z. Wal Caastratrtion Permit 0; NA, NA, NA —
1.,xr<r♦i w ?Iprrm,rr r,.r. -. . r. I „rjolx�. LF^Y,ui?, rlr. i1 klrorrr
& Wd t use (check well uae):
Winer Supply Well;
❑Agrir.alti,Ltlrl
❑Gee t4mwt ftalinovolftig Supplyi
❑ IndinI risIWomrrtcrcial
❑iripliols
Non -Water SaI" Well -
❑Aquifer RecharDV
❑Aquifer Stowage aid RecroVM
❑Aquifer Teal
❑ExprAincnl9l Trclrtlrpbe-w
DGwihenikal (ClosixdLoopt
LIC,eo(hemal (Healingr'C'ooliug
4. DMM wgIL(f) a¢gntlpncd: 4/2/2021
Via. T�'rii hrratiirn.
11hl1lni0FMl1PVhlic
❑Rrsidrnrial Water 4upph- f-,ingle)
❑Rcsidknriat warn ��upply tshanedi
❑Gnamidualer Renkedialimur
❑Salinii; Hamer
❑Stornm,dicr Dmirwgr
❑S3llbridn3xe C'orrml
l7Tracer
LlCghertnplain under 7g)
FOT lrkFrwl Use ONLY:
W E LL A BAN DQN M ENT DETAM
7:L Numlrrr iriwdis beio%abandoued. 1
F,-y Irrnfriple OiNiViLUr uP hrJ rlxrreY 31V1JJ5-
c+ousrrxcrror3 rxar.vb mt orwe j;jrwi.
ar1A MLY wig Oke satyr
lip. Appnrximatlr airlurrw of %ater remaining in wdl(x)NA (Rd.)
FOR WATER SUPPLY WEU5 ONI,V;
7a Ty
pe ur diaofeetaut uncd: NA
7d.:Artwli.nt of disinf4ctamil. ubed; NA
7c, Staling mstterials usi d (Cheek rill heat mpply);
12 Ncat Ccmcni (train
12 Ecntonitc Chips or PCllcts
❑ Sard Cenrem Gmut
❑ Dry C"las
❑ ConcretrGroui
❑ DrilJ Cutliogs
❑ 5preralry Gruui
❑ GM,;e1
n Henrouile 5ltktp-
❑ C)iher lexplain under 7g)
717, For 1;lch nkalpri;tl wlrcot'il Ahavg, provide 3malmt of nMtQrJaJS 11995:
Neat Cem.:941b ,Wtr:7gal. Sand Cem.:lb ,Wtr:gal.
Bentonite.:551b ,Wtr:gal. Bentonite/Portland Amount:22 bags
7g, F3 FrWic a Irrlef dcscrilitian of the alranilonmrot pnr4Ydum:
Over -drilled to 43.5' (refusal) and back -filled to surface
with bentonite chips.
Republic Services -Foothills Landfill 1403-MSWLF-1998
FacH0y.kh%-rrerNu31.V 1r,w ps lDW (if aDRlkaNel S. CeHil1radon:
2800 Cheraw Road, Lenoir, 28645 4/1/2021
Pin -sisal Adkcs. Cm}, and Zip .5Igm rcirf,...:iJ*d WCII (lpmLiGxLmr w Well om-cor "L:
Caldwell
COMM.$
Nr-ccl 1&0:1k 6411. N0.(PIN)
5h.14r1i0u4e;md Imngitmicin dquvcafmirru#c iwmndsordccinriA dcuccx;
{ifwk:ll I'KA0, iriw UVWLS i, uiff4Punl}
35.914897 lti
-81.595177
By .sigrrrrig this ferrety, f fmmby certify rlhar the wLJ1fsJ was (*er0 abarrdimed in
lrux,rxhr&r<v wilh 2 A ,kC'AC 02C .0100 -,r X .fl20fi wtv conarrlcfian SGmArdz
imdfJ'mtacopyofAriNrecordhrubeerypro dedfafhewei!owner.
9. Site diagram or ad4itfoilalvvell details:
You may use the bad, of this page to pror•ide additional well site details or %V11
W abartdonutertl detail,. You ma-v a1w :t112i;1L additional pOges if rkeCr M(V_
{"SINSTRIIITIONDETAINT[
OF SU11MITTA1.rNSTRUC0
.lrGuir vrf1 cr,mvJrucJrare rrLnrst�u �7 �Vrul�d,k. Iru matk�,dr x�rr,rm rxr rae,a-wx.rdrr xup�
n�irx ONLY w id ilk &Wet i+w Liam nr�mtfd Lore firm I Os For A31 W011SE Subnril 113k form witkun 30 dwofcomrpletFan of well
63L Wrii [DO: GP-12
6b. T61s1; 44V11 depth: 29.65 (Ft.)
Coe. Bo rehrrle d larriew: 2 flu.)
(tit. V4'sttgrkrcl hclnw Pukind-mlrfmc- NA ;ft,)
abpndanm¢ry tg the fgllmsing-
Divi:lina of W ier Rcmiuren, Jurormarurn Procinsing U61,
1617 Mail Smicr Center, RalriRh, Iti C' 3709-1617
14b. Four Itllettian Vri'elis: tit addilion [a sending like forth io the address in 10ik
abo;-e_ atsu strbodl Otte oop; of This Form nyidrim NP days rrf r.Umptelion of well
obandanrrtera to the tbllnarmg:
Ditislon of Water Rcaou reps, Undlergrou ad Injection Ciral rol Program.
11G36 Mail _Sm-igc Ccut[r, Ra irig r, P(C 276"-J 63d
Ift. For Water Sumsly & 110ecdon Weiss: In addi6au io sending ibe farm io
6c. Outrr casing Icngtb {if loim a): NA (ft• I the address;es) above_ also sub -mil owe cop- of this form wilhin YU daYs of
comptetioo of nrll abundlomnent to 11ir county Imtth depitrinirim Of dO co3rnly
(it. lnncrcasingltulrinp k7r};th iif imruwnl: NA (k,l
rr1KT4 9tMr d4nCd.
6��. Ser&n l4ngHh;tf hno%a), 45 fft.l
Fame GM-10 NonhC'arohre Depannion ofEm ironimnl and N,Irulat Rcsuiaccs - DIti Iswn of'i uerRL5airrRr• Rnkscd Alpeustl20B