Lee_Well Abandonment_20220719 (2)

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Wesley J. Sorrells 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 1 GW-30 is needed. Indicate TOTAL NUMBER of
3577 wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 1.27 (gal.)
Terraquest Environmental FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well constructionpennits(i.e.111C,County,State,Variance,etc.)rflmowrr
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublic a Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
01ndustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Portland Grout 47
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Water 3.5
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
Poured Portland Cement t`ro�ug-h=trerrsm!p pipe from the bottem of well to surface.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 6/23/22 19 ,2029
5a.Well location: ? dr„Ftyt
Magnet Marelli Vvu"':lv;,rl
Facility/Owner Name Facility]DO(if applicable) 8.Certification:
2101 Nash St. Sanford NC, 27330 -�Z-2 6/24/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Lee By signing this forms, I hereby certiA,that the ivell(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 01C.0100 or 1C.0200 Well Consintetion 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 latlong is sufficient) 9.Site diagram or additional well details:
35.46633 N -79.14247 `,I, 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
Artach well constntctionrecord(s)ifmailable.Formultiple injection ornon-warersupplywells
ONLY with the same construction/abandoamunt,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#• M W—F P-6 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 25 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
A 10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: N/A (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: 17.20 (ft.) Division of Water Resources,Underground Injection Control Program,
/�
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): N/A (ft.) 10c.For Water Sunaiv&Iniection 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
6E Inner casing/tubing length(if known): N/A (ft.) abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

i
i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor IInformation: WELL ABANDONMENT DETAILS
Wesley J. Sorrells 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
3577 wells abandoned:t I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 1.68 (gal.)
Terraquest Environmental FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ij7arown
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 a 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: - ❑ Bentonite Slurry ❑ Other(explain under 7g)
MMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Portland Grout 47
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Water 3.5
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer C-)r_rt;x. " ` T_
i Poured Portland Cement through trernmie:Pipe from�he'b"&in of well to surface.
❑Geothermal(Heating/Cooling Return) ❑Other explain under 7g)
JUL 19 2022
4.Date well(s)abandoned: 6/23/22
5a.Well location:
Magnet Morelli t,a l;fsia, �,1���;l.i..•t=,u,� Ji.i
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
2101 Nash St. Sanford NC, 27330 6/24/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Lee By signing this form, I hereby certify that the ivell(s) was(were) abandoned in
County Parcel Identification No.(PIN) accordance ivith 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:
35.46633 N -79.14247 `1 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)ifavailable.For multiple injection or non-water supply wells
ONLY with the same construction/abandonment,you can.submit one form.
It t� 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID9: 'V'W2 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth• 25 (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: N/A (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: 14.71 (ft) Division of Water Resources,Underground Injection Control Program,
.1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NIA (ft) 10c.For Water Supply&Iniection 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): N/A (ft.) abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
WesleyJ. Sorrells 7a.For Geo robe/DPT or Closed-Loa Geothermal Wells having the same
P P g
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
3577 wells abandoned:t
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 1.03 (gal.)
Terraquest Environmental FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,e1c.)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 a 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
❑lrri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑Bentonite Slurry O Other(explain under 7g)
IRMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Portland Grout 47
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Water 3.5
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
Poured Portland Cement through tremmie pipe from the bottem of well to surface.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 6/23/22 JUL 19 eaz_2
5a.Well location:
Magnet Marelli n' '`'
Facility/Owner Name Facility IDfI(ifapplicable) 8.Certification: �'
2101 Nash St. Sanford NC, 27330 111��f -� _ 6/24/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Lee By signing this forni, I hereby certify that the ivell(s)was (here) abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Constriction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.46633 N -79.14247 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 svel/construction records)ifavailable.For multiple injection or non-water supply wells
ONLY svith the same constructiotvabandoninent,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: M W 1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth• 23 (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: N/A (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: 16.67 -(ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
i
tie.Outer casing length(if known): N/A N/A 10c.For Water Suaaly&Iniection Wells: In addition to sending the form to ti.e._
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): N/A (ft.) abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016