WI0800528_Injection Event Record_20210527

RECEIVED
MAY %Val Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Cal Me
Permit Number W10800528
1. Permit Information
Brookfield Properties
Pennittee
Former Modern Dry Cleaners and Laundr •
Faci l ity Name
3750 Oleander Drive, Wilmington, New Hanover
Facility Address (include County)
2. Injection Contractor Information
Carolina Drilling
Injection Contractor / Company Name
Street Address 1 14 Chimney Lane
Wilmington NC 28409
City State Zip Code
( 910 ) 799-0493
Area code — Phone number
3. Well Information
Number of wells used for injection 24
Well IDs 1-21 geoprobe borings, MW-WSP-1S.
MW-WSP-2D and MW-WSP-1XD
Were any new wells installed during this injection
event?
X Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells 21
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled X Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the.GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
X Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells 21
Please include a copy of the GW-30 for each well
abandoned.
Injectant Information
Sodium Lactate willClear+)
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration 50%
If the injectant is diluted please indicate the source
dilution fluid._Upgradient groundwater from MW-
WSP-1D.
Total Volume Injected (gal) 5,500gallons
Volume injected per well (gal) 21 borings :d, 220
gallons each. MW-WSP-1S, MW-WSP-2D. and MW-
WSP-1XD (a 293 gallons each.
5. Injection History
Injection date(s) 4/20/2021 to 4/28/2021
Injection number (e.g. 3 of 5) 3 of 5
Is this the last injection at this site'?
❑ Yes X No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM 1S CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS ID Q TT I$I THE PERMIT.
PRINT NAME OF
Submit the original of this form to the Division of Water Resources within 30 days of inje
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-
41/:/Z1ZI
TRACTO)!' f DATE
ERs,U\ pmerilTHE INJECTION
nitalAY 27 2021
:6464
INC DEQIDWR
Central Office
Form UIC-IER
Rev. 3-1-2016

WELL CONSTRUCTION RECORD GW-I
For Internal use kJ,[ty.
I. NVell Contractor Information:
George Bridger
Well Contractor ,Name
2393A
NC Well Contractor Certification Number
Carolina Drilling
Company Name
I Well Construction Permit #:
U I C#W 10800528
Lest all applicable well c Un,1171,lirnt prrmrl.t (i.c L /( Com+t,, .Since I arnmcc eft r
3. Well Use (check well use):
Water Supply Well:
❑Agriculwral
❑Geothermal (Heating/Cooling Supply)
D industrial/Commercial
❑ Irri cation
Non -Water Supply Well:
Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothcrmal(Heating/Cooling Return)
4. Date Well(s) Completed:
5a. Well Location:
April 20-28, 2021
1Municipal'puhhc
_iResidential Water Supply (single)
,❑Residential Water Supply (shared)
Wells > I00.000 GPI)
❑ Recovery'
nGroundwatcr Remediation
DSalinity Barrier
OStormwater Drainage
Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
Fvnnr Modem Dry Cleaners and Leurdryr&oakkeld pfaaerkaa
Well ID# N/A
DSCA ID #65-0001
Facilit 'Owncr Name Facility ID# of applicable)
3750 Oleander Drive, Wilmington, NC 28403
Physical Address, City, and Zip
New Hanover
C'uunt) Parcel Identification No. (PIN)
5h. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
If well field. one lat(ong is sufficient)
171013.833 N 2331802.645
H'
6. Is(are) the well(s): ❑Permanent or inTemporary
7. Is this a repair to an existing well: ❑Yes or iNo
thus ix a repair. Jill ow known a elf cwr..Truction information and explain the nature a/ the
repair under i21 reniarL secliwh or un the hack of this form.
8. For Geoprobe'DPT or Closed -Loop Geothermal Wells having the same
constriction. only 1 CAN -I is needed. Indicate TOTAL NUMBER of wells
drilled:"
9. Total well depth below land surface: 21 @30'
1 or multiple weli2 lip! all eieplhc it different (example 3(0,200 and 24+ 100)
(ft.)
t
10. Static water level below top of casing: (ft.)
!1 lltucr leech is cihore crtirrrg• fL e
11. Borehole diameter: 2 f(in.)
•
12. Well construction method: direct push
{ l.e auger, roIarc, cable, direct path, etc.
FOR WATER SUPPLY 1VELLS ONLY:
13a. 1 ield (gpm) N/A
131t. Disinfection hype: N/A
/„
Method of test: N/A
/„
Amount:. N/A
f1.
I5. OUTER CASING for multi -cased wens OR LINER if a, , licable
FROM TO DIAMETER THICKNESS,
ft.
16. INNER
FROM
ft.
ft.
ft.
CASING OR TUBING
TO
ft.
ft.
in.
eothermal closed -too
DI•t METER THICKNESS
in.
in.
17. SCREEN
PROM
ft.
it.
10
ft.
n.
DIAMEI ER
in.
)
SLOT SIZE THICKNESS
MATERIAL
18. GROUT
FROM
r0
ft.
ft.
MATERIA .
EMPLACEMENT METHOD & AMOUNT
n.
ft.
ft.
ft.
19, SAND/GRAVEL PACK (if applicable)
FROM TO MATERIAL
rt.
re.
ft.
ft.
I %1PLACEN1ENT METHOD
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION t color. hardness. soil rods qpe, Crain size. etc.)
ft. ft.
ft.
rt.
ft.
ft.
ft.
ft,
ft.
ft.
ft.
ft.
ft.
21. REMARKS
21 geoprobe borings were drilled to a depth of 30 feet.
22. Certification:
4
S at of Certified Well C ,ntra4or
V r i
141igntng lhic harm. I hereby teeth that the tee/1Lsr was (were) constructcd in accordance with
/.?A ;1'C'.AC 02C' .0100 or /5AA AC -IC 02C•.0200 neli Construction Standards and that a ropy
of.th6 record ha., been provided to the welt olive,
23. Site diagram or additional well details:
You may use the hack of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary.
[C
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC. Raleigh. NC 27699-1617
24b. For Injection Wells: Copy to DWR. Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells• Copy to the
county envinmtnental health dkp.lnmcnt of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCLIA
Pemtit Program, 1611 MSC. Raleigh, NC 27699-1611
I ot•m GR-I North Carolina Departtnonr of Environmental Quality - Division of Water Resources
Revised 6-6-2018

WELL CONSTRUCTION RECORD
1. 11te11 Contractor Information:
George Bridget
Well Contractor Name
2393A
NC Well Contractor Certification Number
Carolina Drilling
Company Name
GW-1
-. Weil Construction Permit4:
U I C _ 10800528
List all applicable hell c•onctruction permits ti.e. UIC' C ounti .Snot'. 1 arlar7cr er<•
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑Geothermal (Heating/Cooling Supply)
▪ industrial/Commercial
❑ irrigation
)Son -Water Supply Well:
❑Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
DAquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (cleating/Cooling Return)
4. Date Well(s) Completed:
April 20-28, 2021
7 Municipal/Public
JResidential Water Supply (single)
DResidentiai Water Supply (shared)
DW'ells > 100,000 GPD
❑Recovery
1Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
Tracer
DOther (explain under #21 Remarks)
5a. Well Location:
Forme, Modem Dry Cleaners end LaundryrartONhield proo9Tes
Well lDdt N/A
DSCA ID #65-0001
Facility/Owner Name Facility ID# (if applicable)
3750 Oleander Drive, Wilmington, NC 28403
Physical Address, City, and Zip
New Hanover
Court)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one laulong is sufficient)
Parcel Identification No. (PIN)
171013.833 N 2331802.645
6. Is(are) the well(s): 7Permanent or dTemporary
7. is this a repair to an existing well: ❑Yes or .No
this is a repair. lrl/ our kno➢'rr IVe// construction infor-mal/On and explain the nature o/ the
repair under 21 rema rir r section rurr me back ofihis form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction. only 1 GW-i is needed. indicate TOTAL NUMBER of wells
drilled: z�
9. Total well depth below land surface: 21 @30'
For nruitip/r- wells list all deplln rfdilierenh (example- 31'a lrc 200' and 2ll'WT)
(ft.)
4
10. Static water level below top of casing: 6 (ft.)
11 water level is above lasing. use --
11. Borehole diameter: 2 (in.)
12. Well construction method: direct push
t i.c augur- rolan-. cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. field (gpm) N/A
13h. Disinfection type: N/A
Method of test: N/A
Amount: N/A
t-or Illtritiar wj.
14. WATER ZONES
FROM
DESCRI PITON
111.111.111
15. OUTER CASING (for multi -cased wells) ORLIR N RSif a, r &Mbl ER1.4L
-rn DIAMETER
16. iN NER
ft.
CASING OR TUBING
ft.
ft.
17. SCREEN
Paoli TO DIAMETER
18. GROUT
FROM
ft.
ft.
ft.
ro
ft.
ft.
ft.
eothermal
in.
in.
NIATF.RIAI.
SLOT SIZE THICKNESS
MATERIAL
MATERIAL l EMPLACEMENT METHOD B: A.VIOt: NT
19. SAND/GRAVEL PACK (if applicable)
FROM TO MATERIAL
ft.
EMPLACEMENT METHOD
ft.
t't.
20..11:DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (color. hardness. soil/rod( (Ape, erain size. etc.)
ft. ft.
ft.
It.
ft.
It.
ft,
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
21 geoprobe borings were drilled to a depth of 30 feet.
22. Certification:
fig •
m ( ed Wetl C?ont for
of Centfifete
f;
1•Tiigning this.form, 1 herebY certilr dial the are 1145i was (were) constructed in accordance with
l i.4 NCIC' 02C .0100 or 15d ,NC .fC 02C.0200 1I d! Construction Standards and that a copy
of this recant has been provided to the well owner
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary.
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DV.'R),
information Processing Unit. 1617 MSC. Raleigh. NC 27699-1617
24b. For lnjection Wells: Copy to DWR. Underground Injection Control (TUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
'roc For Water Supply and Open -Loop Geothermal Return Wells• Copy to the
county environmental health deportment of the county where installed
24d. For Water Wells producing over 100,000 G{ WR, CCPCUA
Permit Program. 16] 1 MSC. Raleigh, NC 27699-16
Pan, GW-1 North Carolina Department of Environmental Quality- Division of Water Resources
MAY 2 7' 2021
NC DEQID'
Central Mae
'ised 6-6-2018

31912021
f
hridgerdrill.00m Mail - Fwd: Morehead City Boring Locations
WELL ABANDONMENT RECORD
1. Well Contractor Information:
George Bridger
Well Contractor Name (or well owner personally abandoning well on his/her property)
2393A
NC Well Contractor Certification Nutnher
Carolina Drilling
Company Name
2. Well Construction Permit #1: U I C#W I0800528
Lie, all applicable well construction permits (i.e. UJC Count'. State, t' r' a amce. etc.! if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irri abort
Non -Water Supply Well:
❑ Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return) ❑Other (ex lain under 7g)
4. Date wells)abandoned: April 20-28, 2021
5a. Well location:
Fnmwr Madan Oro Owen, and lanerneroMMie Proem..
Facility/Owner Name Facility IDN (if applicable)
3750 Oleander Drive, Wilmington 28403
Physical Address. City, and Zip
❑Municipal/Public
❑Residential Water Supply (single)
❑ Residential Water Supply (shared)
❑Recovery
BIGroundwater Rentediation
❑Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
DSCA ID#65-0001
New Hanover
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field. one lat/long is sufficient)
171013.833 N 2331802.645
W
CONSTRUCTION DETAILS OF WELL(S) BEING AkIANDON Efl
Attach well construction recnrd(s)iiavailable. For multiple injection or non -water supple wells
ONLY with the same construction/abandonment, vnu con .submit one farm.
6a. Well ID#: 1 — 21 borings
6b. Total well depth: 3O
(ft.)
6c. Borehole diameter: 2 (in.)
6d. Water level below ground surface:6
6e. Outer casing length (if known): NA
6f. Inner casing/tubing length (if known): N/A
6g. Screen length (if known): N/A
/A
Form GW-30
(ft.)
(ft.)
(ft.)
(ft.)
North Carolina Department of Environmental Quality - Dis ision of Water Resources
[For Internal Use ONLY:
WELL ABANDONMENT DETAIL S
7a. For Geoprohe/DPT or Closed -Loop Geothermal Wells having the same
well construction?depth, only I GW-30 is needed. indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): N/A
FOR WATER SUPPLY WELLS fONLY:
7c. Type of disinfectant used: N/A /
7d. Amount of disinfectant used: N/A
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bcntonitc Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
0 Gravel
Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
12 bags
❑ Sand Cement Grout
_ Concrete Grout
❑ Specialty Grout
0 Bentonite Slurry
(gal.)
7g. Provide a brief description of the abandonment procedure:
Filled geoprobe hole with bentonite chips, compacted and then sealed with asphalt patch.
8. Certification:
r
re of Certified Well Conti for or Wdl Owner
By .signing this form. 1 hereby certJi' that the n'et%) was (were) abandoned in
accordance with 15A NC.4C 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.
SUBMITTAL INSTRUCTIONS
10a. For AI) 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 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 Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-I636
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 depanment of the county where
abandoned.
Revised 2-22-2016

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Legend
0 Deep Overburden Monitor Well
ki Shallow Overburden Monitor Well
• Soil Boring / Injection Location
--► Groundwater Flow Direction
fly Injection Area
n Site Parcel
Property Parcel
LACTATE INJECTION QUANTITY
2,750 GALLONS SODIUM LACTATE
2,750 GALLONS OF WATER (FROM MW-WSP-1D)
INJECTION PLAN
21 - GEOPROBE BORINGS
15 FEET ZONE - 110 GALLONS
30 FEET ZONE - 110 GALLONS
3 - INJECTION WELLS
MW-WSP-1S, MW-WSP-2D, MW-WSP-1XD
293 GALLONS EACH
TOTAL INJECTION QUANTITY — 5,500 GALLONS
BROOKFIELD PROPERTIES
INDEPENDENCE MALL
3750 ORLEANDER DRIVE, WILMINGTON, NORTH CAROLINA
INJECTION PLAN
FIGURE NO.
3
PROJECT NO.
4213317
its