Robeson_Well Abandonment_20220627

WE LL ABANDON NIENT RECORD rat Imcnal USCONLy:
This faun.can be usedfor siutatr.ormultiplewelis
1.Well Coatr'actor lufortnation: W L ABANDONMENT DETAILS
Scott Hunt, sr 7a.�Tumlurr►tdlsbciay;abandunetl: 1
bYclCCor�crc�orNatne�eeucttuatrr c�tntl dx�ntonia ��eEt.ontiisft� F'ar w1figrlr of"e tlorr or Mesa-enter Sg'irly welh ONLY wide th rune
cw,trrm;�rrM,:�t�vt�claz�rra:f.r.yrrtl eeRrsai�tulrcrric/F,rrli,
4561-A
NC WQII'r*MmclorC6tlil`mAiotc Naaibcr 7b.Apprvtxlmi c volume of water remaining In wefl(fiy: (gal.)
1
SASDACCO Inc FOR a4vTFliIIPPj.Y Wt[,T S ilraltll;
Contyaay Name 7z Type ofdifutrtth iantused.
2.Well Coustructfan Permit
Lira ad1 ty lal t,tAle ts�PP p s rtiti x fi H Ccx�rrle;S:,tr f uradmre,li�csifc rt rlr i if klirarsrr 7d.Mnodut of disinfertitnt teed' ..-_y
i
� ii�ia.ie+.n S�rr+ �..Sx�..Q I RTt
S.Well use(thecicwell user):
`Eater Supply well: 7e.Scaling ma rtial-used.(cbcct,41 What apple:
❑A.otrt ulttuafl to Ncat Ccttico Grout P Rcruonitc Chips orPeRm
❑t=thertmt(Hcadpt Cooliug Suplttyt ❑Itcsideirtial' aterSupple(single) ❑Sand Catnedt Grout ❑Dry C -,
❑hadt>SlrialfCottmtsrcial [3ltesidfltiat j17s>tcr Sngply(,feared) ❑'Concrete Grunt ❑ Drill Cuttings
❑ini tion ❑ Sgeiafty Grout ❑Gravel
Noa-water SupptyWell.- 0 Bent4nite Sherry 0 Mix(ex7laint under 7r)
®hlt}rtitorink ❑Recoc�etti
lajcctron` 7f.For each urttetial selected aboxc,provide anwunt of materials used:
OAquiferltechwge ❑CroundnawReniedirtion Neat Cem.:471b ,Wtr:7gal. Sand Cem.:lb ,Wtr:gal.
❑Aquifer Stan%e and Reomiay ❑9a6nily Barrier
❑Aquifer Test ❑Stonmuterr Dtain:rs e
❑Evperitnentttl Techaofan,6 ❑Sedesidet>~e Conttu) 7R,provide a lief description of the abandonment procedure:
tMot wanat(Clascd Loop) Mincer
Tremie grouted from bottom up
t3Grotftertnaldli�nti .* ootin Return) t9Qtircr( fain.urtdcr7Rl
i
i.Date"VII(8)abioulooe4L. 6/13/22
Sa.Well fnrartfon:
Maynor's Exxon
r=1i1cf014t4r Name Rwilin-lD» �dravpli wcW R•Ctl tlrtCSll4p:
57 Htvy 710, Pembroke, NC 28372 � < 6/18/2022
Phgsical Addrm.:Ci v,and Zip q Leci;ln:e of(`est%liC W&I1 Ce •ter nr ltl+it 6 n tincr t);a
Robeson By satvmig tt4t.0 Anis,f hewhy ceraft that tilt=u ellfs)teas lnra )athmidoneJ- ill
Couuty Psrcrl l(kiat>-Aea No.(P161} arcxvtrlance nvltjr MANCAC WIC,t)MO or a'l•.010#IF-ill Coax(mr1fari fStdoduals
cmd drat a cup etAflltis l FCttrd etas!}eFt t 11rpt lefGella line even astatc'r.
5b.Latitude and longitude In dr;r+eesfminuteahstcttnds or decimal dehmces:
(ifnett tastd,seer fat+tou is sit t ) 9.Site diagram or additional well detait9:
You mq we time bade of this page to provide additional call site details or cull
h' W a baudonnient&tails. You ara,also attuctt:tetiiitiart tt poems of retry
r
CONSTRifC.MON DE'TAII-14 OF NI E M RE MC,ABANDONED SI RIMAL INS'FRY7('TiOVS
Alwda Well coarinictiacra n-M&&t ifatwabht 12w)anrfk�le Pry.ttiara at cvtnwi .vppfy
t,elfr ONLY With rig sarvto cia!ttiieYf me�vc7elarrRi�Mlb icxt cam:silmltaae forari 10a. For All We Gthmft this fort aidlin 30 days of compaction of aril
62 44'cB @�. -1 abandonment U1 the following:
Diviatian of WiterResaamen,InfortuationPrutetcing Unit,
6b.'Total uvfl depth:15. 00 C I 617 A a7 mite comer,Raicrgb.XC 27699-!fill
IOU.l:nr Inler�lott!(fell in addition to stndiug the form m the address in Ma
6e.Bor>rlWia dfaeretew 2 (iu,y aibott.also suhndt one�'of this ibrat%ithin 30 d;hs of t;oinpletion of call
abaruiomncra of the fa fewittg:
ftistoa at Water ltesourres,Underground tojeettan Control Progrnm.
rid,water fact below!round surfaec: 10 (fL) tt 6 Mall Stxeite Ccntte,Ratci r.114 27G99-t636
6e.Outer casing le no(f known). 5 ({L) 10c ens•&For Watcr-que intcy&a Wdb. in addition to sending the forin to
Me address(esY above, also submit one copy of this torte %vithin 30 days of
Completion of ircll ahatndant�nt.to the county hratth deparh arnl of tic coiutiy
6C Inner casiaghuhing length Of known): (fL) e1 h abandon d.
6F,Screen.length(if[mot€n):10 tilt.)
I
Faaa t,W-li) Kanh Camden Dzpxttiieati afEneytumi2nt uti W ituml Resources siinaC Watar#a aoua�:s leased Augum 260

WELL ABANDONMENT RECORD rmrltaemailir ONLY-
'lids form can be usetlfor single or rimltiple wells
i
1.Well Contractor information: WFLL Al O D M1 NT D)i 15
Scott Hunt, Jr 7s Namhern �ellsbcin};abtndfJtied•1_
b4rd[Cet3rnc9orharne(mr�ezkFati1urp� ��reoillyuF axtardngcsall,:nhisllr�rpr e:tci Fw• rrarr?r!f,1r viffecHur or ,xr+a-rrarer mrpptl wells ONLY with r,'x srarre
eerrvtmrefrrar.etbr r<rSt!rraemv,7rrNrvrsrlvflirrut�frrrrr.
4561-A
NC Vtll ConirrctorCvttit�w�tlicn Ntat a�R fib.Approtim ate volume of water retnaiinin in we l(tt): (gatL)
SABDACCO Inc FOR WAIF 5UPPLY WEi.1G13 ONLY; , .�?t•:_s° VI
L
C'UnTaay hams lc,Tope of d tiafectaut used:
2.Well Construction Permit#';.
1i:luifm,rf!1L•�fil ulffirtre�fi.e:C'rrtlr.•S.cle darimrrlryrn!metcltfftiu�tr M.Anwuut4fdMallmantused: in; ;1F'rcCv
3.Well use(eheckwell use):
Water Supply Well: 7e.Scaling m;tcrials used(uhcelc all that apply):
❑Agoc rlturut ORluni,, -tl'Pttbfic 17 Ncat Ceuicut•Grout 0 e Conte Chips or RAMS
130katltcrurA ftilmomoling Supply) 1311csid.:mW bracer Supply(single) 13 Sand Ceme lf.Grout ❑Dw CUS
❑lndusiriaYCommcrcial Mcsiidm ixl Water Supply shtmmt!) 13 Conerttt G10111 0 Drill Ctutinr..
❑hti:retiou ❑Sp::daEty Got 0 Gravel
I oaeater Supply YY`eth 0 Bento"ile SUM- 0 0€Iz-c(exiskain under 7g)
Mmaniforing i IRecotety
eat on Well; 7f.For each u ateriul selected above,provide aniouut of utauerlals used:
E3Aqui&r heel aqc LiCrmunduater 18cntediation
i
❑Agneler Storm and Recovery USalinii4 Barrier
DAguifer7est 0StormiiaterDrainaec Bentonite.:501b ,wtr:gal.
❑Lrcg tiuteutui Technology Mubbidence Cotumt iw Pr<n•ltlr:a grid description of the abandonment pntccdure:
Maotheartal(Cfescd Loop) Mtacer•
C7Geoth@it1u11(iI1EinRr�Q01inCR0tttr11) [ GL1eC[$ iaiUUtFi1e[7.�) Once groundwater sample vras taken, pvc removed and bentonite
from bottom to top
4.Date well(5)ahandoncd; 6/14/22
'qu.Well location:
Commercial Property
r=1iW,'0i%nrrrNmrre ras,7th iA�(iEapptiotblCt 8.Ccrti(icatlo r:
3400 N. Elm St. Lumberton, HC 28358 5/18/2022
Plkysical Addc-,s.City,and Zip Segrtifan:0[C.1-4 I1'.q WeII C:otu or or Wtii 0nr.
s
Robeson IFj stvilrit;drii for911, I herkby 4'r,fi'ol Chat the ueflfs)was fw'?rel ahmitanerfill
tZ,tw(y It cd ldantif'crriun No.(PtN,) accuniance I U4 C,1C 02C.0100 or 2C.0 00(Mell Gonsintcoon Standarr7s
mil lfror a cap[ol7 us record kcal been provided to the wall ou-n r.
5b,Latitude and longitude in rli^greeshaiantealseeonrpor decimal degrees:
(irwelt A td Ores ia100113 is iart7 Cram) 9.Site(duagra Ior additional well details:
You mag use bad of this(rage to provide a-Mlional dell site details oc yell
h W atbaudonatent tails You may also attach ac4elitional pages if necessary.
JALTW511111C' ON DETAILS OF WEi Idgt BEING AHAMMNED &iTBb1iTTAL INSTRiT �NS
.-trh.`ir»cfl er�r..ettrrclrarr mecreleX!irrn�vt rL.4�. For mr(rHpio ayeraeju of rsfrr-nv2cr svpplr j N --CTi
rte3tt rJ tEY work rh s:r!!n.cvnsrsari uu°ulr�nrah?rrta:Nvrr.�,u corF V '-'r rr.are-fimn. 10a. Nor All Wells: Submit Ibis fbau within 30&�Ys of completion of well
6a.Well lD#..TW-3 abandomtun— at ptherollolvlk;
Di4tioa of%later Remu mts,Information Processing Unit,
fcb.Total well depth: 2 0 ((1,) 1617 Mail Serwrice Center.Raleigh,tC 27699-I617
Ulb.)<�r rove yen WtgN.,In addition to sending the form to the address in N)a
ric lBareltote diameter I an.) above,aura Stitit one eopy of this form within 30 dags of completion of%well
abarndoumeot`Y rite following.
l
Di%Won a a�WaterResanr ,Undergrvennd injectlnn Control Program.
am,
Water level below mend surface: M.) 636 Mad Senice Ccuts;Ratcigh.NC_276"4636
6e.Outer easing Icrrgt6(f Imowrr): (fist
1(k EaL-%A.'Ai r S0921v A IolectFnrr Wet1A: In addition to sending tin forma to
ilia addresses, above, alsosubmit one copy of this form within 3n kyS of
Completion of hell abandonment to the county hearth depurtrrtcut of the com4y
fif.InnereadnWinbing length tis tmown):10 (ft.) whcw abandmtµd•
I
i
0.,Serer length(if knowrn):10
i
Fanmt GtV-30 Nonh Cawftm Delpmocra of Envimumem:Oat Natomt Rc artncsL Dis-ision of Watcritewtuo s Revtscd Au_wm 2ot_a
a

WELL ABANDONMENT REICURD larrarir�tl�_��,:
This fortu slat►be used for single or multipte wells
1.Well Contractor information: NVELL AB '-00}N 1 'T DETA ti
Scott aunt, Jr 7a,Number alf wells being abandatied: 1
11TelICotmetof Nana:(ear sell on iwr p_nonAy altaudiittirtg%ven as hisiturprafteryi Xw ra dapk ,vt ecncor n- w%m-irciNt- siti p;A• we!?s ONLY wid) I& stnie
i eJwumrsrAvr�b rrinurru�ru,agar.eenr.sklxwlra'rcf tear.
4561-A
NC W03 Cam>tcrarCc:rtiKccsliirto Nmti)cr 7b.Appn)xim ate volume of Crater remaining.in wdl(.t9)z (gaLi
SAEDACCO Inc FOR WAIF:IR g11PPIN WF.I.X,S ONLY' _
Cangt t,Natna 7c trpe of d�Iiufeetsut used: Fa . ERIEPD.
I WW I Construction Permit&:, — I J U N 2.7
Idst adt a rdrltmt3lr uxl!put rr1<,7.r_C trT SLIT,t are,a r,fir.eltrar.,rdca Fl karcnrrr 022
X_Mao"I sIf disinfectant"seal• rr L
3.Weil use(thedcnellaie):
Water Supply Welt 7c.Scaling m:itetials used(r]omk all that apply): M;rsZ,r BOG
i]Agricultumt 0 NcM..Ccmcgt.Grout ®llentonitcC<iip%arPcllcts
Df rathennal Swpt}•t Oltcsidential Water Supply(rankle) O Sand C'ent'ent Grout ❑My Clay
t]ladworialfCeawtercial Oltcsidenrw Watcr Stjpp}y(siulmd) O Conc€eta Gtont ❑ Drill Cwtinp
omit lion O Specialty Giant ❑Gravel
Nazi Water%,ppl`v Weill, 0 Hentouite Slurry El Odta(eNplain under 7g)
M&161 itoruog ORctot;`r►'
Injection Well. 7G For each material Selected above,provide amount of materials used:
OAquifer Rechuge DGmaraltrWer Remediation ti
OAquifer Storage and Recovery ❑Salinity Darricr !`
Bentonite.(:50lb ,Wtr:gal.
❑Aquifer?'est OStorutontcr f)rtiu:ree
OEsperintental TechuoloLn• OSubsickttce Control 7Z Provide a iorirf description of the abandonment procedure:
Meothennal(Closed Loop) OTracer
f fx'otlterttCi[ 3L�ttinlL�C-0a60RlietutnD CiOtlterlUlaiuunder Once groundwater sample was taken, PVC removed and bentonite
i
from bottom to top
4.Aatc cacti(%)ai audaued: 6/14/22
5 L Well location,
Commercial Property
Farri1sty0C%'MTVarre felling I1)6(ifapDticabla? $.Certittr�act�ialt
3400 N. Elm St. Lumberton, NC 28358 �«w 11 6/18/2022
Physical Address.Citr.mdZip 5igr:lttm(ri'ceo iEd wizit C4 m6darorWeilOw•:abr Du,
i
Robeson Ru ig;Mftg 1l11Si THI, 1(rcrvtip'rernfj'Ilrttr t%1F 14'@pltSl tl'r75�1CFSL)abandoned in
Piml ld ni ficttion No.d['M ace alancr-mule i&I AY:-1C�!2C.0160 or?C,4er'tt ff'ell Comgrucann Staurrltrrdls
and Ilene a capi of[Iris recard kris i aup prof tiled to the well otvier.
Sb.Latitude and longitude In ttegt+seaftrsFetntkw/sesttnds ordecntal degrees:
tituell field,ctv b0ang ts;wLM;rq 9.Site diagra r or additional volt details:
You ntay use t lie back of this page to provide additional ttt:il site derails or well
?t W abandonmenu tails. You m ty also atl:telt addition il pub tf tcer tt}.
C.QNSTrlUCTIOal DETAiis(3F 1uELL4s#BtirNC:ABANDONED SVBnttTrAi siNCTR1iCTfaN
.�tPur.r nrl!xbrat�.acficat trwrclfsJ l,�a�uwlwr�lrl for drnlrlpfr inf�rYiarz ear rar'mtrxrtcr s•rpF13• �
xaltoe�RrLYnttf,rlw• ere tiers» r ,rr?mr orr.�,ent.lcrairstr.r;:rrrt m. 10a.For All 1Vetic: Submit Ibis form within 30 days of completion of well
6ti.WVeR IDg-TW-2 abandonment tbthc following:
Dhv siou of water Re..iunvs,Informatiou Prut cWng Unit,
6b.Total well depth: 20 ift.) 1yy617 Mail Service Center,Raleigh,KC 27611'1-1617
lab.Fur Xnlcctiot WcllF: In addition to sendiugr Cite farm to the address in 10a
6c.Borehole dtanteter:l fin,) abate:a[so sttbntit om vap_L'of this form withbi 30 days of completion of well
abandonment 16 the followigng:
fid.Water level`betoty ground-surface: DMsion of Water Resources,Underground Injection ControlProgram.
�636 Mail Service Center.Raleigh.KC 2760-1636
1[ic Fnr W.�r hgoniv&iufec ftsj 1& In addition to seraliug the forno to
6--Outer casing length(if lvncra)• ( ) the address;;es,above. also subtu t oue copy of this foam tvitttf t 30 days of
completion of well abandomrrm to the county health department of the cotmty
6f.Inner casinW/tnbispteuyFh tit lmown):10 ( ) wfi=abarwalnI d.
6M Screen length(if knolva):1°. _. -A)
f
Fora GWI-'16 Noah Carotim M-panurcra afEmirokuwat and Natumt Rcsotac�-DjvL,ton of Pater Resoumzs &i:Eied Augan it)C>
jI
i

WELD ABANDONIMEN`I°RECORD For trgamlUfC1JNLY:
This form Lau be used for single or maltiple,Bells 1 ,
1_WCO Contractor Information. 57L ARAM E T DETAII
Scott Hunt, Cr 7•a.Number o�wells being abandoned 1
Ohre]!C..ottnrcrm Name(of'ti ll0"W pet.;attafly�t�rrgftrnirrg%wu orthwah't prepem) F(W r22utiiph �tiJ4 2P JJt a tv,s sr�f r N�,r�tr +ar.-iia aVLY c;rh t1x wvJrr
rr�2rarlPiCNf+lMr�r0.�j21t7/r21J4!1(,ltlt>ci.UP S.IfAJr2f,Nlt!Nf3.tf.
it
4561-A i
7b.Apprlmim'tc volume of water rtrn:tining in well(s): 1 ltl.l
NC Wcu CotltriclorC,11frowtion Nnnbcr
SABDACCO Inc FOR%VATF SUPItT.Y WFI.1 tDAe1.Y: K E U° .5 V as�_+
Company Name 7c.TWpe of d l ulketant used:
2.`YellConstraction Permit&Tw-1,
Lrg"Nir{>rlt:ahlc well 1wrU.-J<ri.e.4iwov.SWis ,tari�wwe.hxv4eian,et:i f81tmasJa 7d.Amount disintivanttmLA: jnfaiffis"Jt,�^;1�rCC�.y1F�l Unh
3.Well usr(Chcdczvell use).
Water Supply Well: 7e.Scaling ux terials used(Oxcic all that apply):
O ftricultur:aE ❑hlmriciitaliPilbiis 0 Nout Cciuct t Gwia t9 G3cntonitc Chips or Pellets
E3Cmoelrertnal(HcjcinerCtwling Supply] 1311midential Wratcr Sapp)) S en
•(single}
13 and�' mt, GM ut 17 Dn Cl ty
llp
DltadustriallCotnntereial ❑[3c4irlentiatt47ta Supply(sltarcd) ❑ConcremGfout ❑DrillCutt%
❑Sp`riahF G nt Graa'ei
❑irrtian
Non-Water Snlrnh Well: 0 Bentonite S urrg M Od�, (eagllain mq&,r 7g)
Mouitorhm,, 1711CcoVet1'
7L
Injection Well: For each it aterial selectedab0vC.pmtide amount of materials used:
E3Ati ifet Rcc[wV, Mman duater Kcuiediation
❑Aquifer Sterage atttl Recovery ❑Saliu[tt Barrier t
Bentonite.+:501b ,Wtrsgal.
!]Aquifer Test OStommater Drainage
❑E.rpatinwmal Technoto—m [7Subsidewe.Conroy! 7„.Provide a I)rtrf dmeriptioa of the abandonment procedom
Moothenral(Closed Loop) ClTen=
Once goo dwater sample was taken, PVC was removed and
Motherrmt(Hsatiae+Coali0;Retuml 001h6gle,plaiu under ZR)
abaadonediwith bt3ntonite pellets
3.Date wctl(S)ahandr)ncd: 6/14/22 f EE
Sa.Wail location: f
Commercial Property
ractligf0wWr Nairn: ratil y ID0(ifappliQ*tc) � $.Ccrtilicati i.
3400 N. Elm St. Lumberton, NC 2835B �cely�curt 6/18/2022
Physical Addm.Cite,mid 2itJ SrgmiPi�orce;ititci va Cut° •tor orMkll(hurler Da r:
Robeson Au.vag);tng th ,fa,,wl, 1 lre=tlrkv ecagfy alig 1/u w dl(.$)wen(iwx 1 abaawfoned ne
Couuiy f eel ld'afficaku No.(PIN) awirdance iv th 1��XCUC 01C.111(YJ or eC A200[ ell Construction Sttiodartl+
and 11rat a co Hof]his record has he of provided to Are.well owner,
ib.I.atitade and Iougitude in dCgrceafminatcslsCcoards or decimal det~rccs:
(jr well t6:td,ouc Ett?IDits it 3yrli]c ) 9.Site diagra i or additional wetl detalls:
You may use else back of this page to provide additional well site details or well
1\ W alwntlauvtetu�lecaiis. You may also attach additional pages if necessary.
CONSTRIIG'7 ON DE'T'AIL-S OF WELIAS. 6Et111 ABANDONED Suflm ITAI,IN TR 1C i tUNS•
.ttknft trail czJrvv,:uvu rrtcrJr lr 3f urxJ`m5fi. For tnrk pl 'Llmai ae or ranJi-IJUI.r mppJ�,
t,-elly 0M.Y cult file wnte svJcvnractacv a5mta14rt:.aExJt.YI(c ea S:dac t oJ.e fbntr. Itla. For Ail{Welk Submil this morn nithin 30 da}'s of conviction of uell
6a.Well ID#.-Tw-3. *anjonn ut�o the fallatiakg.-
D Vision of tYatcr Resources,Information PtoceAing Unit,
6b.Total Hell depth: 16 ((Y.} ISEx Mul Service(eater,RaileFfth,NC 27699-1617
10b. ' In io idly: In addition to seuding the form to the address in lfia
6e.Borehole diameter.l (iu.) abot�also s#bntit one copy of this ronu Milk')y dogs of eompletiost of%veil
abwWonutem to the f allanii g:
Division bf Water Resourta,Underground-Injection Control Program,
6d.Wader level below ground surface: (ft.) !i E63G 111aii tienice Center,Raleigh,KC 276"4636
le;. For wa wr Snnnh•&lnFertta n Kitty: In addition to saWing the forto to
6c.Auto casing length Of known): 00 the address(es) above. also submit one copy of this form Within Yl days of
Completion of well ahatulonment to the counly I%Wth de-panrrretd of the couty
n�Irtc at�itmigncd.
6L Inner cming!tubing ten),Kh(if Imonn)5 6
i
6g.Screen length([f knoatn):10
3
Fonu GSY-34 Noah Camlim MpariJrtem of Enviromne rt aW Natumi llewtur� -Dh ision of Water Rcsources ftev ed Attu 200