Wake_Well Abandonment_20230109 (2)

WELL ABANDONMENT RECORD For Internal Use ONLY: l
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1.Well Contractor Information: WELL ABANDONMENT DETAIL`S
Corey D. FUtral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
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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
4300-B Wells abandoned:
.77-7
NC Well Contractor Certification Number " x 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientist2AN �, FOR WATER SUPPLY WELLS ONLY:
Company Name
Ir f3T'nt y? ;j ?r".�,.,;.,;� 7c.Type of disinfectant used:
2.Well Construction Permit#: NA e-.,, "'. l. .;!
List all applicable well construction permits(i.e.UIC,County,date,�aPlorlce;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 OMunicipal/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) ❑Concrete Grout ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry. e Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Pellets ~ 50 Ibs
❑Aquifer Storage and Recovery []Salinity Barrier
[]Aquifer Test ❑Stormwater Drainage TOPSOII 5 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) Well abandoned in place with hydrated 6entonite
pellets to within 6 inches of surface and topped
a:Date well(s)abandoned: 12/20/22 with topsoil to existing grade.
5a.Well location:
NCDEQ-Fortner Star Flite 52 Property NA
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
��jztg .
1904 St. Albans Dr., Raleigh, 27609 12/29/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Wake NA
By signing this form, 1 hereby certhl that the wells)ivas(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 ivell 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:
35.834 N -78.606 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.For multiple injection or non-wa(ersupply wells
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-8 abandonment to the following:
Division of Water Resources,Information Processing Uniti
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- 8.25 (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: Dry (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 276994636
6e.Outer casing len gth(if known): NA 10c.For Water Suomly&c Iniection Wells: In addition to sending the form to the
(ft:)
address(es)above,also submit one copy of this farm within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casing/tubing length(if known): 10 (ft) abandoned.
6g.Screen length(if known): 15
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

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WELL ABANDONMENT RECORD For Internal Use ONLY: i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral
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
4300-B wells abandoned: I I
NC Well Contractor Certification Number 7b.Approximate volume of water>Laining in well(s): (gal.)
CATLIN Engineers and Scientists ~`� `;,9 F=V; �(i�•` FOR WATER SUPPLY WELLS ONLY:
Company Name
JA N 0 9 2023 7c.Type of disinfectant used:
2.Well Construction Permit#. NA I
List all applicable well construction ermits(i.e.UIC,Cout4', r.v4a c' p.,ic.)•.ifno)t,.
It'7d.Amount of disinfectant used:
3.Well use(check well use):
I
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout R Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑IndustriaUCommercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry e Other(explain under 7g)
eMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite Pellets — 25 ibS
❑Aquifer Storage and Recovery ❑Salinity Barrier
El Aquifer Test ❑Stotmwater Drainage Topsoil 5 IbS
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Well abandoned in place with hydrated bentonite
❑Geothermal(Heating/Cooling Retum) ❑Other(explain under 7g)
pellets to within 6 inche's of surface and topped
4.Date well(s)abandoned: 12/20/22 With topsoil to existing grade.
5a.Well location:
NCDEQ-Fofiner Star Flite 52 Property NA L
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
1904 St. Albans Dr., Raleigh, 27609 12/29/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Wake NA
By signing this form, /hereby certify that the ivell(s) was(tivere) 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 ivell 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:
35.834 N -78.606 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 WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable:For multiple injection or non-water supply wells
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-9 abandonment to the following:
Division of Water Resources,Information Processing Unit,
66.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: 8.25 (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: Dry (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
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6e.Outer casing length(if known): NA (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): 10 (ft) abandoned.
I
6g.Screen length(if known): 15 (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 DETAILSi
D.T. Chalmers 7a.For Geoprobe/DPT or Closed-to Ip 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
4146-A _ wells abandoned: I
NC Well Contractor Certification Number Approximate volume of water�i aining in well(s): (gal.)
n.,.,•
CATLIN Engineers and Scientists ,JgNz3 FOR WATER SUPPLY WELLS ONLY:
Company Name a 7c.Type of disinfectant used:
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,eic.)ifknoivn
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublic ❑Neat Cement Grout 19 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 e Other(explain under 7g)
AMonitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Pellets - 50 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage TOPSOII ' S Ibs
i
❑Experimental Technology ❑Subsidence Control 7g.provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Well abandoned in place with hydrated bentonite
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
pellets to top of well. Vault pulled and filled with
a.Date well(s)abandoned: 11/23/2022 nearby crushed concrete to within 1 foot of surface
5a.Well location: and topped with topsoil to existing grade.
NCDEQ-Former Star Flite 52 Property NA
Facility/Owner Name Facility ID#(if applicable) 8.Certification: ��`
1904 St. Albans Dr., Raleigh, 27609 /� 12/29/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Wake NA By signing this form, I hereby certify that the ivell(s) ivas(were)abandoned in
County Parcel Identification No.(PIN) accordance ivith 15A NCAC 02C.0100 or 2C.0200 Well Constriction Standards
and that a copy of this record has been provided to the ivell owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.834 N -78.606 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. For multiple injection or non-water supply wells
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 1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 40 (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: 8'25 (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: NM (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft) 10c.For Water Suunly&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): 25 (ft.) abandoned.
6g.Screen length(if known): 15 (ft.)
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Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources i I Revised 2-22-2016