WQ0000484_More Information (Received)_20230203

Terra Science &Engineering Consultants
S511 Keisler Dr # 102, Cary, NC 27518 1919.858.9898
VIA email: [e-mail]
February 3, 2023
Ehsan Bagheri
Division of Water Resources
North Carolina Department of Environmental Quality
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, North Carolina 28301
Reference: Supplemental Information Regarding Permit Application No. WQ0000484
Mountaire Farms — Lumber Bridge WWTP
Wastewater Irrigation System
Robeson County, North Carolina
Dear Ehsan:
SynTerra submits this Supplementation Information Regarding Permit Application No.
WQ0000484 on behalf of Mountaire Farms Inc. (Mountaire) for the above -referenced Lumber
Bridge Plant (Figure 1). The information herein is to address the Additional Information Request
dated January 5, 2023. NCDEQ's information requests and our respective responses are
presented below.
Request 1: To ascertain the appropriate compliance boundary (in accordance with 15A NCAC
02L .0107(c)) for your irrigation sites, the originally permitted irrigation fields (approximately
120 acres) need to be identified. During our application review we could not clearly discern
these fields, and we requested this information in the email accompanying the draft permit
sent on December 16, 2022. Since no relevant information was provided in your response email
dated December 29, 2022, we are formally requesting that you identify the original 120 acres
(including the field names) that pre -date 1983.
Response: The original irrigation fields included fields A, B, C, E, F, and G which totaled
approximately 119.007 acres (Table 1). Records from 2009 specify that Field C had an area of
29.99 acres, larger than its current size. Field C has since been reduced in size due to the facility
expansion. Figure 1 depicts the current field sizes of Fields A, B, E, F, and G. The aerial
photograph of Figure 1 shows the size of the Field C.
synterracorp.com

Application to Construct Monitoring Wells
Alvarado Holdings Property
February 3, 2023
Page 2
Request 2: Pursuant to Condition 1.6 in Permit No. WQ0000484 issued March 8, 2018, we
request you to provide well Abandonment Records (GW-30s) for monitoring wells MW-16,
MW-17, MW-26, MW-27, MW-32, MW-38, MW-39, MW-44, MW-45, and MW-46.
Response: In response to this request, the well abandonment records (GW-30s) for monitoring
wells MW-16, MW-17, MW-26, MW-27, MW- 32, MW-38, MW-39, MW-44, MW-45, and MW-
46 are included as an attachment to this letter .
Request 3: The active monitoring wells listed in your submitted application do not match those
in the Attachment C of Permit No. WQ0000484 issued September 11, 2019. Please provide us
the status of monitoring wells MW-8, MW-18, MW-19, MW-20, MW-24, MW-25, MW-28, MW-
29, MW-31, MW-33, MW-34, MW-35, MW-36, MW-40, MW-41, MW-42, and MW-43. If any of
these wells have been permanently abandoned, please submit the GW-30 abandonment
records.
Response: In response to this request our most recent records indicate that the listed
monitoring wells are active and have not been abandoned. The list of currently active wells and
their locations can also be found in Figure 1.
Please contact me at [phone] or via email at [e-mail] if you have any
questions.
Sincerely,
SynTerra
van M. Hamo, P.G.
Project Geologist
Attachments: Figure 1
Table 1
Senior Peer Review
603���
Tom S. Dunham, P.G.
Senior Geologist
Well Closure Documents
synterracorp.com
P:\_Cary\Mountaire\Lumber Bridge\Lumber Bridge Additional Permit Info\Letter with Attachemnts\Letter of Supplemental Information.docx

Well ID
Latitude
Longitude
Ground Elevation (feet ms1)
Casing Elevation (feet msl)
Depth to Water
(fee[ below top of casing)
MW8
34.8728
-79-0097
199.90
202.33
5.0
MWt4
34.8716
-79.0094
200.79
203.96
5.3
MW15
34.8701
-79.1017
196.84
196.94
8.3
MW16
34.8774
-79.1068
200.75
202.13
N/A
MW 17
34.8743
-79.1 t 10
195.52
197.32
N/A
MW18
34.8763
-79.1023
199.00
200.98
7.2
MWt9
34.8678
-79.1095
189.15
191.09
6.8
MW20
34.8686
-79.1092
188.08
190.25
5.1
MW24
34.8800
-79.1118
204.35
207.58
9.8
MW25
34.8802
-79.1066
203.57
205.33
3.3
MW26
34.8758
-79.1124
200.26
202.66
N/A
MW27
34.8745
-79.1098
197.03
199.54
N/A
MW28
34.8782
-79.1026
203.51
206.41
to.1
MW29
34.8775
-79.1139
201.01
203.26
12.0
MW31
34.8818
-79.1166
208.72
212.43
LLI
MW32
34.8823
-79.1196
195.64
199.72
N/A
MW33
34.8873
-79.1210
205.10
208.96
13.1
MW34 1
34.8901
-79.1122
1 205.50
208.05
6.5
MW35
34.8907
-79.1085
203.02
205.87
7.4
MW36
34.9860
-79.1092
208.04
210.99
12.5
MW37
34.8682
-79.1046
192.11
195.78
8.6
MW38
34.8764
-79.1237
195.50
198.19
N/A
MW39
34.8756
-79.1210
194.76
198.22
N/A
MW40
34.9691
-79.1248
200.02
203.12
5.6
MW41
34.8646
-79.1241
203.31
205.36
4.2
MW42
34.8763
-79.1149
192.51
195.50
5.7
MW43
34.8575
-79.1197
200.97
204.27
5.2
MW44
34.8639
-79.1114
192.81
195.32
N/A
MW45
34.8598
-79.1124
197.5t
200.46
N/A
MW46
34.8718
-79.1173
193.97
197.20
N/A
MW47
34.8682
-79.1046
190.17
192.95
4.0
MW48
34.8764
-79.1237
194.40
197.42
8.2
MW49
34.9756
-79.1210
185.01
187.86
7.1
MW50
34.8691
-79.1248
191.38
194.33
4.8
MW51
34.8646
-79.1241
186.76
190.11
5.0
MW52
34.8763
-79.1149
189.53
192.91
6.9
MW53 1
34.8575
1 -79.1197
1 209.93
212.85
4.0
MW54 1
34.8639
1 -79.1114
1 194.34
197.55
7.9
MW55 1
34,8598
1 -79.1124
1 198.61
201.54
7.0
MW56 1
34.8637
1 -79.1251
1 202.06
205.31
5.0
Note_ Blue shaded
cells represent monitoring
wells installed
in July 2f118
Red shaded cells represeol monitoring wells abandoned
io June 2018
/
N,A-N,t Av I,blc
a\/
I
e� MW-34
200
s
\
a,
jai
ay Fie
198
M5
/
s�/�sai
0
196
i
i
/
mat
Leo
Spray Fiel
00
_
a Spray Field
Spray to
M2
K
/
Spray Field
10/
:
MW-33 eN
M1
a
192
l y( PO /
a
194
MW-36
Spray Field ` - -�
M3
I Spray Field \ /
J 1 /
192 ��
- �� 190 � � I �
m�
1 -owned by
Buttcrball, Inc.
188 \CIO o -32
MW-47 SprayField MW-31
186
^ /m
186 �\ MW-24
/ \
Spray Id
ceMW-51 \ Ra - Owned y /
\ \ a\ Spray Field ✓ Ro rt L. Van oy
"> S Rapid Infiltration
6 sins
Cc�\ 1 a1 m� / MW-29 5�
00 \
c
/ ad
0� s MW-38 _ _
-RB \ \BO
l Re/ ray Fiel E s MW-39 MW-48 M W-26
\
�a l /. \ d
\ a Spra
190 / MW-52 \
> \ o MW-27
MW-17 e
Spray Fi / � 4 -Own by
T / Robert L. Van oy
a Spray Field
Sp y Field B
Spray Field \ aB < MW-49 Spray Field
N \ A
MW-46� MW-50
� / I
Spray eld Stormwater 'in \ \ Irrigation
196 U l MW-53 �, 0 Pond
MW-40 m
�. _� De
Spray Field Spray Field 1 MW-20
VI V2
\ Bl MW-19
198
Spray Field M W-42 �
O \ \
\a eJ\
d
I Spray eld
W
Spra Field
200 P S
L �\
ce
\ MW-41 PMW-54 -
\ Spray Field
MW-56 \ca Bb� R MW-44 \
\ -Ba-
ce ��
Spray Field o \
Q d
\gym \ \ \ 190
\ 194 \�
\ \ 192
cB RBA MW-55
d
y
MW-2�`
a�
\ 200
ce
\ 198
Spray Field
MW-28
MW-16
d0
MW-18
Field I 0n
F
oe
MW-8
Spray F Id /000
C /
Stormwater Basin MW-14
/ 198
196
A�MW-15 194 ;
192
19
188
• /, MW-37�_
\
184
l84
/ 186
Co ImlCornr
YG
. rid Mont
1 88 )83 Datum047 .4181
NAD 83 Datum
N=124039.271'
E=600113.079'
186 Scale Factor-0.9998910
198
MW-45
Legend
196
d
Boundary of Subject Site
Boundary of Tax Parcel
0'IXI/ / Spray Field
0
/ Xl
/
<
Spray Field e0
198
0
Boundary of Irrigation Field
MW-43
Z
/<\
-CB-CB-CB-
Irrigation Field Compliance Boundary
om \'gym
> > -P�
/ \�a �- �0�
-RB-RB-RB-
Irrigation Field Review Boundary
���\ \°av �e
-CB-CB-CB-
Proposed Review/Compliance Boundary
9 \�d
\�
\0
\ \
\
-RB-RB-RB-
Adjusted, Prior Review Boundary
\
\
om \ Spray Field
>
Boundary of Water Bodies
l X2
\ / lz
- G - G - G -
Buried Natural Gas Line
Overhead Powerlines
Control Corner
.C. Grid Monument "ROY"
��II II II
TTTTT
Railroad Tracks
N 83 Datum
N=4 30.497709'
E=196 2.51706'
Existing Monitoring Wells
Scale Fac - .
Monitoring Wells Abandoned in June 2018
PROPERTY SURVEYAND CONTROL POINTS PROVIDED BY:
Potentiometric Surface Contour (Dashed
POWERS LAN SURVEYING, P.A. LUMBERTON, NORTH CAROLINA
HORIZONTAL CONTROL N.C. NAD 83 DATUM. VERTICAL CONTROL USGS DATUM.
"MARVAL"
a«
Where Inferred)
CONTROL POINT: N.C. GRID MON.
LATITUDE: 34"-52'-05.25540
lj
Zee
LONGITUDE:79'-06'-13.61113
03
(194.54)
Groundwater Elevation 1n Feet (amsl)
0 600' 1000'
Note: Data from MW-31 and MW-53 not included in potentiometric surface contours.
Potentiometric Surface Elevation for August
18, 2018
DUNCKLEE & DUNHAM
Mountaire Farms of North Carolina
•
ENVIRONMENTAL
GEOLOGISTS & ENGINEERS
Lumber Bridge, North Carolina
Drawn By:
Checked By:
Project Number:
Date:
References:
Scale:
Size:
Layers:
511 Keisler Drive Suite 102
[phone]
Robeson County GIS, NC OneMap
Cary, North Carolina 27518
www.dunckleedunham.com
pj s
2017145
June 2019
Aerial-2013, Base Map features provided by
Ill -
600'
2211 x 34"
013_$110J2.16122.27
NC Eng. License No. C-3559
NC Geo. License No. C-261
Cabe Associates Inc. Consulting Engineers
P:\Mountaire\Lumber Bridge\WW Irrig Sys Appl-2017145\CAD\Site Map.dwg

Table 1
Lumber Bridge Sprayfield Totals
Field ID
Acres
Notes
A
8.25
B
6.75
C
29.99
Acres in 12/2009
D
0
Not Developed
E
0
Not Developed
F
26.527
G
1 47.49
Tota 1 119.007

Divider
Page

NVEL1. ABANDONIIIENT RECORD
lob r,'nu, cn he used his mao, is, midripk o5i,
1. Well I ontracmr INnrinArinn:
Michael Nilson
lfdl l lnna.+pf N:nrc .... ..dl nu ml R'r,mWh 1vraklmu_ olio •m rah lai In'nkm 1
F•v r.n. ,A I •, ONI Y
WELT. ARANDONMTNT RFTAIIS —
7a. Nonbrr "("ells being al)andoned: 1
�.�� vn✓apt. �•... �r �-.,.,n• u; •: •;,
.A..........N'r.l • n,..u..vri'Flll.,n,"G.IF•
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SAEDACCO Inc FOR 11'ATF'R SCPPI N W' EI A N ON 1.1:
/'•mwnn, R.Ina f) PC.'( dlwolaxlant used:
:. Well Contraction Prevail
.. ..Nl q•pi,. e0, •.•ill. ...... .,nl NGNr rnnorwr lm'•'Jnne. .'n ).......:
?d. 1numnl if disinlcctael ward:
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❑Qcra kmil iflcauna-Cof lat" Sul.Plc1
❑ inhiwt11Aoanssciewl
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❑.Altolen Ieri
DEXPrnnsemal lalamloIz,
r.ICw'otlwrtnnl (Closed I:oopl
7- Date mllsslahandnnedo 7/9/2018
Sa. Well krroth)n:
❑hlunKtpd'AIdIK
❑Rttidcmnl Witter SuMh statute,
❑Reskieuiul Winn Stgmhishsn-dl
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❑Salaam Flamer
❑5m�J.rwrawer Drainage
Clsubuidewc ('anal
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1:1 RcNonne ('hips of Polkta
❑ Sand yentas ( dour
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❑ time[
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I (tier 1e(pklai splint -v,
7f. Fur each m.nrrial wlcmd Alane. In'Inidr anunnw n( naalrriAla nird:
Neat Cem.:9A lb lb , Wtr:7galgalSand Cem.:lb ,Wtr:gal.
79. Pros iM a brk-r dcacriptkm of the ubundooment Pnscrdurt:
Grouted well from bottom to
Mountaire Farms
Rears, .inn Nnnv r•caa. InN. d:nrola:.hl.'. N. (C/atilkalionn; 17269 MC-71 Bwr N. Lumber Bridge. NC 28357 iA N i /i D // )/irDAsf 7/23/2018
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t',111.1,
r.nc:r Idann•.::n,.n ru.:rr.I
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1. nd1 rclJ .•m I.n
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mid Nod n apt :!f lln.v rcl an!!an heal rmn'ul..J l� • !!i:.' a i+..., urn
a. Silr diagram hr additional e'etl details:
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�1' d.:uukmaknu dd:db. 1':w note ulx .ul:a:b;dditxnwl Ixipea d mressun
(ONS'I III (II(1\ 11IFTAI1SOFMIKA.ISI RFI\(:ABANDONED SCRAIITFAL INSTRUCTIONS
uvl.,, . .. rv.. s.. m:A"rcn.� i..., n. .'rv.•., .1. l .lu' 1'
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be. &mhulr Aianxlrr.2
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10A. For All 1\db. Stlbnul 1 HU Iona iris an •u u h .ongrkluo, aI of: I
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Ph isthn of Water Roonrreo. Information Ptucearng Unit.
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Didahm of \\ Ater Re+unn'o. 1 odrnlrsmnd Inµ'rilon (enlml Program.
I636 Mail Senirr Center. Ralcielt. NC ?7h99-1h3[I
Ilk•. Fur Water Sulrola A Iniaelhm \Yell,: In :uklihon (O wabng life (i.ml a,
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I.K. SCI"it Icngth (if knhnn l: 1ft.)
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WELL ABANDONINIENTRECORD
kv IW." .:In h,- used fi„ wwk, or -
I litsell WTTL ARANDIONWN't DETAILS
Michael Wilson 7A.
OVIF I
3351 A
N( IkIll, Netter"
SAKDACCO Inc
I '..,.Ieelee, Nalm
1. Well Cosimirudion Permit 0:
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LIA-gs-11,01111111.11
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r tCvitsevinil jvl,,x,l Lees-ni
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5A. Illicit hwation:
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nitcNidenum water surerh lesser v ii,
0kcademcd %%':act S'itpreh ishalred
D(itoundis,140 Kellwdl-lllvll
r1sall'uh Ilarrier
0SIorefi%altar LIntio-VI:
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FOR iele A URSUPPIA N% 11 I-S ONI 1:
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7e. Scaling sowlerrA. efrd (Chock All that arsibl) V
M Nrif Ccnicsa (itow
r I Flelvorlile rhea w TUICI\
CJ Sand L Crean I'mill
rl Dn L LA
rl ( onerfuls: I'lout
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71 tw.oel
I , rkeivoints: Slurn
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7f. For earl, "wee vil w1cried ahow, swosue Anniuvol ter ustAieriAt. vtorst:
Neat Cene.;94 lb lb Wtr:7qalgalSand Cem.:1b
T9. Protest,- a briefdrwriloutsif wl file jbAndi,sioncon isrocedwe:
Grouted well from bottom
Hountaire Firrial;
17.vellll (1,1111 'Ll",
17269 KC-71 Hwy N.
-
r"I", ID.A. "r..Ml, ",
Lumber Bridge, NC 28357
a.
7/23/2018
kddl,4, - 1, - on /.,,1
Robeson
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Sh. latitude and lingluote iu trittruvininuirvetwor, or oleffillAt dre"i':
.1 "d, 11,14 ^m It, War r
9 ONSTRII TION DETAILS OF 11% E11-1.6i BFING ABANDONED
..... .....
4.A- Iist ell 111,:MW-39
61'. Wal"ell sIvIlib: 15 ill.1
III. HL.Mholl lJiAlnVfCl: 2
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ts..Iiiv diserfamor Additional well dirgaiIN:
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lbord-noliclif so the tollo,%1ne
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NVELL ABANDONNIENT RECORD
Nos li+nu:ao he o_rd !•x s11,uk of ondfipk "Vil,
I. Nell Cnntrarmr InformAtion:
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3351 A
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SASDACCO Inc
2. Well Con,/ructhlo Pmnll N:,_c. ..—_—_..... ._----
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1. well Rw fcbeLk well user:
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❑Sdnid,ice ('ularof
I lTru'Cr
Fur t•9rn1;11 t'.e OSI 'r
R'EII.ARANDONMEN't DF.TAIIS
?A. Nnmlrer of well, luting Abandoned: 1
11101pM1 .1.11.6-1 xni. �.� �. ONI.I ..n n .inn.
.. i.Lu .0 9............. n. od..n,n... ,1.,,,
7b. Appmeimale solutric of w miff remaining in wdlisl: (Ad.)
FOR N14 FTR SITPI.Y M FLI S ONIA:
7r. I)pc of dninfar'tllu used:
7d. 4m.wnt of d'uinfcclaot uwd:
7e. Scaling material. awd (rlu'Li. At that ,grill) 1:
Naito Cement Drool 1-1 Rcrainnrc f'op. or Pellets
❑ Swd I cluent tmoa
❑i MYtc Grow
Cl Slrecraln tlrUUl
n Rwa.vnle Shorn
❑ On I. LA
CI Unll ('w11m'a
(irncl
It n[ho (r Cp(n1111odCl 7g1
7f. For each maireial wdcrlyd alwi e. pros ide anuoun or atalrriAl. uied:
Neat Cem.:94 lb lb , Wtr:7galgalSand Cem.:lb
Prm file a Intief dew'ripnun.d the Abandonment pracedurc:
Grouted well from bottom to
Nountaire Harms
P.R11m'(hvn Moor fc,In!ID'ni �gq.Ir.Alr� A�C/r�rlRkafhm:
17269 NC-72 Nwy N. Lumber Bridge, NC 28357 �/J//1A! �i rNY.'Il 7/23/2018
I•lodael.addrain ld,..+td Zw ,../nor:.., 1: '1!(,nm. Dag
Robeson hl owww rh;t I..rv. 7h.:'rhI nn BAN rn, a,$.,,
!'a.unr Isrnal FLnlrl-_N«ar M.. ,I'!'.1 ,...o.Lwr0 o. o.! i 11r I1''! Y' ohA'..•_ 1 .1Va. I17A r.unao. a..u.b,n.u,.-,1.
non .d Chu rv. nrd il,l, hen:14 noJrd s. 111. u.. .... w,
5h, latitude And hmgflude hr M•pn l's:minuirw'wamd. er drrintal dL'pl't's +:
niwdcr.Fl mra I+I bin; r. nGew:l r.
("(INSTRUCTION DETAIi v OF R EIJASI BEING ADANDONED
cur„ ....... r..• ...�,f, .. .n. ... ...... r:•rv'.. n.,., .,............
u. n•r1\LI'u..r .. .,, .., u,. .. .n:.A..mr. �.. r. n....n.
A.A. Nell llfr:NN-«
1.11, pool well depth: 15
ic. Ih,rchulr Illallw'Ifr; 2 fin.)
,d& \later h+el helon ground wlrface: Ifl.t
9. Site diagram 'or AdditlnnAl well Miailu
Y.,u own use, de bA'F of dos Isige to Iuosule addworrd ocll al, dcbols nl odd
:drwd.nmwlu Jc(m] 1'uu ow Aw duwil alkh"mul 1xigo if lwr,asan
Loa. For All NcR.: Stlhmtl this local within :u dm> of cwllpkinni 4 ucll
.dmrdn!unew w rtw follnrme
Ifhufnn of \1 Ater RrwmrcLti. Informulinn P111CC sing lrnit.
1617 Mall Srnlce ("entff. Raleigh. SC 27-1,19-1617
I'll, For loismion Ndla: In.nhdoual to wilding Ow 1'ornl to lie ,KWI,sb n1 eat
:dun¢. ALu submit olo, copy of III* hen, „r16i11 21. days ad' cwrndelhn, of cell
.Ibaldmnlwnl to dw lollowula
11hi+Inn of N airr Rea wimm. l: ndcrgnanol Injection ( unto of Program.
1636 NIAB Senler Center. Raleigh. 1( 27699-1616
Inc. For Rater Supnis & Infection NCR : Ir. ;nWitwo nr .ails); da Lent :o
M•.1 ulcr Ca.ing length lif l.wlwlr.: M.) Ilk :wmisoe>, atKoe. ;dw) <Idrllol Olc dopy •.i 1111s howl whin,$ 11, .Los .i
_:a11*11oo of mill .lhaiihnnncnl to 11w colarn 11011111 d:pinman A Ilw ..ullao
mute +haMnrcd
61. Inner cuwnzonihing length (if knowne Ok,
f.g. Screen length (if Msnnl: 1R.r
I.nr I.'N.,:, Y, nlhl.wrhla?4`ill,bli:n•.16a,1•,.niF:a.h«I'On,n:a l!.N,h:i('. L11''nhr11y1 \1'AId 85Uh0.cc '1r. ..J br"I. I:

NVELLABANDON:NIENTREC'ORD L.rrn'..o>:I',
11r I:ulo cur he uieJ Fit ,nr¢I: nl urvl; rydI "tdb
I. \1 ell t lmn'arn,r Inlnnnatiun: R'F:1.1. AR\NIIONMEM1''1 DFT � I!?
Michael Wilson 7A. Nnnher tit "ell.' hrmL alranibmcd: 1
Hrdrrrl ......... r�.. �.e II\(1 ... ��
3351 A
'Ji \tali C.vnr�cwr t'anr^..amitiunbcr
SAEDACCO Inc
f,n+ram fan•:
:. \l rl I (unwvclinn 1•arndl k: , _
3. \l'rll ux lchtxk"ell uul:
❑Agn. llrrlrll
❑(itnlhemrdI earnur.:('nnling SupithI
❑inluunll:( onnrsntal
z
❑Appiler RCLlI;rgc
uAyitrtcl i4nr.�r.n.1 Kra" rrt
❑:bymha Isl
❑[tprnmcnWl I tctinukn�
II'0.JtIKOii'JI (1'10.4'il I.MJiI
1. DAte grill,) AhanJnned: 7/9/2018
54. N%Vll locution:
ClAhuvn(sllAlhtu
❑Rcsilklaml Witter Spoilt* lemcim
011"dclninl Wald Si pithIsheemdr
OCinnlrAfiuuci Kuiod.ltieu
05,111nitt Ucuner
❑S 1, m"iater Drat mwe
LlSubstikrme CUtilnil
I Twar
7l) loppnrzinrAtc volume tit' m aler retnaitunk n v rllt.l:
FOR 161VTFR SUPPI.b \l'FI IS ONIA:
7" T} pr of diwnktYam usrJ:
?d. Anu,nu of di,ird'rruul u.rJ:
7e. SCAllin$ nkil l• to rd IchrcL all Thal apph I
It Nclt I"cnlunt (in'on
I Rnaonlic Clnte poi rl•Ekls
❑ SnM ( entrul I emit
CI Un ( it,
El f ono. ele Umul
CI Drift Culllli_az
❑ Spenalli Ciruul
Cl (;rile\
11 Rrl'(Olitle Shirr%
I I rltlwt i'%jit.inl millet 'o
7f For t'ac'll nriteriAl "'Ruled Alit e. Dent loll, atimina "r nimeriAl. site,[:
Neat Cell :94 lb 1b , Wtr:7galgalSand Cem.:lb ,Wtr:gal.
72. Protide a Irriel' dex'riptiou of the abandonment procedure:
Grouted well from bottom to top.
Mountaire Farms,
n:(hv... I 1-1::11n1 Ii1. [",I. ddr Y. 1 I [llit lllnn
17269 NC-71 Hwy N. Lumber Bridge, NC 28357 _��/{y/r//� ��/1/•J/,/r/J./7�JJ/.� 7/23/2018
I l . cr A lddre.,. I'.r ,:uui r: r;r •"-:' r . I_ rc tl .. �'N� I� I ✓ I -rain
Robeson sir •e.�:• ;:r.. .�r r r. .'
1'u.n.l. 1'nmd LLriL-nxnL•. 19'•r ��.i. � .. �� � r�..� ���,. . �... r....
Mo. I.Atinulr Anil low!iwdr in drLl rt.rninuo-.:wnrud. or defullal degerrs:
r.,,d'14 e, ho k,n¢ r Alin: _, ,
N
'r. Sill IliALr:uu to -idJi uroul "r11 1,'1.ul.:
V"Ll sir.. uv r 1. L u i.. n i 1, I'.Iz. I, r p ....I; JJ.' n vol :,Ill •,u, doml•, e, 'il dl
1l IN1164Wlitil Jl-i:d_ I.Iuu:+. .16,r r'd._u :1-1] 1 1`,11Ve 1]1Kie+un
CON.S7 RUt-TION RETAl15 OF \l El-lA SI BFING AB AN DOM1 ED
.. r7 ..
rr\LI r '. e-1
i.A.l ell IlI.:MW-45
64. IutAl"ell dfiflu 15 111.1
or. lktn'Nolc dlAnn•Irr:2 Cra.l
I.& \\' air I Irt rl bdo" Lrnond 41rfarr.
S(. RA11TT 41. INSTRUCTIONS
111a. For .All \bell.: Snhnul fill loan notion A: dAlx of ,:Inuplulrnu of tall
ahittldunntcn: In rhr tnllearnc
Di,v%vin tit Biter Retonrur,. Infonnalion PrucestinL Unit.
lot- 161.0 Senit'r ( enter. Raleigh. %(' : -69i1-161
IJIL. Po, lot,crr n"elfC top .R1,111,111111.>[IIdIn I; lIW 11-11111u 114'.0111111 It. l:. l:l
iv.rnw aw ralnal; ,•sic .opy of Ihas linen "nIn11 to, Ja%i ul.unlcldbaa of ";II
iholdtrluucnl In Ike *dlnu me
Di.i>Inn ur \l'Ak, Ncsoan'o-. 1. ndrrul utnd Interiloot ( annul Prou'Aln.
16.76 Alai{ Srnter [cater. RAleigis. N(' I7er9n-1636
i.e. Outer cation_ IenLrh (if tenon sir ift.) Inr. Fnr %Wlet Si"mh ,S loiwio l� Rill,: Ili wd...silo 6!. vifo,: it., irnm :.
Ibt aJdles,.:,I ',0Vnr :I%50 Wor, .'Ili CO{.'. ,'I Ilw, I!•nn orl to 1G%%, .'I
aunlnleuopo al "cil ah:nulomh_nr it die counn Ite:dlh demnmtem A Ile: _:mn.,
"here lba ,,to tcd
ol. hmrr raaint!aulrm_ k•nk'Ih kn o"no: il'Lr
6y, Srrern Icul;ih !If km". n I: I Yid
I u rti..n .nil 1'Jr. `kF-1 x.l •:r �'... A.uJ'A.n.n '1 r.... ..rin i mr _..Ant.. J .r..:^I'

WELL. ABANDON:NIENT RECORD
This Ineu` r:st he used to ,lack o, undrink ,tell,
i. t.{cll Lontrucelr Information:
Michael Wilson
W,nI'I•I,mrthl N.maL•t'..:Iu,us;1 Nrwnalh a6a+,F.ututc o.!Itotlur'It t I.1 ,;,
3351 A
!iC \\[I'1l•IDL,[Lnf TIfK.1119H finni.[f
SASDACCO Inc
Cenyom, Now
.. Nt91 (unafvcllnn Permit 0:
J. Well use leheck "ell utc):
ClAgrcnlrarai
❑(:cmikirt it f Hcanne-Crolins Snppltt
17:rdrr.rnd ("ativammi
ater Supply Well:
❑A4nttef Nedurgc
❑Agmfer Stornge:ud Router±.
❑Atimkr lest
❑E,pcirnannal I winailop
i(wcdk'rnstl l(kiu;d I.eop)
1. Nor a rut s) abandoned: 7/9/2018
4. Well location:
Mountaiie Farms
1::, ,1 1, (hvct Nnmc
17269 NC-71 Hwy N. Lumber
f•I1.,ICA ludrcs (III Zin
Robeson
t o olt,
CINhmlcttcll; Plfilk
❑Rrirlemtal Willer S141ph ismglel
❑Radeaial Water Slgephislmredl
LiGimtidu:up kemcdcawn
05:dnutr Ramer
❑51ortf",mer Urnmgc
❑Slbsttlewc ('utan.l
Ilfacer
Fade, IDR of anpl, .btr.
NC 28357
I`,::166nol ealxn: pin ;1'P••t
Sh, latitude uud krngiturh• In olverreunlinttrr•,.ovoind, or it root at drgrres:
u ,Icl' 41,1 .nc Ln km:• r .nfi¢ar..
of ONSTRF( TION DlfAliS (IF N E111SI HFIN( ABANDONED
�. � rt11 (u r u .. �. n ,... t n .n r •.v
ova. Weil II),:MW-46
Lb. I uW l "ell dclrth: 15 11111.1
or, [kmrhnir dimurtrr: 2
od. 1%'Ale, lend I"•b," ground mirfar'r:
.iRANDON'NIFN-r DETAILS
7a. Number of w ell., bring abandoned: I
7h. Appruclnato ,ulovine of"more rtntaining In nell(U:
FOR N'ATFR SITPIA N'FLIS ONL\':
7c'1)-pe of di infectunr used:
7d, amount of dilinfrraul uvd:
70. 4alinf Inalrnal. tt cd (Clock all that Apple)
ill Non (enter Grool
fl Rcrvoonc Ctnpt or Polkas
❑ Sand ("Comm (:not
❑ Un l hn
( orkrVW Urcnn
❑ Drill Cohn
❑ Spk lallp Urnul
❑ Urnel
Il lkrddlme l'hrrty
Il llth4r lc,plum mdcl 'V.t
7f. For rarb InAV 1u1 WICCIC41 abet,•. proud, arunnnl of maft HAk uud:
Neat Ce,.:94 lb lb ,Wtr:7galgalSand Cem.:lb ,Wtr:gal.
.A. Pru,ide a brlr•1' dewrilniuu of the uttan ionmcm prwcet ere:
Grouted well from bottom to
' axe/.t,Crnllkatbm:
7/23/2018
•r. F8a diagrue, ar addlltnnal "ell 41,1ad,:
Ypu Ina, me Ilk b.0 of dus tuec to pan uk �nldHmful Itch slt. IMa), ., s :II
'.thokiL.n"am detail:. 1 u nm) also KWII ;alddnoml Ix@xs d tkeessan
Ina. For All N'rR: Stbntu Ihfs Wool n'nhin ai •Ln's td con4dcnuu al ":II
.tbntdanmem to the tollmnng
[)I, 6i,tn of Rater Ruwurco. Information 11nan,iug t•nit.
1617 Nail Scnicc ( color. Ruldgh. N(' 27644-1617
111h. Poor lntttillon Nclla: In awiloml In Xrdnn; lk. hunt Io Ilk .ddI,Sv IN luu
'.dmc,e. alu oednnu our :op7 of dos tintn "nlun It, dats ul'runlldelu.n III loal
.d:mdu wwrl! In elk lolluu'mg
11110,6ul of Ruler Retltert'c,. 1 advrili'ound Intnylnn (tint lal Prugrmn.
1636 Mail Senior ('rotor. Raleigh. N(' 27(d)9-16K
Ule-, For W'ar,•r Sound, & Inierlkm Well,: hi cNl hnuo h, •,N,IAW it.f.'am
(•r. (later easing length lif knnx nl: dt1 Ilk ;NWkSacel :d+o,r. oNo'Ithm .,Ile e,qn A Illis fool "elms lu IL,%S .-f
conlpklum ul "cil ah.ntd.uuncm tv the :acorn luuhh ,kpltrrmest of Ilc _,?ton,
n' Ir_rc ahaMnn tl
of. Inner cusinwYubing length df knnwnr Ifl.t
og. Scr'ceo Icn Glh of Man n C IM,
J,-vl r•iv-111 ':,;p.ulns•*e.o l:nls..... .—cd W�

WELL ABANDONNIP NT RCC•ORD
I'•n�. I;I'm - w b.' us]J f n ..ILI,I: ill u'd'q•I: �..al.
1. 1\ ell l nnu'Annr Inf onnann u:
Michael Wilson
II I 1 I;r. 1 n1 , " I: r -.0 ••:.1a.'I::1
3351 A
SAEDACCO Inc
1. Ndl C onntivdiun 1'crmil d: , _
J.l{'dI uw 1[•Inrk,dl u,H:
❑Apr. d,lnl
❑(kotit:rm;d aHeanlu_-f'oolill;:! Supple)
❑hY11Hr7L11(�nelmk`felnl
Slgglk Nell:
❑A'j;Iw1 kcdwr"L
❑ Aputfcr 5toraue .n.d Hc:ot u,
❑A,ittdct Icsl
❑E%pennmlind Io.Jnmlo(:,
! itxroriknmd (C'b'Imd Loch!
L D'AIr nrlllr) Abmulnned: 7/9/2018
SA. R%Cll hrculion:
Motmtaire Farms
hmlLl, Shlr.r ;!.nrr
17269 NC-71 Huy N. Lumber
Robeson
_IhhmlclR4l: Nlhll•=
EIRcaidetnml \Gala Sllpph IGelglel
❑RL•snlelnml Water Suppis Islwmd,
of irnulhilsllct Rcnlcdi alas
0SAIIlih h:uncr
❑slonimmer Ltrmntb
❑suhsl(lercc 1. nMml
I 1 fnlC['r
ADANDONNIFNI DFIFAII x
?�. Vundmr of Hell.. bcm¢ ub:uuL.Ina•A: 1
..�. ...Ida, .. . ....._..��. L. ,.1 e1 l .., ... .. •�
?h. Appnrtinufc a ulnmr ur N stet l['111n1111r1$ (it Nrlltrl: Ipn1.)
OR Ymo'rn[ R 4Ureln'ffslrt1 MF11-4011.{
Ipe11t,hril(LI [Hel]Nofdii1clan:
uwdt
Te. Sealing InAte ial, awn) Id.vel. All ties[ 41'10%1:
at Ncn ('enle if Grow
I Berionsc Clnp+ Is, VAos
❑ Sand f ellecim (teeter
CI on (1.'14
Cl f •olk�le ('full
CI Utill (111111,
sIvoal) (.rout
Cl 6m,0
I' Rera"nurr Gum
11 Ctih[rlegllmuundu'y.
Tf. For cAeh III ACV crlcdrd Allnrr. It, us idr munnu or mAlvdiI. IHrd:
Neat Cem.:94 lb It , Wtr:7galgalSand Cem.:lb ,Wtr:gal.
7.8. Fienidr a brieJrn'rip[ion.d [Ire nhandnnmenl prnccdnm:
Grouted well from bottom to top.
Lsabl, IR:•IIi."I.: -ICIrx'
NC 28357
L 0111 hinitl At•,I lr. .19"
7/23/2018
it fl:• .• . 11 •I r r Ial I%pe :!1- .I •. , . r1. .l' rd..11 II •"
.ro: prod eft 1i:111., ,•.r.l i.'1
111., n .I .I ...yl, .r m:.
Sh. 1 a[inlllr and bmgt[udr iu dr0n•errmhm mriannuh ur dreinlal d[•£rnK:
'. •. d' ,Id 1,: Lai; n:.: Ilrl,:.r. 'r-Sift lliA£YAnl nr Addili,ual%ell dojil:
YI'll urn me ere hack ui till h(r:: la per„ Id.: Add.: n•Ieel „ell .A. Ik:LI'('• ,.' .t .II
M Abmdl•nliferl1 JCCIIfL. 'I WIl4r\'9f%1 NWI:Yhhnounl parr 0 I; C',:;r.
['ON.sIMI110%DE IAIIS 01,\\F.1.1 iS1111-I\(;{B 1,M)ONED SJ*UNIITT.%1. INSTRUCTIONS
r . I..• 10A. Fire All NCI[,: Slbmal Ih1e Went ,ulnn ,r::hnx Id' ccugiclaul, ,I '.1:11
4.a. \{ell I11.:MW-16 .(bmel.•naten: w rile lnllmrmr
We. I,014 ,ell depth: 10
up. Nrlreh,lc dlanlaa•r: 2 1111.1
ed. %%xv, Ind lwbrn ground iorfsce: (ft.I
I/ilirinn al' %I leer He„nrcm. Infiirnmlion 1•riwmen_ [-nit.
161, MAII SlnnY (inlet. R:IMI.-Il. M' 27.6119.1417
lab. File Iniee7fo41 Nrlla: In dJdnl.m lu ,<IYhs.4 II.: Lan In Ile .rddn>s n. 1:1:'
INne. ;ds„ ,(Ibmn .me ill III:, L•'nll ,nbw 11' d:a :, r.l' I:omploto" eI tr.11
'IFwdollumm h1 the [Aft-m11Y
IIIai,I.n1 nI {%.live H<wrnrnr+. 1 odcryruwill Iaµcll,n I annul Prottrum.
104, NAit `4a•nire Ienmr. Ru1d21• N(' 17699-141.:
Lr.Ilufer ca.hl_Ien¢eh litlul!ne It.: III.)luc. F.. Ns, 1"l UI•1s � heyt•di,l%'R.: In.nidi!!01:o .a,i:n;•sir. i•m ',
Ilk add".'.•...:.I .II•114' I1110 '41111nn cell( ,al... :q IIIIS hills %%!hen 11, lk'n .f
monlr.lauun of ,..11 eh:(sWnnm:m w Ills ..Hunt bxall It depuEnlem A the
, eare handol,,'d
of df l:memm: III,,
4.2. Setter, lostil, r,11 Man n It IIII. !
I nr l'..-n' 11.IL1.I.h,r'•rp.nnr.'' I . I t 1111. 11... II.,.,I ma.a l!c.: nnc, L.n"I""I1. .•.An ...-ulna., ... .eJ 1nu

NVELL. ABANDON:NI ENT RECORD rnl•nr:m,I cx•oN„
Pus form <:m he well f..r sneak of nerd+ .1: uelh
1. µell Comptair InbwmAnnn: WF.1.1. AI ANf1ONHFnT DET,\IIS
Michael Wilson ?A. Vomiter nC nett.. batinll abanJuncJ:l
N'JI+}n'agrto.!..rre he udio..r.rp:n.,ruih A.!. wlu„m_nollrm lc, In,Tah.I, r ,... .. 01,1, ...o . It\'ll .,
r... r. ........... .. m . .
3351 A
NC Wcll fa,prc+•n 1 bmaAalum `4wb.� ?b. Appnrtinlatr lnlume of osier rcnmmin_ m nr11!.I: I_a1.,
('.mT+m S.trnc
1. \\'dl u.r.chnk well u.el:
❑Agn:vuunl
Ofiealhermil ! H¢nrne�l-nnluu Suppl{ +
bldusmll. Coulummi
❑Agintur Rc.lcngc
❑Atluticr Swrltge.ual Ramvy
❑.Allullcr Icst
❑ \Wtoomnnal Icelouilm,
iIf$Mhenn:d 44-Io6Pd Lmpl
1. Pale nrllnl AbsedomM: 7/10/2018
St. µ'ell lowif lon:
Nountaixe Farms
Clhlunsi ilhlblw
❑ll sick„ nl %Vater Sllppt{ hmglcl
❑RmIctsml µ'airl 11otvls I.horcd.
❑linnirkloxe, keimcdixwo
❑S+dllnln Ilamrt
❑51emn\ W er I lidungc
❑51)bslderAc 1 irmn!1
flTwer
I.1011 m lCNIAon nl.dcl gI
G.dm <M r.T Naow IlATI, IOsrri nm,lr-Ihlr
I'Lr.wvl 1JM. a. t�Ir. aMl C+r
Robeson
I'.rna. k.r .,•PI
5b. IAlumile And h uitimde in Jrrmvminurrvw•amJr or dreiuul diver.:
o od7 r.hl ore LM k kv r nrl,..n. rr. Site diaYraul nr adJ DIMAI weft 4lIYa11Y:
\-nn nln, use tlw buck of !hls 1\fspw its pew uk .hldrlknml +{ell sit, Ikdmh of .{AI
V 1\ .J•alrknun.m! h WiU You nun Illeo mach :wlo rlul Im ws 0 twcasun
FOR µ AITFR SUPPI.1 µPUS irm v
?r. )pr of dtwnfrl'tAnt UWIL
'J. Wmunt of dl.infCCIAnl uwd:
?r. Sr•alinY llluleful. uvd Irbcck all that Apph 1
@ Ncal Cl;nwill Omni
I I Rampnnc / lops m Pe1kR
CI SAfnl 1'emani (irout
❑ Un 1 Ls{
CI of vwA w Oran
CI Drill Cdhltas
❑ SmIalti Omut
CI firocl
11 IlQmJlllil' Slnrn
I I I,I11A1(esp Onl uoilcl`Y.1
7f. Far rack material rrk•ra'd Awoc. pm, fde aau.um of ntaterid. used:
Neat Cem.:94 lb lb , Wtr:7galgalSand Cem.:lb ,Ntr:gal.
%. Pro.ide a brier deu-s iptnm of the akmd,nunrtu proccrhlre:
Grouted wall from bottom to top.
7/23/2010
H II om�(/., tiQ�l/'G hew
fit renal: ,hlt hw.n f It. rrrfit r. run Ms" na .n ll....., ,, ... cis - ohhf,..h d u,
u. ar.Ln,r^adlr,11 {I i 111 1114W .,. .1 r!'rld ifeRI M111M U: 41.'(.116%Ilrf.
1110 01n1.1 . •,r{ old", ,+ , .. ,i;N" l,r•.%, fm.nrh'J!u!11..ri fl,., n
fONST RI 1 I ION DE UAIIS OFµ El I ISI Bfl\I. ABANDONED
. rrru ..
,.a. 11 ell I ll.:MW-26
of,. I.IAI %ell ,Icpth: 15
hc. Rlrrrbnlc dhulu•Irr:2 lin.l
od. \ me, le,el lh• ,,% _rlmnd miriArr.
IOA. For All µdi.: Slliml this hanl onion ;v .Las of cmllpklms of oldl
.Ihmdanmem to the 11,161wotr
Ili, iah.n ofµ offer Rwmrm. hiformatlun i'mcr..ing Unit.
Ikl? AIaJ Srnicr 1 eoer. Raki_A. Nl' :TOM -lot'
Idle. For I"i Kllun µdla: In .ddlln+. h! .ndom de Irrun to Ile .ddlcss ul luu
alone. nlu sabnul role nary su Ili's Elise Ilnlap '+ J:qs of Cmnpldion of Dell
.4,31aklunletn In die I,rlloame
bl.kfoo of %%Ah•r Rc+omrt . 1 mh+wind Initrlhm It onmd Prourom
11.36 Hail Stour ('Mier. Ralcl_h. N'.Th•I9-1636
Ilk.. For \valet Sunnl{ A Inirrlbn \\'ell.: In."Wilwo lu'I'llog if., f�uu
I.,, Iluler ca.inY lcrlgh li/Mon n,: ITLI Ilk :dJ1M•saes1 :INM' ;dw NJIIn✓ •.ek Ur!y. ..4 Ibe genii {{nldo III 1L,{a d
Couipklmmi of uell .I ekloniilwm h+ lite Co{lil1v, tamhb depn mwel Id ale _owe{
{\here kiilomd
hl. InnMCAlin-dubm_ irnr�nh Ill Mnnne lfl.l
f.r..Scrrrn Icuffih !it Max n I. —oft.,
I... O'd-•u imtLl i"0.1. i\pJnp6!rl.ry lnu list... ulJ •IIO.a.:I ll:yv q.'Li: Uanomrl {L.IICIW SUMAC! .. ..iJ 1n J,y NA

NVE LLABANDONMENT REC'OR[)
10", 6"..' ; ... he 11col t I, " ... 1"..
1. Nell 11 innimcmir Infiain.umn: WF I I AD 1,1911I0NMEN't DV.F IIIIN
Michael Wilson "fit.' bellir AIIA"41-mcd;
'..1h 0"11
3351 A 'b. lipimptinnAtc ,Ida vir pit nater rviumning to ildit,ii:
I. sx.t,,
J. %vil uw ichek well It
MA,luncr Rcdcag:
n hillafzI
ONLyIntur Jell
❑f Nintmictiml lctilinvkyp
1 11,116IIIII:(I.Ill irt"I"I I M.111
I Icki)[116111411 it I pale f C.M 1mg R Ul $4, 111
4 Den. "ellIsI, Alijill,,actl: 7/10/2018
AA. lillell hwiviii'll:
Okmkiai:il WiticrSuivit, icingle,
,-IRL%I,k.11lljl Wma 'mipph I'lu'red?
-:it invirdnxe, Rmdixivn
05 flimIN 11arser
OSIornintler I ITanumic
DSubsid,jrcc 'rinol
IT"Im
IfItim,,\pLin, inxici -%,
FOR %% ATFR Sl PPLI %I Ul IN ONI i
717- 1) PC of 'IninferIA"I lecIf:
7d. linmunt 0 elkinfcciaut tied!
'V. NvAllfig material, U.e41 (chrri. At rhAt appll1
It Nall ('1161CIII (r.1411
I -I I'k-witill, flulx ul K-11a,
CJ salki ( Client Carlo
III Dirt 4 W
El I 'q'Wic Incial
El Dnll ( tillinp
Cl SIVcIalm cavul
❑ 6rnel
W Re,ca"Ic still"
7e.
F.. each InAterw wkvccii aln,e. Intili4i, inisium of material. amd:
Heat Cent lb lb Wtr:7galgalSand Cent Wtr:gal.
111 Pm,idv a brief dewripting, sit the ah,midilmuctit I'llice'1411c:
Grouted "11 from bottom to top.
Mountaire Farms
ii,
17269 NC-71 Hwy N. Lumber Bridge,NC
wt. a,h
28357
I I afficalion:
7/23/2018
1.1" "A
---
Robeson
t' I tt.
St.. I Antuill, and InsI lee tie li-runAl &J."ri,:
Site IliAV.FA.l 1.1 unit"... 41 MCII 41114-11:
it uto, im,e tW bAL at the. r, -. I - I j.:'A "I.:
11 0-mkinnoit detail_. N mimi, 11,;1 v..'j. Ajoinvl Ix"Itc, I I
f ONSTRUt TION DETAILS OF %N FITiSl Ill'ING AS kNDONED `iitTNlVFT 41 INSTRUCTIONS
IkIA. 1:1,r All "CI6 Sublull tin, tv"ll nlill"I ;. 1,%% ill -miqlklut. oI 'IJI
OK,ndmiawn! I., be fi,llim-nie
IIj.:MW-17
Priocceinig, Unit.
W, Will "ell depth: 11 Ilt.l
III I- %fail Svelter( cater. Ptitlet--lit M 27-649-1,17,
Fur .Lnj% Lf�: 111 .11111111,41 111 -<IKJIt':' 111. 1.-1111 11. JIL .1111.111 111 1 'i
2.Ilene ako :'Il .... 1: tini, :opt ol this tern, 'W"i III o I'Al
kaikh 11111co; I., III: It'llt'.1lie
,.,I. Uani, ie,d I,A.va grimn.1 murfaI
.... I. r U Airr Reinarccii. I inivirtionaill InitTfissit (onnul Ptsn,,-ain.
IhA Mail ticnitv Center. Rakich, Nf 2709-li,36
Inc. Fit ... h & Iniciviloy itivil
: 1. O'b""I. " 'I.,
i.e. Out or lellm h i if wilt"" I:
Ift.)
-j%AlrL-sI"
III, '. .thine ;,,,I "Ile
oIt'; 'I its., I"I"I %ii'l 11, 'Ll.,
40111.11-d 11,11 11 %%,it A-11kimul,zlit I" Ole
h-'allb 'kplinlivrA A 11',:
%%I,re IkamlorSd
Inner camn-rul'Inkknob ill kniAn.:
Ift.,
W.I.SVICCI. knOlOil kmmml;
rIt,.

NVELL ABANDONMENT RECORD
Puy I'a'u+;:m lx uspl f•,r >nna; m uwlfipk a<II.
1. Hell Imarecart infornutlow
Hichael Wilson
At II 11•"w", I Lore .... ... It..vn n.. p:r•. adh .nl l4.'Is, ",!"I%,
3351 A
M Wf IIl... .IM1fnr (enlf>AI4.1144RIv+
SA6DACCO Inc
I '. ulsLlln S.rn:
:.1\ell Cuuatrvrlwm 1'rrmil M: , __ _ _
.� .., et(d...... ...
}. 11elI ww• u•bcck n ell sari:
\\'Ater Supply' Hell;
l-IAgmidmml
'DUC'uhcmcd IHearInO, violin_ Supply t
bduull.d. C(IulawNLA
t1ell:
GAilwtcl kccluagc
❑: iluetcr .Sb!rwe .ud Raw a ,
❑Aquifer lest
❑[xpnunmllal I nlnlnlur_•s
(.lckrit knlml lt'h)4:d 1 nopI
!. Dale a dbq ahamkrneA: 7/10/2019
Sa. R'cll Irwat on:
mountaire Farms
6:.IlIu Onte.'4e.a
17269 NC-71 Hwy N. Lumber ]
P4.wjl \dates.I sb%qr
Robeson
ClMlmlclfrdplddw
❑Rc uklalnl Witter Supph t=meld
Rcs ❑uklnlnl Wnlrl Slltglh' 1c11,rrd.
DOawninatet Reuladlanou
OSnllsin Hamm
Dsw�mmcr thaum�'e
CISubfdLwC ('alanrl
I ITrwcr
F.":"IcuI11'', oNl r
WFLI. ARANDONSIFN't DF.IAIIS
74, Nunllrrr of nClh bring AbnululhA: 1
...a.."II .., I!t (),17.1
711. AIIpNillrl➢If Mh1111C Uf n a1lY rrallaleieg Ie nell(sl:
FOR W 4MRSUPPI.\ NT'1.1 ONLY:
7c. 'F)pc of dmnfclialn uwd:
7d. Amltenl of dbinfcClant uwd:
le. Sralieg nuirmlc u.rd u•Ircck all Ihal apph l:
Ot NPII CLIMIN Gn'Nll
I 1 Renovilac (brpi m Iklk 1.
❑ 5nld I. enletn t m.nl
❑ Un I. tl.
(onmictoml
❑Unit CuIIIn35
❑ 8tanal1y (owl
❑ lml. II
11 Renol,mft Slum
II Illlkr i.Cldan111rdel `go
If. For each mafrrlal w'krced abnr r. pnlddr ammpnl n( n4lrriah used:
Neat Cem.:94 lb lb , Wtr:7galgalSand Cem.:lb ,Wtr:gal.
791 Prm tde a brief drseriptmn .A the abmMnnlcot procedum:
Grouted well from bottom to top.
Foil, lb" u! J"I.
NC 28357 .11/
I':ecc1 Lkaq!IaAon!:...I'1'.I
Sb. 1ititmlr and Irimim it In drgna'almhlutr•Hw•n.udr ur Ilecitnal drilre s:
.. nd:'uld am In blrg r nlh.xr•l
( ONSI RU TION nl:TAIIS OF N FLI.(SI REING AR (ND(INED
4.a_ 1\ell IIIC:NW-27
6b, IWAI %cd dcplll: 16 1161
I.c. Rrnchsk dinnrcler:2
kA. 11'det ksrl hchm groun,l wlrfa.e:
�'S'M7*` _..4 .z!tSW`�at 7/23/201R
In , ow ra:'. 1, . .. .I . ...l ttpq ah ,wok. -w, tYCr, ..Amd",h d top,1. u.I.f r. 11 Il. � .rl t ��I• .. 1 t1:1,.1 • _1 fl •1111 11 .'(ll-.W\Jfy.(I. Mr \f.111.klrii,
In.l •!I'u .l .,ni .iM1U P. ✓I'.iMnlr'r N1 Hill. i..r Jhr .. r'il1.L q.'I
!1. Site diagram nr addiminal well dl talh:
15w nru to, ILc bark nt (hI, pjev h. prom uk .dllmrlml Hell al...Iewols of B AI
a .lbaldalllniln tklnih 1 m mo akcl n(,n'tl Aw"V.1Wl tra.x, 0 IKce n
SFRNITTAL FNSTRUCTION5
Ills. Fnr All Nell,: Slbnul this term lalbm :0 dlnx If wngiklum of Hell
Ih:nulrnmew Ia rM I.Awnw
Diris6m,d V1 atcr RLvm ryes. Inrurmution PnKtllMng Unit.
1617 \lilt Srnicc ( cuter. Raleigh. N(' 27b"461 T
DIb, For Inkcthm 1l0le: fn.hhhbeu IU ecldmg llk lorm w Ilk ;ddwss III Ise
atwnc. ulw subuut mw "TI of III,, loan nnldn w dty. of CMIJACIA41 01 ne11
.d,atdelmkun le Ills h4b.re
I) swttoi rd1\'site Rcsi cv .. 1 ndergrlmnd Inhvdlln (omnd Plw IAII..
16.36 MAH Senice Center. Rakich. Nf's-7feY.)-16d6
Ilk.. Fort "it" Su11114 A Inirclklu N'rlh: I.. ;ddinlm to s.nhug Ila• foml to
or. flulrrradne length Of lame no: Ift) Ilk :Iddresa.,.:A,wealsl ad:un• .sw r.qn .4 the, fern tulh.n In ltns ,•f
;:nupkiwo of uJl ah.ndonutcm it Ihr :,nuns bcdIll dCpal[nwM A IIW . Mlun
w lilac lhawln..:d
of. inner casing; tubing length Of known,: ffY.I
kg• Sceccn length (If Inman l: —OR.,
/.1rn(-'d.•u .n1 ILI .u. LI. Ugznlne:rLg1',nLu:Ir Ip:11 .4d (hlH.l,d ll::a'arii. Lnn4u11.155"..IF:. ;O. unn,;, ... Ili 1.elP I:PI

WELL ABANUON:NIENT RECORD
I,,r. Goy,; an Its: N-el G•, alnak c1 ondtlillr r,dh.
1. \\ ell ( nntraco,r Infntmmnn:
Michael Nilson
5%, II Il:i tnu+rl r.: r1i I„I :ILn. I'v1 P:Iu'. :A.n.,F:nIII'1 ••dl•cI lu.i'u Ilr-u^e I
3351 A
' ll lull o .:.:r.I, ••n < .n,'+.Iunl. •.nnb. .
SAEDACCO Inc
). \f ell (anal Inrbull 1'l','lllll a: , ___ _
3. \loll ux Ichak %ell uxl:
CIApn_nlmnl
❑(irmhcrmd SHc.umc4 bolnl;_`uls I
❑hduvtsd•Conm¢nc,E
NNI \Fell:
❑Acp efer Redsmur.
❑Aglot-a Rea,, nr
❑Ag:tllcr L_!
❑@gyp mntnlcd Icchxnklp',
111-R011yvbrtl if lor',1 I (Itg,l
4. DAte n 011o abmu ward: 7/10/2018
54, R'ell b,cufkln:
Mountaire Farms
Cade, (MI.,'<anv
17269 NC-71 Key N. Lumber 1
Robeson
lhlnnla¢J.Hll+te_
�'7P.: uklxuJ \4'a1<r 51lpgd, I,mgkl
❑Raklcluud Winn Snpph Ixlum-dl
0611a111Jn.vel Renlcdl.mon
GSalxnl, Karim
❑stommmer t'ruingr
I ri.ncr
r-.::do, I➢.•.'tit atTh: AN,
INC 28357
5h. I aumdc Aud km_nude In drgn cvminun•w'.oatank ur drrinul dc•grccw:
I:,,[ 14 min lnI ulln.,:1
N
l'f1\:C7IIL(-T1ON DETAII-S(IF \\ EI_Llll BI'IN(::\BANDONFI)
tin :. ..... :... .,
N.A.\\ell Ill-: W-32
1.1, foul nell depth: 22
oc. Ihlmbnle dlmuvmr. 2 (if,.I
still. NAtel In rl hdna 211.,10.1 nIA'Are:
f.r, ^,o•mn , •. uxl v
W171 I. ARANDONNIFN'T DELt11S
7a. Nundlrrn(nrll>UmnC ah:mdnnnl: 1
71k. Appnrcinulr vdumr Ill "liferr rvnlauung in nelk,ty ICxld
FOR fill 14TT'RSFPPI I\\FII (1NI\:
?c- pe of dtdnferfant W al:
rd. luu,unt of JLlnfeclJxl uvd:
C. Scaling IIIa11C91Ik UWll it'hn•k all rhAN Appl)1:
tit Vqu!'corm Gnml
i i B"A'Alac Chip,,, f41k1;
❑ Sand t emem 1 mnu
CI Un ( to
❑ r vacnte Gloxl
Cl Drill (-uamge
❑ Sfrn:lll% Grum
❑ God
I I RdIAAllife 41m
Its; Glyn IC 1pinnl lndel 'gI
Tf. For twrh oulerlA1 WIcatrd alalay. pnnidv an n inn of matrriaNivird:
Neat Cem.:94 lb lb , Wtr: 7galgal Sand Cam. :lb ,Wtr:ga
?g. Pru, idc A brad dmrrtptum of file abandummcn procelnre:
Grouted well from bottom to top.
7/23/2018
Reif
!u :yp Nrr. rl..:: I tr .. hI . I..... I::: , n.::. '.::.. if ar
:,,L... n •air . .. 11 I ur::... -.rn o,,.:...,urv•...n :n..l...a..
".Site diagrxsl or addilinnal "ell tR1ak:
) on mu, me ilk hxk n( dnro Rhea ifs pan uk wmolol :,01 SA. Ik1,111S ,., „ell
N lhurdonnKnl joall,. 1bu uun Alx, timch 301mnull jm;W, r1 tree wn
UMHE T'U. INSTRUCTION
INN. Fbr All \\'ell..: Stibrim lift. lams Imbm ;,: la+ n1 anlxdctnnl u4 ual
Ahmdruntem Its she lnik,umv.
Ili, kiun of q titer Rnou rum hQormalion PrinT milm 1 ult.
111 IT Alall 'ten ter ( enter. Raleigh. N(':'uaad4l'
lifts. Fnr Inlegnal \fivil ; Is.Id-his 11 I:: •;ld-.'11 :1.: L•I I le Illy .IJch.v, III I lu
tom e. ak,:,. it's p r.nc c:qg :,I till. I•:IIi :•.I:II1, 11 Jens L1 r.am, A:u:,n al 11
11!alda.lunent lu tine Iolhlnxlu
m.:,km of m ma•r Rcnmrcm 1 ndaRnnnul Injection (nnaxl Primmer.
In31i'limit Scnier I efiter. Raleigh. H':'flan-loll:
Inc. fist M11,1,I% & Inirclkm \Foli.: Ir. ,nrdIs IInI ., I.hn;: the t.'11�
tic. fluter eating lrn_th lif IJI'm tic Ift)
III, ;,14w—, f :Il,ute :IISJ ':III'NI 'll, plllq nl Ill', Ialrn V\IEI011 III I1;,%,
tcanplebinf u1 nail Ah: iduum:ut Is! life :olull, hCAlltt 1104 ium al Ilm _oum,
a Ic re tilestdnc<d
tit. Inner xamng/tuhmg q•nkah (if It n.: IA.,
ug. tiroms le -ell, 6f knunnn Ift.)
I .", I/O-•1. wV.1111.in: 4Pnnnw!IbA f:n,u un. ll .11 al..nun..: 11-, k'C' Dr mr,arl ltslli dulunll" .. :,J Iuo,