Iredell_Well Abandonment_20221216

WELL ABANDONMENT RECORD - •'
1.Well Contractor Information: XNF.LI.ARANDONNIF.NT DETAILS
l
Alfred Kieslin Jr. '
g 'a_Far Geoprohe/DP'f or Closed-1_oop Geothermal Wells having the same
Well Contractor Name for µel!o..ncr personally abandot mp w;c+rri'3E='A c .S^ 1� j: ell con: tructiorAcpth,only 1 GW 30 is needed. Indicate TOTAL v-LtMBER o:
3266-A � abandoned:
NC Well Contractor Certification Number DEC p ZQZZ 7b_.approximate volume of water remaining in well(s): (g�1
B & K Well Drilling Inc 7, ;,y :3Un" 'FOR WATER SCPPLYWELLSONLY:
Company Name 1(t`u�..•a;JU^1�ir � _ Chlorine
; c-Type of disinfectant used:
2.Well Construction Permit M 12 (n 4 2.�
List all applicable urll cvrr,Vruc7ion perrnit,(i.c•.UIC.Coma::
-d.Amount of disinfectant used: Q�_>ngtC f
3.Well use(check well use):
Water Supply-Well• 1 7e.Sealing materials used(check all that apply): '
CAgricultural ❑'lulticipai Public _ peat Ce[ncnt Grouz entunite Chips or Pellets
(Geothermal(Heating/Cooling Supply) l.i t = Sand Cement Grout C Dry Clay
ClndustriaVCommercial (Residential<<atcr Suppi% ,>aa-a : _ .nacre Grout C Drill Cuttings
❑Irrigation I 7- S C:ialR GruuL 7 Gravel
Non-Water Supply Well: 1 = Bentonitc Sltuiy :3 Other(explain under;g)
f7 Mun i tori nc ❑R,-covery
Injection Well: 'f.For each material selected above,provide amount of materials used:
(Aquifer Recharge ❑Groundwat-er Re-ed'atiar-
(.':Aquifer Storage and Recovery 715alinin-Ba-ier.
UAquiferTest uStornHater Dramace �°—
❑Experimental Technology ❑Subsidence Control !
7g.Provide a brief description of the abandonment procedure:
(Geothermal(Closed Loop) OTracer � ��
LGeothermal(HeatingiCooling Return) UOther(explain under �
itii �_� J
i
4.Date well(s)abandoned:
5a.Well location: t
Pacllity/Owner Name Facility ID"(ifapplicable) 8.Certification:
n I /f �
23l Ober 6-e r LD OO M.AO+f eSV C.. i lq
Physical Address.City.and Zip $i Ema�ture 'Ccnilied Neil Contractor afN'el!Ur+nyr 7a[c
4102L - 10 - 453k a; signing:tis tour., I irerei, that the nrll(s) was(ivere) abandoned in
County Par.'el identiiicadan Nn.:PN' second dance:rit)r ,5.4:L.4C t)2C•.0100 or 3C.0200 Well Construction Standards
:nd rhat a covi n!i;i.;record has been provided to the well owner.
5b.Latitude and longitude in degrees"lluinutes,seconds or decimal degrees: j
(iftvell field.one IaViong is Sufficient) 9.Site diagram or additional troll details:
You MEN.use the back of this page to provide additional well site details or well
N W abandomt:cnt details. You ma.also attach additional page;if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUKMITTAL iNSTRUCTIONS
Arraclnrellrnnsrrrrrrionrre•orr149i/'arailah/e. Fnrnnuitiplrinlrcrioeornou-warer.cu)rjr/vK•ellc
OrVLYlcirh the scone ranstructiorJabandanmpnr,rnu non su(rmit ono torn.
' 10a. For .all Wells: Submit this form within 30 days of completion of well
6a.Well IU#: abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: (ft.) 1617 Mail Service Center,Raleigh.NC 27699-1617
10b.For iniecton Wells- Inl addition to sending the form to the address in I0a
6c.Borehole diameter: (t�? (in.) above. also submit one copy If this form within 30 days of completion of well
abandonment to the.follow•ing:�,
i
6d.Water level below ground surface �� (ft.) Division of Water Resour1.
ces,Underground Injection Control Program,
1636 Mail Service'Center,Raleigh,NC 27699-1636
i
6c.Outer casing length(if known): (ft.) 10c.For Water Sunuh•do lniection Wells: In addition to sending the form to the
address(esl above.also submit one copy of this form within 30 days of completion
of well abandonment to thel elounty health department of the county where
6f.inner casing/tubing length(if known): (ft.) abandoned. I
6g.Screen length(if known): (ft.) I
i
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Form GW-30 North Carolina Dcpaamenl el'Environmcntal Quality-Division of Water Resources Rcviscd 2-22 ell 1 o

WELL ABANDONMENT RECORD ::,:1-::rnai ONLY:
3
1.Well Contractor Information: «F.LL ABANDONMENT DETA9I.S
Alfred Kiesling Jr. "?, Pr�`m � -a_For Geoprohe/DPT or ClosedifLoop Geothermal NNellsha%ing the sane
Well Contractor Name for wcll owner personally abandonin_kc.cni: �t:^sa Y�, "m "con;tnr_on/depth,only 1 G%V-30 is needed. Indicate TOTAL N. MBER�t
3266-A DEC 1r ZL�22 abardored:�
NC'Wcll Contractor Certification Number l' -b.Approximate volume of eater remaining in well(s): (ral.)
B & K Well Drilling Inc In+v"� ''"n?r: I•
,3t"e'�?w'� ;FOR WATER SUPPLY WELLS ONLY:
Company Name. Chlorine
,�/ I�e2I -c.Tv pe of disinfectant used:
2.Well Construction Permit#:2Y
List rill applicable well construction pe'ratfrs(i.e.UX.C'orurt::Srarc•.t;Wr___
-d.Amount of disinfectant used:'
3.Well use(check well use):
Water Supply Well: 7e.Staling materials used(check all that apply'):
ElAgrieultural ❑Municipai Public f -Neat Cetneut Grout ./E'tientonite Chips or Pellets
CGeothermal(Heating/Cooling Supply) C'1�ezidcntial Wawr Suppl-, .�ir:_lc+ ` — S=nd Cement Grout :1 Dry Clay
CIndustrial/Cotmnercial ❑Residential Water Supph tshar d; i - oncrcte Grout 7 Drill Cuttings
0-Irrigation ! = Sne salty Grout 7 Gravel `
Non-Water Supply Well: y = Bent.)nite Slurp 0 Other(explain under 7g)
r'Monitoring CIRecoyen• i
injection Well: If.For each material selected above,provide amount of materials used:
0.Aquifer Recharge 7GroundtvaterR:-:;ciiation ` ��� C- /,e��
f.'Agttifer Storage and Recovery ❑Salinin-Bat-ier
faAquifer Test CJStorm%;ater, Drainage
GExperimental Technolo nSuhidence Control ig.Provide a brief description of the abandonment procedure:
GGeothermal(Closed Loop) ❑Tracer J
❑Geothermal(Heating/Cooling Return) L)Other(explain under 7gi
J
4.Date well(s)abandoned: /P lab .2 �-
5a.Well location: I:
�f
'h.c.1 fri V d�Y�-M1•�i off. ` � +
Facility/O+sner Name Facility 1D#(ifapplicahle) S.Certification: I,
l
I'lrysicaI Address.City.and Zip Jat o enilie ell 'on,act' O er Date
'SSG MIT -/3- 'P3o 7
+
• t3�'.•d,•rrin,this lore!, l here.; rerti(i• ilia[the ue11(s) nns (were) abandoned in
County Parcel ldrrtitica:iou No.rP1N1 accordance:rirlr 15.4 NC.-IC 02C".0700 ot•2C.0200 Well Construction Standards
and that a co.v.v of ti:is record hers been provided to the well owner.
5b.Latitude and longitude in degrees/minuteslseconds or decimal degrees: i' +
i it well field,one lavlong is sufficient) 9.Site diagram or additional ,;'ell details:
You may use the back of this page to provide additional well site details or well
>r H ahandormnmcttt dc(aiis_ You tna}'alse attach additional page;if accessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL fNSTRUCT10NS,
.artaclrxrNr•ansrrnr•rinnmrorrlC•)r•'fw<rilahle. Fnrntuiriplei,jccrimrornotr-;+arer•.+apph•t,•clLs
OALY it*h the some constnrcriordabandarnnerrt.You ran submit one form.
10a. For All Wells: Submitihis form within 30 days of completion of-well
6a.Well ill[#: abandonment to the following: I
Division of Water Resources,Information Processing Unit,
6b.Total well depth: (ft.) 1617 Mail Service Center,Raleigh.NC 27699-1617
lob.For Iniection Wells: In laddition to sending the form to the address in I Oa
6c.Borehole diameter: O (in.) above. also submit one copy of this form within 30 days of completion of well
abandonment to the.following:i
4
6d.Water level below ground surface: Division of Water Resources;Underground Injection Control Program,
1636 Mail Service'Center,Raleigh,NC 27699-1636
i•
6e.Outer casing length(if known):�5 (ft.) toe.For Water Supply&Iniection Wells: In addition to,ending the font to the
addressees)above_also submit nne copy of this fornm within 30 days of completion
of well abandonment to the county health department of the county where
6f.inner casing/tubing length(if known): (ft.) aiandoned.
6g.Screen length(if known): (ft.)
I
-z
Farm GW-30 North Carolina t)cparCtncnt el'Encirunmen[al Quality-Drvi;ion of Vb'a[er Resources ItCL'ISCd r.._ UI h

WELL ABANDONMENT RECORD i=::1- t-',_ONLY:
1.Well Contractor Information: WELL ABANDONMENT DEIT.MLS
Alfred Kiesling Jr. For Geoprobe/DPT or closed,Loop Geothermal Wells raving the same
Well Contractor Namc for%,:ll owner personally e!i,construcaort/depth;only 1 Gi -30 is needed. Indicate TOTAL NUMBER of
3266-A :v. `V tt_r l ; i..abandoned: i
NC Well Contractor C.cnir=tion Number DEC 1 �'4 2l'LL b.Appro,imate volume of w t1tel remaining in well(s): (gal.f
R t
B & K Well Drilling Inc t 1,i; FOR WATER SUPPLY WELLSONLY:
I
C'ompanyNatna Vtd�al.ZluC��7 _ (.Chlorine
nn AA '' {x / c.Type of disinfectant used:.
2.Well Construction Permit#:O 4;222 V!/4 i
List till applicable,tall construction permits(i.e.UIC.Count::Jtcrc ,,,.:._ - . r.
f'd_Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: i 7e.Sealing materials used(check all that apply):
GAb•icultural ON'lturicipai Public _Neat Cement Grout _,.4-Scritonile Chips or Pellet;
GCreothermal(Heating/Cooling Supply) 2<'idcntial Water Supply tbiraci j = Sand Cer:ent Grout ❑Dry Clay
C Ind ustriaUCommercial ❑Residential Water Supply ishas .CC—oncrete Grout ❑Drill Cuttings "
t —
❑Irrigation l — Speo:aln•Grout D Gravel
� '.r -
Non-Water Supply Well: i = Bentonite Slurry ❑ Other(explain under 7g)
f-I.Monitoring ORccovcry
injection Well: 7f.For each material selected above,provide amount of materials used:
CAquifer Recharge ❑Groundwater Remed:ation U
('•Aquifer Storage and Recovery --]Salinity Bar-ier ///���
LAquifer Test ❑Stornw ate,Dramaee � Q IL
CExperimental Technology OSub�idence Comm]
7g.Provide a brief description of the abandonment procedure:
CGeothetmal(Closed Loop) ❑Tracer �����
UGeothetmal(HeatinglCooling Return) 00ther(explain under'e)
I
4.Date well(s)abandoned: /,* /j �--�—
i
5a.Well location:
,la L.,
Facility/C?xnerName Facility Me'(if applicable) 8.Certification:
1'hvsical Address..City.and Zip d Sig;tatur f C'"LiFwa 41Fnty c or or N Ow" er Date
*Wing.his torn:, !rercFr crerti ta[the teeIlls) was rttrrel abandoned in
County Parcel Identification No.;PIN. accordance:?iris ;J.4 A'CaC 03C.U/00 or 3C.0200 Well Construction Standards
.and that c'JUl'Ot trfl. record,has been provided to the well owner.
5b.Latitude and longitude in degrees/minutesiseconds or decimal degrees:
(if'well field.ono lattlong is sufficient) 9.Site diagram or additional well details:
You may use the back of this page to provide additional%cll site detail;or well
N H abandomnait details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
:Inaclrxtllrnnsrrucriorra•ecrordrs)iJatsailah/e. Fnrntaltipleinjrcrianornorr-vuteraupph•x•ellt
DiVLY with the same canstrtretiott/abandotin+e+rt.you can submit one form.
" lUa. For All Wells: Submit this form within 10 days of completion of w•cll
6a.Well iD#: abandonment to the following:
Division of Water(Resources,Information Processing Unit,
6b.Total well depth: (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
I.
10b.For iniection Wells: 1n addition to sending the form to the address in IOa
6c.Borehole diameter: (in.) above. also submit one copy of this form%+thin 30 days of completion of well
abandonment to die.following.-
N Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) i ,
16361fail Service Center,Raleigh,NC 27699-1636
1 ,
6e.Outer casing length(if known): (ft.) 10c.For Water Suaaly&luieIction Wells: [n addition to,ending the form to the
addresses)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): (ft.) abandoned.
6 .Screen length(if known): (ft.)
g g :
Form GW-:U North Carolina Dopariniam of Fnvironmental Quality-Division of Water 110?OUrces Revised'--2]2u)o

WELL ABANDONMENT RECORD For Internal Use ONLY:
II
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Sam Bowers I
i
7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
�, j, �1 'P""' a well construction/de th,only 1 GW-3Q is needed. Indicate TOTAL NUMBER of
We1lContractorName(orwellownerpersonallyaba�o`nin-well'a '.his/herpro erty, P Y
3220—/� L., n�_. a 4t�1 1±>� u+ wells abandoned:
NC Well Contractor Certification Number D(_C 16 2022 7b.Approximate volume of water i remaining in well(s): 1.70 (gal.)
Geological Resources Inc.
rr-nati^sl ,, � ;,,�Lf l 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.)iflmown
7d.Amount of disinfectant used:
3.Well use(check well use): j
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agicultural ❑Municipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared)_ e Concrete Grout ❑Drill Cuttings
❑hri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: _ _ _ _ ❑ Bentonite Slurry. ___ _ _ ❑ O__t_h_er(explain under 7g)
*Monitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite 501bs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Grout iL 15 Ibs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Pour as placement
4.Date well(s)abandoned. 12/14/22
5a.Well location:-
Home Run Market #3 00-0-0000021566
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
1228 River Highway, Mooresville NC 12/14/22
Physical Address,City,and Zip - Signature of Certified Well Contractor or Well Owner Date
Iredell 4637099700.000 By signing this fonn, I hereby certify that the wells)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C'01,00 or 2C.0200 Well Construction 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.602365 N 80.9145.09 _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 record(s)ifavatlable.For multiple injection ornon-watersupplywells
ONLY with the same 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 abandonment to the following:
I
Division of Water Resources,Information Processing Unit,
6b.Total well depth:47.33 (fk) 1617 Mail ServiceCenter,Raleigh,NC 27699-1617
tr 10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 6 (in.) above, also submit one copy of this form within 30 days of completion of well
�] abandonment to the following:
3 �I
6d.Water level below ground surface: 6.93 (fh) Division of Water Resources',Underground Injection Control Program,
1636 Mail Servicel Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 0 (ft,) 10c.For Water Supply&InjectIion 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): 25 (ft.) abandoned.
6g.Screen length(if known): 25 (ft)
i
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETA$"A
Sam Bowers DEC 16 2022 I
7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well qn 1)is/her,�rogerly)J Ls:i well construction depth,only 1 GW!30 is needed. Indicate TOTAL NUMBER of
!"! wells abandoned:
3220-A7b.A roximate volume ofwater1remainin ,n wells . Unknown
NC Well Contractor Certification Number PP I 1; ()' (gal.)
Geological Resources, Inc. FOR WATER SUPPLYWELLSIONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: !
List all applicable well construction permits(i.e.UIC,County,State,Variance,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 A Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) RResidential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) s Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: O Bentonite Slury I__ __ ❑-Other-(explain under-7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite 1,500lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier r
❑Aquifer Test ❑StormwaterDrainage Grout 640lbs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Pour as placement
4.Date well(s)abandoned:
12/14/22 i
5a.Well location:
Home Run Market #3 00-0-0000021566
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
1189 River Hwy, Mooresville, NC 12/14/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Iredell 4637198705.000
By signing this form, 1 hereby certyy that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.60272 N 80.91162 __ ."" __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 record(s)ifavailable.Formulliple injection or non-water supply wells
ONLY with the same constructionlabandonment,you can submit one form. "
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#• WSW-5 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 1 00 (fL) 1617 Mail Service Center,Raleigh,NC 27699-1617
f
10b.For Infection Wells: In addition to sending the form to the address in 10a
Unknown above, also submit one copy of this form within 30 days of completion of well
6c Borehole diameter: Un•) abandonment to the following:
6d.Water level below ground surface: 60.1 0 (ft) Division of Water Resources,I'Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
i
1
6e.Outer casing length(if known): 0 (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
6E Inner casing/tubing length(if known): Un known(ft.) abandoned.
6g.Screen length(if known): Unknown (ft•)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resour is Revised 2-22-2016
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