New Hanover_Well Abandonment_20220607

WELL ABAA DQ1N ME1N T KEUQ" For Internal Use ONLY:
I
I.Well Contractor Information: WELL ABANDONMENT DETAILS
Lewis LeFever
7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
2480 wells abandoned: I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 2.27 (gal.)
Parratt-Wolff, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
Lin all applicable well consinrction permits(i.e. UIC,County.Slate, G'ariance,etc)ifknown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):,
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irti ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: N Bentonite Slurry ❑ Other(explain under 70
R Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.4 Gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
[]Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer FMC left in place _
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
�I,=i--I _ +V t .m
4.Date well(s)abandoned: 5-12-22 ,1 fUN O 7 2022
5a.Well location: ti
Waste Industries MergeCo in��; �� rQMM-i UnF
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
3618 US Highway 421, N. Wilmington 28401
Physical Address,City,and Zip S azure of Certified WeWContractor or Well Owner Date
New Hanover By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.294853 N -77.967897 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Anachwellconstntctionrecords)il'available. Fornmltipleinjectionorison-walersnpplvwells
ONLY with the same consinrction abandonment,you can submit one farm.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#• MW-2R abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth:
15 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above, also submit one copy ofithis form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: '8 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c.For Water Supniv&Iniection Wells: In addition to sending the form to the
address(es)above,also submit orie copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 5 (ft.) abandoned.
6g.Screen length(if known): 10
Form G W-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL AHAADONMENT KEUO" For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
i
Lewis LeFever 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/Iter property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
2480 wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 2.27 (gal.)
Parratt-Wolff, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e. WC,Couniv,Stare, P%7riance,etc)it known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: a Bentonite Slurry ❑ Other(explain under 70
RMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.4 Gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Removed FMC
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 5-12-22 1�,k-11 ._5 V —
5a.Well location: JUN Q 7 202L
Waste Industries MergeCo
Facility/Owner Name Facility ID#(if applicable) 8.Certification: rJWQ;B0C-
3618 US Highway 421, N. Wilmington 28401 (yam
Physical Address,City,and Zip Vgnature of Certified II Contractor or Well Owner Date
New Hanover
By signing this form, I hereby certify that the tvell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.295890 N -77.967605 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction records)rf available. l ortnultiple injection ornon-watersztpply wells
ONLY with the.came construction abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-1 R abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: '8 (ft.) Division of Water Resource's,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
fie.Outer casing length(if known): (ft.) 10c.For Water Suaaly&Infection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 5 (ft.) abandoned.
i
6g.Screen length(if known): 10 (ft.)
Form G W-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016