Iredell_Well Abandonment_20230112

WELL ABANDONMENT RECORD For Internal Use ONLY:
i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Sam Bowers
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
3220-A wells abandoned:
I Unknown
NC Well Contractor Certification Number 7b.Approximate volume of watenremaining in well(s): (gal.)
FOR WATER SUPPLY WELLS
Geological Resources Inc. iJ
ONLY: Jw %
� P' ��.�
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit qf�
List all applicable well construction perutits•(i.e.UIC,County,Stare, Variance,etc.)ifknown ? L`23
7d.Amount of disinfectant used: �rft� di v�
3.Well use(check well use): A P
° C� , 3 Ur,.f
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublic ❑ Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) FIResidential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) a Concrete Grout ❑Drill Cuttings
❑hrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well:, ❑Bentonite Slurry ❑ Other(explain under 7g)
-— - -❑Monitoring — ❑Recovery --- -- — - — - -- - —
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite 1,500lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Grout 640lbs
❑Experimental Technology ❑Subsidence Control I
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: 1 2/14/22
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, I hereby cei•lify that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.b%00 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: I'
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
35.60272 N 80.91162
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 it jection or non-watersupply wells
ONLY with the sauce construction abandonment,you can suhtnit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: V n I V`�c`n,V V-5 abandonment to the following:
Division of Water Resources,Information Processing Unit,
1611 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: 125 (ft.)
10b.For Injection Wells: In addition to sending the,form to the address in 10a
6c.Borehole diameter:
Unknown (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: ft.) Water 60.10 Division of Resources Underground Injection Control Program,
( i
1636 Mail Service Center,Raleigh,NC 27699-1636
i
6e.Outer casing length(if known): 0 (ft.) 10c.For Water Supply&Injection 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): U n kn own(ft) abandoned.
6g.Screen length(if known): Unknown
(ft)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources R c v i s c d 2-22-2016

i,
i.
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS!
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple byection or non-water+ supply hells ONLY with the sane
construction/abandonntent,you can submit one form.
C - 4421 1 1 7.25
7b.Approximate volume of water'remaining in well(s): (gal.)
NC Well Contractor Certification Number !
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONL a''t;,!L
Company Name 7c.Type of disinfectant used:
y
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County.State,Variance,etc.)ifknown 7d.Amount of disinfectant used: �F#i�3y azS:v t ft^f 3•S: ';J i;li
r�ia -gin^
3.Well use(check well use): r
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑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: 21 Bentonite Slurry ❑Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 9.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
5a.Well location: }
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 r9'"`"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By sighing this form, I hereby certify that the ivell(s)ivas (were)abandoned in
County Parcel Identification No.(PIN) accordance with 15.4 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:
350 �47' 19.76' 800 54 59.20' You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS;;
Attach well construction record(s)if available. For multiple ityection or non-water supply 1, i
wells ONLY with the same construction/abandonment,you cat submit one form. 10a. For All Wells' Submit this form within 30 days of completion of well
6a.Well ID#: M W-56 abandonment to the following:
Division of Water Quality,Information Processing Unit,
66.Total well depth: 56.0 (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: 2'0 (in,) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following: 1:
i
6d.Water level below ground surface' 1 1'0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I I
10c. For Water Sunnly& Iniectiott Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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 abandoned.
611 Inner casing/tubing length(if known):
I
6g.Screen length(if known):
Form OW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

I I
I
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON ' ' 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-irate' supply wells ONLY with the saute
C - 4421
construction/abandonment, ,you can subin one jornt.
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 4.75 gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY: R-»
Company Name
7c.Type of disinfectant used: ;�'
2.Well Construction Permit#: AIV 1 2 2023
List all applicable well construction permits(i.e.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 ❑ 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: 0 Bentonite Slurry ❑ Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 9.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 `�'""`"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the ivell(s)was (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 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 47 19.58" 80 54 51.94 W You may use the back of this page to provide additional well site details or well
N
o c abandonment details. You may also,attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple it jection or non-water supply
wetly ONLY with the saute constructiodabandonnient,you can submh one fors' 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-76 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth: 56.0 (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: 2.0 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Gd.Water level below ground surface 27•0 (ft.) Division of,Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
Ge.Outer casing length(if known): (ft.) 10c. For Water Supply&Infection 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
6f.Inner casing/tubing length(if known): (ft.)
where abandoned. '
I.
t
I
6g.Screen length(if known): (ft.)
f
Form GW-30 North Carolina Department of Envir nment and Natural Resources-Division of Water Quality Revised March 2013

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON I 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For ntulliple injection or non-wale,' supply wells ONLY with the saute
C -4421
construction/abandonment,you can subndlf one form.
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 4.75 (gal.)
i
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type ofdisinfectant used: V
2.Well Construction Permit#: JA Ili 1 2l'�23
List all applicable well catslruclion permiLr(i.e.County,Slate,I�artance,e(c.)/fknown 7d.Amount of disinfectant used: .r
t
3.Well use(check well use): tom., Ljr*i
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout i ❑ 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: EI Bentonite Slurry ❑Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 9.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity,Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
_ 5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �"`�'"`"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this fornh, I hereby certify that the ivell(s)was (were)abandoned in
County Parcel Identification No.(PIN) accordance will?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:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
35e 47' 19.80" N 800 54' 57.82" 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 records)if available. For multiple byeclion or non-water supply
wells ONLI'with the same conrtruclio»/abmtdonnhent,you can subotit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#• MW-69 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 60.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
2.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
Gd.Water level below ground surface 30.0 (ft.) Division of Water Quality,UI derground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c.For Water Sunnly&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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
Gf.Inner casing/tubing length(if known): where abandoned.
(ft.)
I'
6g.Screen length(if known):
Form G W-30 North Carolina Department of Environment and Natural Resources-Division of Water Qual I ity Revised March 2013
i
11

i
i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple ii jecfion or non-water, supply melts ONLY with the same
canstructionlabandonment,you can submit one form.
C - 4421 f � 4.75
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number I '
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
.r
List all applicable well constriction permits(i.e.CounO;State,Variance•etc.)ifknown 7d.Amount of disinfectant used: '
1 �
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that appli7?O'%j Da"7 .t ;,,,� l t
❑Agricultural ❑Municipal/Public
❑ Neat Cement Grout ❑ Bentoniteipstia'r Eejlels
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 9.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
201 PHOENIX STREET STATESVILLE 28677 `"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the well(s) was(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 well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one]at/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.75" 800 54' 57.30" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS'
Altach well construction record(s)if available. 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-72 abandonment to the following:
Division of Water Quality,Information Processing Unit,
60.0 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b.For Infection Wells: In addition to sending the form to the address in 10a
2.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: _(in.) abandonment to the following:
6d.Water level below ground surface 30.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I0c. For Water Sunaly&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit)one copy of this form within 30 days of
completion of well abandonment ito!the county health department of the county
where abandoned.
6f.Inner casing/tubing length(if known): (ft.)
4
6g.Screen length(if known): (ft.)
Font G W-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-[vale, supply hells ONLY with the same
construction/abandonment,you can subuit one form.
C -4421 If 1 4.75
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name
7e.Type of disinfectant used: I 1I a
2.Well Construction Permit#: A N 1 2 2023
List all applicable well construction permits(i.e.County,State,variance,etc.)ifknown 7d.Amount of disinfectant used:
3.Well use(check well use): - ! nt,}t; '""'�` ' a i:t
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑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: 21 Bentonite Slurry ❑ Other(explain under 7g)
911vIonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 9.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
--- 5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �" 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the ivell(s)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 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:
350 47' 19.94" 800 54' 57.50" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach ire/1 construction records)if arailable. For nnultiple it#ection or non-water supply
wells ONLY with tine some construction/abandonment,yeu can subunit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-71 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 60.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
2.0 above,also submit one copy of this form within 30 days of completion of well
Gc.Borehole diameter: (in.) abandonment to the following:
Gd.Water level below ground surface 28.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
j
10c.For Water Sunoly&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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 abandoned. j I
6E Inner casing/tubing length(if known): (ft.)
I
6g.Screen length(if known):
Fomr GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
I

1
WELL ABANDONMENT RECORD
For Internal Use ONLY: !
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON l 1. 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-crater supply wells ONLY with the same
C -4421 construction/abandonment,you can submit one form.
NC Well Contractor Certification Number
7b.Approximate volume of water Ire i aining in well(s): 4.75 gal.)
i i
I .
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY: _
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: JA lti
List all applicable well construction permits(i.e.County,State,Variance,etc.)ij'knoum 7d.Amount of disinfectant used:- 'I 2 2p
3.Well use(check well use):
Ui�t
Water Supply Well: 7e.Scaling materials used(check all that apply): dr1„' ';0 3 'ou
❑Agricultural ❑Municipal/Public ❑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: 21 Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 9.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
----- 5a:Well-locatiou: - -- — -- -- — - f - -
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
201 PHOENIX STREET STATESVILLE 28677 �"'"�'�'"'"^` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the ivell(s)was (ivere)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 io die well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one]at/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.68" N 800 54' 57.24" 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)if available. For multiple injection or non-crater supply
wells ONLY with the some construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
Ga.Well ID#• M W-73 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 60.0 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
Job. For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2.0 (in,) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
i
i
6d.Water level below ground surface: 27.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
loc. For Water Supply&Iniection Wells: In addition to sending the form to
Ge.Outer casing length(if known): (ft.) the address(es) above, also submit bne copy of this form within 30 days of
completion of well abandonment(o the county health department of the county
6f.inner casing/tubing length(if known): (ft.)
where abandoned.
i
+ I
6g.Screen length(if known): (ft.)
Fonn GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2113

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
tl
JAMES MORRISON 7a.Number of wells being abandotie I: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-[rate' supply hells ONLY with the same
construction/abandonment,you can submit one form.
C - 4421 4.75
NC Well Contractor Certification Number
7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Namel'..
7c.Type of disinfectant used:
2.Well Construction Permit#: - � zJ
List all applicable treR construction permits(i.e.County,Stale,Variance,etc.)ijknown A � 1 �
7d.Amount of disinfectant used: ,
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply): ate 30n"" Lir;.1
❑Agricultural ❑Municipal/Public ❑ 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: El Bentonite Slurry ❑ Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 9.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/1 5/22
- -- 5a.-Well location: — - - - -- - -- _-
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) $•Certification:
201 PHOENIX STREET STATESVILLE 28677 "`"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, /hereby certify that the wells)was(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]at/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.60" N 800 54' 57.02" 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)if available. For multiple i jeclion or non-seater supply
wells ONLY with the same construction/abandonment,you can submit tare form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-75 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 60.0 (170 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For infection Wells: In addition to sending the form to the address in i0a
2,0 above,also submit one copy of this form within 30 days of completion of well
Gc.Borehole diameter: (in.) abandonment to the following:
28.0 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
I.
10c. For Water Supply&Injection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit bne copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6E Inner casing/tubing length(if known):
i
i
6g.Screen length(if known): (ft.)
Form G W-30 North Carolina Department of Environment and Natural Resources-Division of Water T ality Revised March 2013

WELL ABANDONMENT RECORD
For internal Use ONLY:
This form can be used for single or multiple wells i I
i
1.Well Contractor information: WELL ABANDONMENT DETAILS
JAMES MORRISON
7a.Number of wells being abandoned. 1
Well Contractor Name(or well owner personally abandoning well on his/her property) ror multiple it jection or non-ovate, supply wells ONLY whit the same
construction/abandonment,you can submit one form.
C - 4421 11 7b.Approximate volume of water remaining2'S
in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY: 1(
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well consiructionperotits(i.e.County,State,Variance,etc,)ifknown JAN ,( 2 7n
7d.Amount of disinfectant used: L(L
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑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: El Bentonite Slurry ❑Other(explain under 7g)
MMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 27.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) OOther(explain under 7g)
4.Date well(s)abandoned: 1 1/16/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 TM""'`"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the well(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance ivilh 15A 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:
350 47' 19.00" 800 54' 59.96" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if orailable. far multiple injection or non-water supply
wells ONLY with the same cmtstructiat/abandonnten{you can submit one forth 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: EW-12 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 42.0 (ft,) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6e.Borehole diameter: 4.0 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
� I
6d.Water level below ground surface: 38.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
i
10c. For Water Sunuly& Injection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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
6E Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple h jection or non-haler supply wells ONLY with the same
construction/abandontrtent,you can submit one form.
C - 4421
NC Well Contractor Certification Number 7b.Approximate volume of water re I aining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: �•,�a_ -, �'' n4y
2.Well Construction Permit#: A t
I.ist all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown 7d.Amount of disinfectant used:I A I4 2 ��13
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply): ,
❑Agricultural ❑Municipal/Public ❑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: RI Bentonite Slurry ❑Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 0.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/16/22
ia.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �"' "`^` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the ivell(s)was(were) abandoned it?
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 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:
350 47' 16.50" 800 54' 57.50 You may use the back of this page,to provide additional well site details or well
W abandonment details. You may attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. Tor multiple injection or non-Crater supply
wells ONLY with the saute construction'abandonmmnt,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: AS-26 abandonment to the following:
Division of Water Quality,Information Processing Unit,
1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: 2'0 (ft.)
10b. For Infection Wells: In addition to sending the form to the address in 10a
0.75 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
P
loc. For Water Supply&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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
6f.Inner casing/tubing length(if known): (ft.) where abandoned.
I
t
r ,
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water ality Revised March 2013
• I ,

I
I:
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells f iI
1.Well Contractor Information: WELL ABANDONMENT DETAILS
'
7a.Number of wells being abandoned
ed: 1
JAMES MORRISON
Well Contractor Name(or well owner personally abandoning well on his/her property) For ntulliple injection or non-irate supply wellsONLY with the saine
cons•tructionlabandonntent,you can submit aI form.
C -4421 23.5
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
l ...
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name ""'�••
7e.Type of disinfectant used:
n
2.Well Construction Permit#: I � Z ?023
List all applicable well construction permits(i.e.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 ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: IZI Bentonite Slurry ❑ Other(explain under 7g)
Monitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 42.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/18/22
5a.Well location: !
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) g.Certification:
201 PHOENIX STREET STATESVILLE 28677 "`^` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with l 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:
(ifwell field,one Iat/lottg is sufficient) 9.Site diagram or additional well details:
350 47' 15.53" 800 54' 58.32" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEiNG ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple h jection or non-water supply
wells ONLY with the same construction/abandonment,you cat submit one form. 10a. For All Wells: Submit this'form within 30 days of completion of well
6a.Well ID#: AS-30 abandonment to the following: i
Division of Water Quality,Information Processing Unit,
65.0 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b. For infection Wells: In addition to sending the form to the address in 10a
4.0 2.0 above,also submit one copy of this form within 30 days of completion of well
Gc.Borehole diameter: / (in.) abandonment to the following:
i
Gd.Water level below ground surface: 29.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
i
10c.For Water Supply& iniectiori Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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
6111 Inner casing/tubing length(if known): (ft.) where abandoned. I j
6g.Screen length(if known):
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

I �
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON ! 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple itjection or non-irarerj supply wells ONLY with tine same
constructiott/abandonment,you can submit one farm.
C -4421
NC Well Contractor Certification Number 7b.Approximate volume of water i emaining in well(s): 13.0 (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7e.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.Counly,State,Variance,etc.)ifknown 7d.Amount of disinfectant used:
3.Well use(check well use): jf��_u'I' ,
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chipg-6 I Ol is
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: El Bentonite Slurry ❑Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 35.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/17/22
5a.Well location: -
KINDER MORGAN
Facility/Owner Name Facility 1D#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 ""`^' 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, /hereby certify that the ivell(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with I5A NCAC 02C.0/00 or 2C.0200 Well Constnuction 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]at/long is sufficient) 9.Site diagram or additional well details:
350 47' 15.53" 800 54' 58.32" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply
wells ONLY with the satme constructioniabandonutent,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: EW-10 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth: 54.0 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
4.0 2.0 above,also submit one copy of this form within 30 days of completion of well
Gc.Borehole diameter: / (in.) abandonment to the following:
34.0 Division of Water Quality,Underground Injection Control Program,
Gd.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
I,
10c.For Water Supply&Iniection Wells: In addition to sending the form to
Ge.Outer casing length(if known): (ft.) the address(es) above, also submit,one copy of this form within 30 days of
completion of well abandonment io,the county health department of the county
where abandoned.
6E Inner casing/tubing length(if known):
i
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
I

I
WELL ABANDONMENT RECORD For Internal Use ONLY: I'
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number I 1 1
of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple itjection or non-water supply wells ONLY with the some
C - 4421
construction/abandonment,you can subnmt one form.
I.-
7b.Approximate volume of water ei wining in well(s): 19'0
NC Well Contractor Certification Number (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS'ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.Courtly,State,Variance,etc)ifknown JAN
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply): a>e. ., =•::�Iti;;;;
❑Neat Cement Grout ❑ Bentonite Chi or Pellets
❑Agricultural ❑Municipal/Public P
❑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: El Bentonite Slurry ❑ Other(explain under 7g)
RIMonitoring ❑Recovery
injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 39.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
d.Date well(s)abandoned: 1 1/17/22
5a.Well location: i
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
201 PHOENIX STREET STATESVILLE 28677 •.. 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the well(s) was (were)abandoned in
County Parcel identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Consiniction 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 W/long is sufficient) 9.Site diagram or additional well details:
350 e 47' 16.20" 80 54' 58.50 You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if arailable. For multiple itjection or non-water supply
wells ONLY with the same construction/abandonment,you can subiuit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: EH-23 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth: 60.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For infection Wells: in addition to sending the form to the address in i0a
4.0 2.0 above,also submit one copy of this form within 30 days of completion of well
Gc.Borehole diameter: / (in.) abandonment to the following:
Gd.Water level below ground surface: 31.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Sumnly&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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
Gf.Inner casing/tubing length(if known): (ft.) where abandoned.
I
I .
6g.Screen length(if known):
i
Form OW-30 North Carolina Department of Environment and Natural Resources-Division of Water QI ality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY: i
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned
: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-wa'te'r supply wells ONLY ivilh the same
construction/abandonment,you can subnitl ane form.
C -4421 I i 19.0
NC Well Contractor Certification Number 7b.Approximate volume of wateriremaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS'ONLY:
Company Name 7c.Type of disinfectant used:
5 l i
2.Well Construction Permit#: _V d-
List all applicable well construction permils(i.e.County,State,Variance,etc)ifknown 7d.Amount of disinfectant used:i JAN 7� _
3.Well use(check well use): "^
Water Supply Well: 7e.Scaling materials used(check all that apply): b`b: ✓�J V �J 'lln
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or ellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: 171 Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 39.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/18/22
5a.Well location: -
KINDER MORGAN
Facility/Owner Name Facility iD#(if applicable) g•Certification: } ,
201 PHOENIX STREET STATESVILLE 28677 y '"`"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the ivell(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0i00 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:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
350 47' 17.44" 800 54' 57.96" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Aaach well construction record(s)if available. For multiple b jectimt or non-wafer supply
wells ONLY with the same constructioniabandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well iD#: EH-4 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 60.0 (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: 4.0/2.0 (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: 30.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
loc.For Water Sunaly&Iniection'Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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 abandoned.
6f.Inner casing/tubing length(if known): (ft.)
i �
6g.Screen length(if known):
i
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abando ed: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple ityectioh or non-water supply ire//r ONLY with the same
C - 4421
construction/abandonment,you can submit one form.
Ire�m 19.0
NC Well Contractor Certification Number 7b.Approximate volume of water aining in well(s): (gal.)
i
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLSONLY: �` ~� `7—
Company Name 7c.Type of disinfectant used:2.Well Construction Permit#: 1 i ✓ 2023
List all applicable well construction permits•(i.e.County,Stare,Variance,etc.)ifknown 7d.Amount of disinfectant used
3.Well use(check well use): vSa (]G^
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑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: 173 Bentonite Slurry ❑Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 39.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/1 8/22
5a.Well location: —
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 "`^' 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the ivell(s)was (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 well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one]at/long is sufficient) 9.Site diagram or additional well details:
350 47' 18.50" 800 54' 58.34" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(y)if available. For multiple h jeclion or non-water supply
wells ONLY with the same constructionlabandotunehtt,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: EH-22 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth: 60.0 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in l0a
4.0/2.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
I'
6d.Water level below ground surface: 31.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment io the county health department of the county
611 where abandoned.
Inner casing/tubing length(if known): (ft.)
1 i
6g.Screen length(if known): (ft.)
i
f
Font GW-30 North Carolina Department of Environtnettt and Natural Resources-Division of Water Quality Revised March 2013
f i

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON t I 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-crater supply melts ONLY with the some
C -4421
construction/abandonment,you can suborn one form.
7b.Approximate volume of water remainin in wells• 16.25 al
NC Well Contractor Certification Number PP g O' (gal.)
I i
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS'ONLY:
Company Name o'�. .L,y`1'= •/
7c.Type of disinfectant used: �1 d_
2.Well Construction Permit#: 'A N 1 ,fit Zoz3 u
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown 7d.Amount of disinfectant used:'
ICJ
3.Well use(check well use):
7e.Sealing materials used check all.that apply):
Water Supply Well: g (
❑Agricultural ❑Municipal/Public ❑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: El Bentonite Slurry ❑ Other(explain under 7g)
InMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 39.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/18/22
- 5a.Well-location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 ' "`"°° 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the wells)was (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:
(if well field,one]at/long is sufficient) 9.Site diagram or additional well details:
350 47' 17.91" N 800 54' 56.78" 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(i)if available. ror multiple h jection at-non-water supply
wells ONLY with the same construction/abamlonutent,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: EH-19 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 61.0 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
4,0 2.0 above,also submit one copy of this form within 30 days of completion of well
Gc.Borehole diameter: / (in.) abandonment to the following:
6d.Water level below ground surface: 36.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit bne copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length(if known): (ft.) where abandoned. �
I
6g.Screen length(if known): (ft.)
Form OW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON i 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-s later .supply wells ONLY with the same
construction/abandonment,you can subudl)one form.
C - 4421 1 1 24.25
NC Well Contractor Certification Number 7b.Approximate volume of water I'remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLYWELLSONLY:
Company Name
7c.Type of disinfectant used: 1' ryn
2.Well Construction Permit#: A N L L'��.
List all applicable well construction permits(i.e.County,State,flariance,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 ❑ 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 i ❑ Gravel
Non-Water Supply Well: O Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 40.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/18/22
5a.Well location:
KINDER MORGAN I
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 '''"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 a•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:
350 47' 17.89" N 800 54' 59.36" 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)if available. For multiple injection or non-water supply
wells ONLY with the same constructionlabondmrntettt,you can submit one form. I Oa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
EH-1 1 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 62.0 (ft,) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in I0a
4.0 2.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: / (in.) abandonment to the following:
I
6d.Water level below ground surface: 25.0 (ft,) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I, I
10c. For Water Supply& Iniectiori Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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 abandoned. I
611 Inner casing/tubing length(if known): (ft.)
i
6g.Screen length(if known): (ft.)
i
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water QIua ity Revised March 2013
i

f
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For mulliple injection or non-u6ler supply wells ONLY with the same
C -4421 construction/abandonment,you can subnut one form.
7b.Approximate volume of water r Imaining in well(s): 16.25
NC Well Contractor Certification Number (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLSIONLY:
Company Name 7c.Type of disinfectant used:
v �.
2.Well Construction Permit#:
List all applicable well construction peratils(1.e.County,Slate,Mariance,etc)ifknown
7d.Amount of disinfectant used:-. Itie'si:i >^3r ,r`l
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all4hat apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout i ❑ 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: 0 Bentonite Slurry ❑ Other(explain under 7g)
MMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 36.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g•Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain tinder 7g)
4.Date well(s)abandoned: 1 1/18/22
5a.Well location: -
1
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 '' 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the ivell(s)was (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 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:
350 47' 16.75" 800 54' 56.82" You may use the back of this page provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple it jection or non-crater supply
we/Lr ONLY with the same construcaonlabandonmeni,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
EH-24 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth 55.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
4.0/2.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: 30.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Sunnly&Infection;Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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 abandoned.
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known):
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Qality Revised March 2013