WI0800528_Injection Event Record_20221118

WELL CONSTRUCTION RECORD (GW l)
For Internal Use Only:
1. Well Contractor Information:
George Bridger
RECEIVED
Well ConnaetorName
2393-A
NOV 182022
NC Well Contractor Certification Number NC DEO/DWR
Bridger Drilling Enterprises, lnc.Oentral Office
Company Novae
2. Well Construction Permit#: UIG#W10800528
List an applicable xeil construction pertnits 1 e. UIC County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
['Agricultural
DGeothermal (Heating/Cooling Supply)
DladustriallConemercial
Obri,oation
DMunicipallPublic
DResidential Water Supply (single)
['Residential Water Supply (shared)
DWells> 100,000 GPD
Non -Water Supply Well:
OMonitoiing ❑Recovery
Injection Well:
['Aquifer Recharge
['Aquifer Storage and Recovery
[(Aquifer Test
DExperimentai Technology
['Geothermal (Closed Loop)
['Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 10/4/22
5a. Wen Location:
FortrnainientDrp OnnnanntemdyAmend AweNes
19Groundwater Remediation
['Salinity Barrier
DStormwater Drainage
['Subsidence Control
['Tracer
['Other (explain under #21 Remarks)
welIID# N/A
DSCA ID #65-0001
Facitity/OwnerName Facility ICI (if applicable)
3750 Oleander Drive, Wilmington, NC 28403
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees►minutesiseconds or decimal degrees:
(if well field, onelet/long is sufficient)
171013.833 N 2331802.645
6. Is(are) the well(s): ['Permanent or nTemporary
14. WATER ZONES
FROM TO
DESCRIPTION
6 t. 30
f.
ft
ft
15. OUTER CASING (for mulli-cased was} OR LiNER (if appil cable)
FROM TO DIAMETER THICKNESS ] MATERIAL
ft. ft in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DiAMETKR
THICKNESS
MATERIAL
ft
ft.
_ 17. SCREEN
FROM
ft
in.
ft.
in.
TO
DIAMETER SLOTSIZF j THICKNESS
MATERIAL
ft.
ft.
18. GROUT
MOM
ft. D.
ft ft
ft
tt
in.
in.
TO MATERIAL
EMPLACE METHOD & AMOUNT
ft
ft.
19. SAND/GRAVEL PACK (If auHwble)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
ft
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION {color- hardenk seif1racktype, gra& dam, etc.)
ft ft
ft. ft.
ft.
ft_
ft
ft
ft
ft
ft.
21. REMARKS
22. Certification:
W � 3 11 /4/2022
- - - ---- ---- --------
Si fC Well Contractor --------_-- - -_-.._ Date
7. Is this a repair to an existing well: ElYes or IJNo
If this is a repair, fill out known wel! construction information and explain the nature oflhe
repair under 4121 remarks section or on the back of this forma
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 47
9. Total well depth below land surface: 17 @ 30 (ft)
For multiple wells list all depths lfdlfferent (example- 3®200' and 2(4I00')
10. Static water level below top of casing: 6
Ifwater level is above casing, use "+"
11. Borehole diameter: 2 (in.)
12. Welt eonstrraction method: direct push
(i.e. anger, rotary, cable, direct push, etc.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) _ _ Method of test:
13b. Disinfection type: Amount
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance with
15A NCAC 02C _0100 or 15A NCAC 02C .0200 Well Construction Standards and that a copy
of this record has been provided to the well owner.
23. Site diagram or additional wen 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 (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 environmental health department of the cotmtywhere installed
24d. For Water Wells produrino over 100.000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
FormGW-1
North CaroiinaDepartment ofEnvironmental Quality- Division of Water Resources Revised 6-6-2018

WELL ABANDONMEN 1IVRD
For Internal Use ONLY:
1. Well Contractor Information:
George Bridger
Well Contractor Name (or well owner personally andmvf/ner property)
erlrra pace
2393A
NC Well Contractor Certification Number
NOV 18 2022
Bridger Drilling Enterprises, Inc.
CmnpanyName
2. Weil Construction Permit#: UIC#VlII0800528
List all applicable well construction permits (La Ulf County, Stare. Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ lndustrialfCommercial
Mai ion
Non -Water Supply Well:
❑Monitoring
Injection Wen:
❑Municipal/Publlc
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑ Ai nifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
fExperimentai Technology
❑Geothermal (Closed Loop)
❑Geothermal (ffeating/Cooling Return)
UGmundwater Remediation
❑Salinity Bawer
❑Stonnwater Drainage
DSubsidence Control
❑Tracer
❑Other (:'vlain under 7
4. Date welt(s) abandoned: 10/4/22
Sa. Well location:
Femme e Modem Day Dry Clamors and Laundry amedle.] Propesties
DSCA ID#65-0001
Facility/Owner Name Facility ID# (if applicable)
3750 Oleander Drive, Wilmington, NC 28403
Physical Address, City, and Zip
New Hanover
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Tat/long is sufficient)
171013.833 N 2331802.645
W
CONSTRUCTION DETAILS OF WELLIS) BEING ABANDONED
Attach weilconstructionrecord(s)rfawzilable. For multipteinjectionornon-water supptywells
ONLY with the same construction/abandonment. you can submit oneforra.
6a. Weil ID#: 1-17 borings
6b. Total well depth: 30 (ft)
6c. Borehole diameter: 2
6d. Water level below ground surface: 6 (ft.)
6e. Outer casing length (if !mown): N/A (ft.)
(ft)
(ft.)
6£ Inner casing/tubing length (if known): N/A
6g. Screen length (if known): N/A
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): N/A
(gal)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check an that apply):
❑ Neat Cement Grout
❑ Sand Cement Grout
❑ Concrete Grout
❑ SpecialtyGrout
❑ Bentonite Slurry
0 Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7£ For each material selected above, provide amount of materials used:
7
7g. Provide a brief description of the abandonment procedure:
Filled geoprobe hole with bentonite chips, compacted
and then sealed with asphalt patch
8. Certification:
11 /4/22
Signe ofCertitied WelContract Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
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 All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Marl Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in l0a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division or water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
l0c. For Water Sutbnly & lniection Wells: In addition to sending the form to the
arldress(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
abandoned
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

RECEIVED
$ �ehth Carolina Department of Environmental Quality — Division of Water Resources
NaV 1 INJECTION EVENT RECORD (I ER)
®ai owe Permit Number W10800528
. Permit Information
Brookfield Properties
Permittee
Former Modem Dry Cleaners
Facility Name
3750 Oleander Drive. Wilmington, NC New Hanover
FacilityAddress (include County)
2. Injection Contractor Information
George Bridger/Bridg_er Drilling Enterprises. Inc.
Injection Contractor / Company Name
Street Address 114 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 17
Well IDs 1-17 geoprobe borinws
Were any new wells installed during this injection
event?
Yes No X
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Type of Well Installed (Check applicable type):
Bored Drilled Direct-PushX
Hand -Augured Other (specify) _
Please include a copy of the GW-1 forrn for each
well installed
Were any wells abandoned during this injection
event?
Yes X No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
17
Please include a copy oflhe GW-30for each well
abandoned
4. Injectant Information
_ Sodium Lactates W'ifClear+j
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 MW-WSP-1D
Total Volume Injected (gal) —5000
Volume injected per well (gal) 17 @ 294 each
5. Injection History
Injection date(s) 2/2020, 8/2020,5/2021,8/2021,10/2022
Injection number (e.g. 3 of 5) 5 of 5
Is this the last injection at this site?
Yes X No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
5t 11 /4/22
SIGN;C NJECTIO ONTRACTOR DATE
Gear. e Bridger
PRINT t OF PERSON PERFORMING THE INJECTION
Submit the original of This form to the Division of Water Resources within 30 days of injection.
Attn: MC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 3-1-2016