WI0600036_Well Abandonment Record(s) (GW-30)_20230530

DEPARTMENT OF THE ARMY
U.S. ARMY CORPS OF ENGINEERS
SAVANNAH DISTRICT
100 W. OGLETHORPE AVENUE
SAVANNAH, GEORGIA 31401-3604
May 23, 2023
North Carolina Division of Water Resources
Groundwater Management Branch
Attention: Michael Rogers
1636 Mail Service Center
Raleigh, North Carolina 27699
SUBJECT: Injection wells associated with permit numbers W10600031 & W10600036 at Fort
Liberty, NC for site FTBR-069
Mr. Rogers:
This submittal is being provided to change the wells associated with the above referenced permit
numbers from active to inactive: permanently abandoned. The GW-30 forms are attached to this
letter and below is a listing of the multiple injection wells.
FTBR-069: Multiple Injection Wells: TA1-1 to TA1-10; TA2-1 to TA2-16; TA3-1 to TA3-15; TA4-1
to TA4-10; TA5-1 to TA5-12
If you have any questions, please contact me at [phone] or kevin.e.moon&use..
Kevin Moon, P.G.
Kansas Registration No. 912
Geology/Hydrogeology and HTRW Design Section
RECENE©
MAY 3 0 2023
NC CEQ/DWR
(�wtmi Office

Department of Environmental Quality - Division of Water Resources
STATUS OF INJECTION WELL(S)/PERMIT RESCISSION REQUEST FORM
Permit Number: WI0600031 & WI0600036
Permittee Name(s): Fort Liberty Directorate of Public Works
Mailing Address: IMBG-PWE M 4-1275 Reilly Road Stop A
Physical Address of Well(s) (if different than mailing address): Woodruff Street and Glider Street
City: Fort Libe County: Cumberland Zip Code: 28310
Daytime Telephone No.: 910-396-4009 Cell No.: NA
Email Address:
Please check the selection which most closely describes the current status of your system:
1) ❑ Well(s) still used for injection activities
2) ❑ Well(s) not used for injection but used for other purposes: a) ❑ Water Supply
b) ❑ Recovery
c) ❑ Irrigation
d) ❑ Monitoring
3) X Injection discontinued and: a) ❑ Well(s) temporarily abandoned
b) X Well(s) permanently abandoned
c) ❑ Well(s) not abandoned
4) ❑ Injection well(s) never constructed ❑ N/A injection well(s) never proposed
Well(s) Abandonment/Comments:
If you checked (3)(a) or (b), attach a copy of the GW-30 (Well Abandonment Record). If not applicable, then describe
the method used (or to be used) to abandon the well(s), including a description of how the well were sealed and material
used. If the work below is proposed, a GW-30 will need to be submitted to the UIC Program 30 days after abandonment.
Site:FTBR-069
Permit Rescission:
If you checked (2), (3), or (4) and will not use a well for injection on this site in the future, you should request rescission
of the permit. Do you wish to rescind the permit?
X Yes ❑ No
Certification:
"I hereby certify, under penalty of law, which I have personally examined and am familiar with the information submitted
in this document, and that to the best of my knowledge the information is true, accurate, and complete."
�;.. �C- 7%,,— a 3 N ao 2-5
Signature Date
Kevin E. Moon Geologist
Print or Type Name Title
GW-68 Injection Well Status Form Rev. 3-1-2016 Page 1 of 1

Well Abandonment Summary Report
Fort Bia¢Q, NC
FTBR-069

WELL ABANDONMENT RECORD
I. Well ConlracterInformation:
John C. Schappell
Wet CantmelorNaate (cr well owner personally abandoning well an hiker property)
2332-A
NC Weil lantraaor Certification Number
M&W Drilling, LLC
C wtipany Name
2. WellConstruetioa Permit#: W10600036
List all applrcabl. %warv"micnbn permilr (I e GIG Gororra, sidle. Veriarme, Cie.) ifk m-
3. Well use (cheek we11 use).
Water Supply Well:
ClAgricultutal
[Geothermal (HeatinglCooling Supply)
01ndustriallComtnercial
ton -Water Supply Well:
UAyuifer Recharge
[]Aquifer Storm and Recovery
O tufer Test
OF-xperirnetdal 'rechnology
DGeothermal (Closed loop)
0GeothertnalIii�snn l .elide
ChMunicipal/Public
[]Residential Water Supply (single)
olkesidenual Water Supply (shared)
s Groundwater Rernediiition
Maturity Barrier
CSterrawater Dhaiaegc
OSubsidence Control
❑Tracer
60thet (aa; shin under 7g 1
Forintanna Use ONLY
WEL ABANDONMENT DETAILS
7s. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well constructiowdepth, only 1 GW-30 is needed. Indicate TOTAL lni%MBE.R of
wells abandoned
7b. Approximate volume ofwater remaining in well(s): (PI-)
FOR WATER SUPPLY WELD ON IN:
%Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
M Ncmt Cement Grout
❑ Bentomze Chips or Pellets
* Sated Centeal Grout
❑ Dry Clay
Cl Concrete Grote
❑ D611 Cuttings
L7 Specialty Grout
G Gravel
* Bentonite Slurry
0 Other (explain under 7g)
7L For each material selected above, provide amount of materials used:
Portland Cement 13 lbs
7g, Provide a brief description of the abandonment procedurm
Neat cement funneled from top.
3/22123
a. Date well(s) abaadoned:
Sa. Well location -
Fort Bragg
FactlaNlowner Name Facility IT* (ifapplicable)
3. CertiGt ijio
FfBR-0691SWMUS9, bounded by Knox, Butner, Woodruff & Varsity Streets
t 3127/23
Physical Addos:r City. and Zip
Stii%"ure ofCemfied Well Quitw6r7r Wall r Date
Cumberland
IN argnmg this Jonn, f hereby certiA, dral the WeN(s) was (were) aharrdarred in
County Parcel identification No (PIN)
aecordanns with 13r1 AVAr 02r'.l)I00 nr 2r: _0200 Well Consumiian Jiandarus
and Motu cwpy ofthis record hac been provided to the well owner
5b. Latitudeand taogitude in decrees/minuteslaeCronds or decimal degrees-
(if wall Feld, ores latlloxg is suffiment)
9. Site diagram or additional well details.
35.16492658 -78.98292672 W
You may use the hac of this page to provide additional well site details or wet
y
abandonment details You may also attach additionai pages if oecessary
CONS I�Rti(.-Ill .N DETAM OF MLL(Si BEiNG
SUBMITTAL INSTRVCTIONS
Aan<haeltmresrnretiosnturd(.ejifatwrYahlc F"ermnhtpkinjcaMnorrwr-rarnrxnppfrtrclb
ONLYinthfhd.farrrecdnshuetionutwrrrionwent,yarican submitomfdnn
ipa, For Alt WeiLa: Submit this form within 30 days of completion of well
6a. Well IN: TA1-1 abandonment to the following,
Division of Water Resources. Information Processing Unit,
6b. Total well depth: 51 00 1617 :4lail Service Center, Raleigh. NC 27699-1617
ION Far Iniection Wells: In addition to sending the form to the address in 10a
6c. Borehole diameter• 0.75 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the fallowing:
6d. Water level below ground surface: (lt) Division of Wattr Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): 00 10c. For Water Sapp h & Iniection Wells: in addition to se1161118 the Corm to the
addre.9(es) above, also submit one copy of this form within 30 days of completion
of well ahatrdnrument it) the county health department of the county where
6f. Inner casiaghubing length (if known): 011-) abandoned
F,g. Screen length (if known): (B.)
Farm GW•30 !North Caroitna Department orFm tonamotal Quality - Division -iMatar Rewurcer Ret tsed 2.22-20t6

WELL ABANDONMENT RECORD
1. Well Contrattorinformation:
John C. Schappell
Well Cowndor Name (or well owner personally abandoning well an hig1 er property)
2332-A
NC Well Contractor Coacanon Number
M&W Drilling, LLC
Company Name
2.Well Construction Permit il; W10600036
List allWncable,mll conxtr tctlanpera7tts #.e. UX_ County. Slate, Varlanee, etc.) tjkamm
3. Well use (check well use):
WaterSupply Well:
[]Agricultural
❑ eathe mal (Heatir4lCooling Supply)
❑ lndustrial(Commereial
Non -Water
OMunic Wtiblic
❑Residertial Water Supply (single)
❑Residential Water Supply (sbared)
,injection Well;
OAquuifer Recharge
HQroundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
DAquiferTest
❑Stormwater Drainage
0ExperimenwTechnology
❑subsidencecontro)
❑Geothermal (Closed Loop)
❑Tracer
❑GMthermal(Kcatin Cooling Return)
❑Other(ex lain under7•�)
4. Date well(s)abandoned. 3/22/23
Sa. Well location:
Fart Bragg
FacilitylOwner Name Faeihty 10ll (irapplicable)
FIBR-0691SWMU-69, bounded by Knox, Butner, Woodruff & Varsity Streets
Physical Address, City, and Zip
Cumberland
County
Pracel identification No. (P ,7�
Sb. Latitude and longitude in degrees/minutesiseconds or decimal degrees:
(if woll field, one Iamorg is sufficient)
35.15792267 N-78.98234736
For Intermit Use ONLY'
WELL ABANDONMENT DFTAiLS
7a. For GeoprobeMPT or Closed -Loop Geothermal Wells having the same
well co ustrucuon/deplh, only 1 OW-30 is needed. indicate TOTAL NuhMER of
welsAbandoned,.
7b. Approximate vot—e of water remaining in well(s): (gal.)
FOR WATER SUPPLY WELLS ONLY:
7a Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
® Neat cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout 13 Gravel
❑ Bentonite Slurry Q Other (explain under 7g)
If. For each material selected above provide amount of materials used:
Portland Cement 18 Ibs
7g. Provide a brief description of the abandonment procedure:
Neat cement funneled from top.
S. Certification:
3127123
Signature cnifim Well Contraaorer I i]wner Date
fly signing this frn'm, 1 hereby certo that the well(k) 14,as (wet&) abandoneri m
accordance with 134 NC4(' b2C.0100 ar 2r.0200 Well Construction Siarn7urde
and drat a copy of thiv record has been pr6wdi l to the well owner_
9. Site diagram or additional well details:
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 ifnecessary.
CONSTRUCTIONDETAILSOF WELUSIBEINGAEANDONED
ilttachtcallcoartn+clianmcord(s)iJartiilabtc. Farmukpkialaerionor>Ma-unlrr�apptysnclh
&aYrvith thesnore cwurn+dtwJalwndnnorrrit.}vn—submit arefit m
6a. Well IIN1: P-1 1
6b. Total well depth: 40
6c. Borehole dia meMr: 1 (in.)
6d.'ftJer level below ground surface: (it.)
51:ISMITTAt. INSTRUCTiONS
10a. For All Wells Submit this form within 10 days of completion of well
abandonment to the following:
Division of WoterRewurces, Information Processing Hatt,
16i7 hTail Service Center, Rnleigb., NC 27699-1617
10b. for injection Wells: In addition to sending the form to the address is 10a
above, also submit one copy or this form within 30 days of completion of well
abandonment to the fallowiW .
Division of Water Resources, Underground Injection Control Program,
1636 Mal Service Center, Raleigh, NC 27699-1636
be. Outer casing length (of known): fri.) 10c. For Water Supply & laiection Wells: in addition to sending the form to the
address(cs) above, also submit one copy of this form within 30 days or completion
of well abandonment to the county health department of the county where
6LInner easing/tubing length (ifknown): lit,) abandoned,
6g. Screen length ('tf known): (fit.)
FormdW-30 NonhCarolinaDepartmentofEnvironmentalQualify- Divisionof+ValerResources Revised 24 2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John C. Schappell
Well Contractor Name (or wellowner persoaany abandoning well on biarber property)
2332-A
NC Well Contrsctor Cenificaticn Number
M&W Drilling, LLC
company Name
2. Wall Construction Permit fix W 10600036
t in all applicable Nell canstrilctioit perrnils ( e. IAC. C'oim% Stale, 4artance, etc.) J Amwn
3. Well use (check well use):
Water Supply Well:
ClAgicultural
130enthermal (Heattng/Cnoling Supply)
❑ Industrial/Cominercial
❑irrit.,tinn
Non -Water Supply Well:
I lAquifer Recharge
OAquifer Storage seal Recovery
❑Aquifer Test
OExperimentat Technology
❑Geothermal (Closed Loop)
[]Geothermal (lleatingiCooling'
4. Date, well(s) abandoned: 3/22/23
Sa. Well location:
Fort Bragg
Faci)ily/OwnerNarac
❑Municipal/Puhlic
DResidential Water Supply (single)
CiResidential Water Supply (shared)
F-Groundwater Remediation
.-I Sal inity Banter
08tormwater Drainage
❑Subsidence Control
OTracer
LiOther (explain under
Facility ]DO 6fopplicable)
F-rBR-W91SWMU-69, bounded by Knox. Butner, Woodruff & Varsity Streets
Physical Address.. City. and Zip
Cumberland
rounly
Parcel idennficarion No. (PIN)
5b. Latitude and longitude in degreeidmimrtoodwconds or decimal degrees:
(irwnll field, ore: lat/lons v sufficient)
35.15642765 N-78.98114171 W
CON9X&V-aION DETAILS OF W E fSi BEING ABANDONED
Allacti",ellcanrrrnctionrecord(s)tfatwilable, llorturdriple injection ortran-waterareppty wells
ONLYwth lhe.wine- can crrucrian,abandonment. van can nib ind sae form.
6a. Well ID#: P-3
61L Total well depth: 15.35 A)
6c. Borehole diameter: 0.75 (in.►
6d. Water level below ground surface: (ft)
6e. Outer casing length (if known):
6C Inner casing/tubing Length (if known): (ft)
6g. Screen length (if known).,
For Internal Vhe ONLY.:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DP'T or Closed -Loop Geothermal Wells having the same
well 0011struction/depth, only I OW-30 is needed. lndicate'ROTA1. NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
19 Neat Cement Grote G Bentonite Chips or Pellets
17 Sand Cement Grout C Dry Clay
G Concirte Grout C Drill Cuttings
Q Specialty Grout G Gravel
❑ Bentomte Slum Lr Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Portland Cement 4 lbs
7g. Provide a brief description of the abandonment procedure:
Neat cement funneled from top.
R. Certification:
3127/23
Si trrearCortified Well CA, tractor Il Owner Date
6y stgntng this form, l hereby certfi, that the ti-ell(s) was (were) abandoned in
accordance with 15A NCAC 01C .0) dO or 3C .0300 Well Construction Standards
and that a copy of this record has been provided to the well awner.
9. Site dingram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages it necessary
SUBMITTAL INSTRUCTIONS
10s. For All Wells: Submit this form vnthm 30 days of completion of well
abandonment to the following
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
106. For Iniection Wells: In addition to sending the form to the address in 10a
above, also suhmit ore copy of this form within 30 days or completion of well
abandonment to the following.
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10r. For Waler Sul Ir ilv & Injectiom Wells: In addition to sending the form to the
nddress(es) above, also submit one copy of this form within 39 days of completion
of well abandonment to the county health department of the enunty where
abandoned
Form OW-30 North Carolina Depanm--nt ofEmironmental Qualify - Division of Outer R,asotecas Revised 2-22-20I 6

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John C. Schappell
Wall Canlracror Name (or well owner personally abandoning well on h(slher property)
2332-A _
NC Well Contractor Certification Number
M&W Drilling, LLC
Company Name
21. Well Construction Permit #: W10600036
l ht all appNeabtc, "ell mnsmrcfranpermirs 6* vic Carmry, Slane, Yariaoce, 01a) tt(mmin
3. Well use (check well use),
❑Agricultural ❑Mutucipal tblie
c3Gcothermal (Heating(Caoling Supply) ❑Residential Water Supply (siuglc)
❑industrial/Commercial OResidential Water Supply (shared)
Supply Well:
OAquiferReehatge
0AquiferStorageand Recovery
nAquiferTest
OExpe 1mental.Technology
❑Geothermal (Closed Loop)
CGcotherram (Hcatin.xoolina Retnm`1
4. Date well(s) abandoned: 30 /23
5a. Well location:
Fort Bragg
❑Reeovery
MtGroundwater Remediation
❑Salinity Barricr
t7Stomtwater Drainage
❑Subsidence Control
OTmcer
130ther(r:,r, lain under7.
Fw tyl WnerNeme Facility 109(ifapplicable)
Ff8R-069/SWMU-69, bounded by Knox, Butner, Woodruff & Varsity Streets
PIrAreat Address Cty; and Zip
Cumberland
County
Parcel Identitir2lionNo. (PIM
9b. Latitude and longitude in degreestmiuutWseconds or decimal degrees:
(ttwell Iitld, me lat11ong is Sufficient)
35.15996340 N-78.98112293
For lnterrrat Usa pNLY
WELL ABANDONMENTDETARS
7a. For Geoprobe/DPT or Clased-Loop Geothermal Wefts hating the same
well eonstrucuonideptb, only I GW-30 is needed Indicate TOTAL NUMBER of
wells abandoned:
7b.Approximate volume ofwaterr maininginwe11001 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply)[
tS Neat Cement Grout
❑ Bentonite Chips or Pellets
0 $and Cement Grout
O Dry Clay
❑ Concrete Grant
❑ MU Cutbugs
❑ Specialty Grout
❑ Gravel
❑ Bemtonite Slurry
0 Other (explain tinder 7g)
7E For each material selected above, provide amount of materials used.'
Portland Cement 10 Ibs
7g. Provide a brief description of tbeabandonment procedure:
Neat cement funneled from top.
s. certir►
3127123
Signature ofCcrtified Well Contractor or Well 6wer hate
By .rigning this form. I hereby ewaff drat the tvell(s) nps (ware) abandoned in
acwrdlanee wdh 13A NCAC 02C.0100 or 2C .0200 Well C.'a drucllan Standards
and that a copy a%this rteoid het heen provided If, the u xtl uwtter.
9. Sitediagram or additional well details:
You may use the back of this page to provide additional well site details or well
W
abandonment details. You may also attach additional pages if necessary.
CONSTRUCT1214 DETAILS OF WEI.t_(S1 BEING ABA ONED
SUBMITTAL INSTRUCTIONS
Attach (mllcanvinwdacreeord(s)Onvilable. Farnrvtapteurjrarionwnonawrtrrrtrpp(vrrellr
t7NLYwiththesomcrotr3lrErMlavabmxlanme+rhynucon.svDm+toaefnrrn.
10a, For All Wells: Submit this form within 30 days of completion ormell
TA5-12
abandonment to thefoUowing:
6a. Well IDN•
Division of Water Resources, information Processing Unit,
6b. Total Well depth: 40 (ft.)
1617 Mai Service Center, Raleigh, NC 27699LI 617
10b. For Infection : In addition to sending the form to the address in 10a
0'76
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 (ft,)
Division of WeterResourcer, linderground Injection Control Program,
1636 Mail Service Center. Re Leigh, NC 27699-16M
6e Outer casing length (if known): (g j
file. For Water Sanely & loieeden Wells: In addition to sending the form to the
address(es) above, also submit one copy of this farm within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casbr g bing length (if known): (ft.)
abandoned
6g. Screen length (if known): (ft.)
Form G W-3n Namh Carohnn Department afEnVnunanental Quality- Diwsion or Water Resourocs R�d 2 22-3a16

WELL ABANDONMENT RECORD
I. Well Contractor Information:
John C. Schappell
well Contractor +lame (or rvell owner personally abawowng well an hisftr pro:serty)
2332-A
For Internal Use ONLY
WELL ABAND MIENTIDETAILS
72. For Geoprobe/DPT or Closcd-Loop Geothermal Wells having the same
well eonsuuctioa:depth. only 1 GW-30 is needed. indicate TOTAL NUMBER of
wells abandoned
NC Well ContractorCertrEeationNun*er 7b. Approximate volume of water attaining in well(s): (gal.)
M&W Drilling, LLC FOR WATER SUPPLY WEIAS ONLY:
Company Name
7c.1'vpe of disinfectant used:
2. Well Construction Permitil: W10600036
List all appheabre oval cvAlfoaellon pdAiri[r (1.0. (.1C. C+nany, .Slate, I/anance, ere.) ifkimnn
7d. Amount of disinfectant used:
3. Well use (check well use): — —
Water Supply Well.
OAgricultural
L1Geothtxmal (HeatingiCoolmg Supply)
❑ lndustriab'Commenial
Non -Water Supply Well:
❑Aquifer Recharge
ClAquifcr Storage and Recovery
L7Aquifer Tcst
GExperimenttd Technology
CGeothermal (Closed Loop)
OCzenthermal (l�eaUrg"Coglini
4. Date well(s) abandoned: 3121123
52. %Vell location:
Fort Bragg
OMtmicipaltPublic
OResidentiai Water Supply (single)
oResideatitil Water Supply (shmedi
f(iroundwaier Remediation
❑Salintry Barrier
❑Slortuwatrr Drainage
❑Subsidence Control
O7 racer
OOther (explain under 7g )
Yacility:Ch"er Name Facility 04 (if applicable)
FTBR-069/SWMU-69. bounded by Knox, Butner, Woodruff & Varsity Streets
Physical Address, City, and Zip
Cumberland
Coumy
Parcel Idcntrficrrimr No, (PIN)
5b. Latitude and longitude in degrem/minutes/seconds or decimal degrees:
(if usll field. one In ion,, is cuRteient)
35,15998204 N-78,98116115
7e, Sealing materials used (check all that apply):
* Neat Cement Grout
d Bentortite Chips or Pellets
O Sand Cement Grout
17 Dy Clay
* Concrete Grout
O Drill Cuttings
❑ Specialty Grout
O Gravel
13 Bentomte Slum
G Other (explain under 7g)
7L For each material selected above, provide amount ofmaterials used:
Portland Cement 10 lbs
%. Provide a brief description of the abandonment procedure:
Neat cement funneled from top.
8. Certifi n }
1 1
3127/23
Signature Cemfied Woll Contractor or ell O M bale ��
By signing rests fomr, I Hereby ccHif}, lbut the well(%) iyar ewere) ahutrdnned m
accordanr:a wieh 1511 AICAC w . nine or 2C:.0200 Well f'rmshu tion Smrrdardv
andthat a e ipy trfthis record ha: becror providedto the csell awtow.
9, Site diagram or additional well details:
You may use the back of this page to provide additional well sate details or well
W abandonmentdctails You may also attach additional pagesifneaessary
Q,NSYRIICTION DETAILS OF WLLL(S) BEfNGABA•NDON-E
Alfacherrllrnustnretiunnentr!(sJifarotfubfe, pbrnmllllniClt+�ietiarnrmun•u�otertu;yrtyNclls
ONLY aplh the .arm carsrrudian obmulonment: lint can submit onefamr,
6a. Well tDn: TA5-11
6b. Total well depth: 40
6G Borehole diameter: 0.75 (in.)
6d. Water level below ground surface:
SUBiFIITTAL JN—URUCTIONS
ilia. For An Wells: Submit this form within 3O days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit.
1617'Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In add -pion to sending the rotor to the address to 10a
above: also submit are copy of this form withm 30 days of completion of well
abandonment to the following:
Division of Water Recourccns, Underground Injection Central Program,
1636 Mail Service Center, Raleigh, NC 2769?-1636
6e. Outer cadag length (if known): M.) 1 Oc. For Water Supply & Infection Wells: In addition to sending the Form to the
addresses) above, also submit one copy arthis farm within 30 days ofeampletiol
of well abandonmert to the county health department or the counhv where
6E Inner casing/tubiag length (if known): (h,) abandoned
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Enviran nwhil Quality - Wvi-ion of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John C. Schappell
Well CmttraciarNaaie (er wall awner personalty Aandanmg well on hisrher pmperty)
2332-A
NC Well Contractor Certi6cationNumher
M&W Drilling, LLC
Compatty'Name
L Well Construction Permit ": W 10600036
L1sr all opphathk n el1 ronrfnmrion prrmrrs ro,e UIC Carmry. Srme, lrarionre. rre) ifkrorvn
3. Weltuse (cheekweft use):
CAgricultutal ❑MunicipaUPublic
OGeothermal (Hesting/Cooling Supply) OResidential Water Supply (single)
❑IndustriallCommercitti OResidential Water Supply (shared)
Non -Wafer Supply Well:
Injection Well:
❑Aquiferl1wbarge MGroundwaterRemediat(on
❑Aquifer Storage and Recovery ❑Salinity Barrier
©Aquifer Test ❑Slormwater Diansage
❑Experimental Tethnology ❑Subsidence Control
OGeothermal (Closed Loop) oTracer
❑Geothermal (Heatir j� Coolfrio Return) 001herinplain under 7 • I
d. Date wel l(s) abandoned: 3/21 /23
SR. Well lom*n:
FortBragg
Facility/Owner Name Facility tD# (if applicpble)
FTBR-0691SWMU-69, bounded by itnM Butner, Woodruff & Varsity Streets
Physical Address. City, and Zap
Cumberland
Comity
Paroet Identification No. (PIN)
Sb. Latitude and longitude in. degreesiminutes/seconds or decimal degrees:
(if well field. one Imflang is sul6ciont)
'35,16000260 N-78.98120139
For Internal use ONLY,
WELL ABANDONMENT DETAIL$.
7a. For Geoprobe/D.PT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW 30 is needed, lodicate TOTAL NUMBER of
wells abandoned, _
7b. Approximate volume of water remaining in well(s):
FOR WATER StIPPLY WELIS ONLY:
7rs Type of disinfectant used:
7d. Amount of disinfectnot used:
7e. Sealing materials used (eheck.all that apply):
a Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ SentoniteShury
Q Other(expWn under9g)
7E For each material selected above, provide amount of materials used:
Portland Cement 10 Ibs
7g. Provide a brief description of the abandonment procedure:
Neat cement funneled from fop.
kC..aor
8. Cerdfl a: , 3/27/23
5iti.tureofCenifieddllrWell vner two
By signing this fart:, i hereby cert6 that the ,vel!(v) ryas (were) ahandoned in
accordance with 15A N(_AC O2(,' .0100 or 1C_• .0M Well C;nesiructian 3Tandardv
and that a cepy trf the record has heen provided to the well owner•.
9. Sitediagrom or additional well details:
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.
C0NSTRUCf1QN DETAILS OF WELL(S) BEING ABANDONED
AtfPClr wetico+asrarcaa»xmrr!(sJ ifmnllabte Fornrmtapfr mjeMlmtar court-owfrr.ruppllnnvI1.e
ONLY WO) The some coasfrucriatra4mtdolrmemt, Wte rot stehmeB onefanr_
6a. Wen WO: TA5-10
6b. Total well depth: 40
6c. Borehole diameter: 0.75 (in.)
6d. Water level below ground surface:
SUBMITTAL INSTRUCTIONS
10g. For AllWells: Submit this Form within 30 days of completion of well
abandonment to the following:
Divltion of Water Resources, information Processing Unit,
1617 Rlail Service Center, Raleigh. NC 27699-1617
10h. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the follgwittg_
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Centery Raleigh, NC 27699-1636
tie Outer casing length (if known): (R-) 10c-For Water Snnoly & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casing/tubing length (if known): ((I,) abandoned
6g, Screen length (if known): (ft.)
Form GW-30 Nardi Cardona Department of Environmental Quality -Division of Water Resources Revised 2-22-MI6

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Jahn C. Schappell
Well Contractor Nema (or wall owner personally abandonnin well on h+sthcr property)
2332-A
NC Well Cuntraaor Cenificat rn Number
M&W Drilling, LLC
Company Name
2. Well Construction Permit#: W10600036
L+s1 all applimblc UIC. Calmly. Siate, Variance, 0a) +Jhaan+a
3. Well use (check well use):
Water Supply Well:
❑Agriculluml ❑MunicipaUPubiic
aGewhermal (HeatinglCoohng Supply) ORcsidential Water Supply (single)
0IndustriallCommerial GRcsideanal Water Supply fshar€AI
Non -Water
ClAqui fi.rRecbarge
RGroundwater Remcdiation
LIAt)uifer Statage and Rwovery
OSalinity Bardcr
❑Aquifer Test
❑Stormwater Drainage
of•:uperimcntal Tx1mology
❑Subsidence Control
00eothermal (Closed Loop)
OTracer
❑Geothcrmal ! ileaun= coohn • Return I
❑Other I-milam under W i
a. Date well(s) abandoned: 3/21/23
sa. Well location.
Fort Bragg
FacilityiOwner Name Facility 1Di! (if appli: AW
FTBR-0691SWMU-69, bounded by Knox, Butner. Woodruff & Varsity StreetS
Physical Address, City, and Zip
Cumberland
County Parcel Idem+Gcaunn Na. i P1M
5b. Latitude and longitude in deareWminuttslseeonds or decimal degrees:
tifwell field, one ta0long es sufficient')
35.16003631 N-78.98123525 W
CONSTRUCTION DETAILS OF WELL{SIBEIVG AB 1NDUIED
Athal+nrefltour+rac+ioanecan/(sJ7JawtitfabM tern+alNplc+njc+c7wa.irratd-wdre+st+yinl�•xrlts
Oft ruith the .ra+re ctanstruc+ron-ohar+s.iarrme+rf. )wu can s116mit owe fain
6a. Well Ion: TA5-9
6h. Total well depth: 40 eft.)
6c. Borehole diameter: 0.75
bd. Water tevel below ground surface: ttZ•)
For Inlercml Uze, ONLY
WELL ABANDANMENT DETAIL S
7a. For Geoproba'DPT or Closed -Loop Geothermal Wells having thr same
wall construcnora+depth, only 1 OW-30 is needed. Indicate TOTAL NUM13ER of
wells abandoned;«
7b. Approximate volume of water remaining in well(s): (P,ol•)
FOR WATER SUPPLY WELLS ONLY:
7e. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
* Neat Cement Grou: ❑ Bentouite Chips or Pellets
O Sand Cement Grout O Dty Clay
* Concrete Grout 0 Drill Cuttings
* Specialty Grout ❑ Gravel
O Bentorine Slurry O Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Portland Cement 10 Ibs
7g. Provide a brief description of the abandonment procedure:
Neat cement funneled from top.
r
�. certfra t aq;
3127/23
Gngnature ofCcndf+ed NX-ell Contactor or Well dwiler Dare
,'iy .viguing this Jn+m / hereby certify that the well(,v) was (were) abandoned in
clowrdwtce with 15A NCdC Od('.nion or 1C.0100 WeJ1 Carstruction Standards -
and drat u copse of the record ha- been provided to the well anner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional wel! site details or well
abandonment details, You may also attach additional pages ifnecessan,
SUBMMAL INiSTRIICTIVNS
10a. For An Wens: Submit this farm within 30 days of completion of well
abandonment to the following
Division of WaterResources, tnformation Processing Unit.
1617 M. ail Service Center, Raleigh. NC 27699-1617
i0b. For injection Wells: in addition to sending the form to the address to 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
juvision orWattrResouraes, Underground Injection Control Program.
104 Mail Service Center. Raleigh, NC 27699-1636
tic. outer casing length (if known): (ft,) 10e. For Water Suouly & Injection Wens; 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 healdt deportment of the eoumN where
6f. inner easing/tubing length (if known): 00 abandoned
6g. Screen length (if known): (ft.)
Fo= OW.16 Nlmh Carolma ocyanment orPnvuonmental pua;ih� - litvmo+l of Water Remurces Recnscd 2-Z2-2Qle

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John C. Schappell
Well Contractor Name (arwell owner aersanally abandoning well on h sltor prony)
2332-A
"NC Wall Contractar Certification Number
M&W Drilling, LLC
Company'Name
2.Well Construetion Permit*: W10600036
Llsl all applicable well mnstmallan permlts (l e. tllG Gmrrtty. &arK -Variance, erc j iftrtanw
3. Well use (check well use):
Far infernal Use A131.Y
WELL ABANDONIMAMM DETAILS
7a. For GeoprobelDPT or Closed -Loop Geothermal Wells having the some
welt construction/depth, only i GW-30 is needed. Indicate TOTAL NUMBM of
wells abandoned•
7b.Appro=imatevolumeofwaterremalainginwetl(s):
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
Water Supply Well: 7e. Scaling materials used (check all that apply):
❑Agriculltutrl OMunicipaMblic eS Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal (Heating/Cooling; Supply) CiResidential Water Supply (single) ❑ Sand Cement Grou: ❑ Dry Clay
01ndustrial/Commercial i llesidential Water Supply (shared) O Concrete Great 13 Drill Cuttings
Non -Water
0Aqui£erRecharge
oAquifer Storage and Recovery
❑Aquifer Test
_ o Specialty Grout a Gravel
Q Bentonite Slurry ❑ Other (explain under 7g)
oRecovery
7f rartaeh material selected above; provide amount of materials used:
InGroundwatimRemediation Portland Cement 10 lbs
❑Salinity Barrier
oStormwaterDminage
oExperimemtal'rechnology PSubsidenoeControl 7g. Provide briefdesfxiption oftbeabandonment procedure
❑Geothermal (Closed Loop) ❑TrarA Neat cement funneled from top.
❑Geothermal llicatin--.'Conlin-,Retum) oOtherlex! Wnunder7,7)
4. Date well(s) abandoned: 3/21123
Sa. Well location:
Fort Bragg
Facillty/Owner Name
Facility m#(ifappticable)
FTBR-069/SWMU-69; bounded by Knox, Butner, Woodruff R Varsity Streets
Physical Address Cily,=it Zip
Cumberland
County
Parcel identilimienNo. (PIM
Sh. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
8. cc r - es . 0:LLA�4
1.3!27l23
5itma of iFcdWellt nr ornrW wner Dale
By ,signing skis form, I hereby certrfi_e that lire well(k) was (wire) abandoned in
accordance with 15A NC.dC 02C _0/00 or 2C .0200 Well (.nnrrrucfinn Standards
and that a copy vflhts racord has been provided to fire well nwrrer.
(if wall Feld one tattlong is suffieiera) 9. Site diagram or additional well details:
35.16007112 N-78.98125771 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 ifnecessary.
('0,NWR11DN MTAI" OF WF.LL(M BEING ABANDONED SIIBMIrM INSTRUMONS
Attach tvallemrslnrcnanreconl(pJOnwhable, FornathipteinjacYranor�wn-warorsuNptyrretfs
Oft Pwith the some cm0nietluatabandlann+enf.}nucansulem1afla orm. lOn F All Wuml Ie11s S b 't N f mt 1 tiUys tin 30 da of corn letion of Weil
6a. Well lDM- TA5-8
. or S c p
abandonment to the followmg:
Division of Water Resources, Information Processing Unit,
6b. Total well depth: 40 (ft.) 1611 Mail Service Center, Raleigh, NC 37699-1617
10b. For injection Wells: in addition to sending the form to the address in 10a
6c. Borehole diameter: 0.75 _(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 surrace (M) Division of WaterResources, Underground Injection Control Program.
1636 Mal Service Center, Raleigh, NC 27699-1636
be Outer easing length (if known);{;t,) 10c. Fort•Yater Sunniv & iaie(!don WeHs: In addition to sending the form tothe
address(es) above, also submit one copy of this rtnm within -30 days of completion
of well abandonment to the county health department of the county where
6E inner easing/tubing length (if known): 411) abandoned,
4 Screen length (if known): (ft.)
Form GW-30 North Cnmlina Mpartment arEnrironmental Quality - bivision of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor lnrortoation:
John C. Schappell
%Yell Conractor Name (m neN awns perso;tally abandoning well an histherproperty)
2332-A
NC Well Contractor Cereificawn Number
M&W Drilling, LLC
Company g3mc
2.Well CoastructioriPermit 0; W10600036
Ltnnll applicable wall o'4o mcdaalurmits (l e. UX'. Cannot Sralw Penance, err.) ijhraa>r
J. Well use (check %sell use):
Wen:
❑Agucultum)
UGcothermal WcatinglCooling Supply)
01ndmtriaKommercial
Non -Water Supply Well-
l%Aquifer Recharge
13AgtufcrSiorage and Recovery
❑Aquifer Test
claperimemai Tcohnoloyy
❑Geothermal (Closed Loop)
d, hate well(s) abandoned: 3/21 /23
[IMumcrpal/Public
C7Residential Water Supply (single)
❑Restdrntia] Water Suppjv (shared)
atGmundwater Remediation
ElSalioity Ranier
O5tamtwutcr Aratuagc
❑Stibsidence Control
❑Tracer
❑Outer texalain under 7Ll
is. Well location:
Fart Bragg
FaotliglUwner, lame Facility 109 (irapplicahle)
FTBR-0691SWMU-69, bounded by Krim Butner. Woodruff & Varsfty Streets
Physical Address, City. and Zip
Cumberland
County
Parcel Idemfflicannn No. (Pity)
5b. Latitude and longitude in degreetlminutalseconds or decimal degrees:
(fwO lield one latllonr, is sufictent)
35.16010621 N' -78.98127716
For Internal Use ONLY —7�
WELL ARANDONAIENT DETAILS
7a. For GeoprobeMPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only I GW-30 is needed Indicate TOTAL NL7v113ER of
walls abandoned.
7b. Approximate volume of water remaining in wWl(s):
FOR WATER SUPPLY WELLS ONLY:
7e. Typeof disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (cheek all that apply)=
9 Neat Cement Grout d Bentnnite Chips or Pellets
G Sand Cement Grout
❑ Dry Clay
❑ Con,= Gran
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
a gemonite Slurry
G Other (ex -plain under 7g)
7E For each material selected above, provide a mount ofmaterials used:
Portland Cement 10 lbs
7g. Provide a brier description of the abandonment pro"Aare:
Neat cement funneled from top.
8. Certif ion: 1
3127_1_2.3
Sigaatui ofCartifiad Well Comtractor or W01 omit, Date
gy rlgnipg this form. r hereby certV dim the well(v) was (mere) abandoned in
nctv)rdwim with 15A N AC 02r.01011 or 2C.0200 Well f.onsrruclron Slaudurdir
tend that a cope 2f thtr re aryl has been provided to the bell owner.
9. Site diagram or additional well details:
�� You may use the back of this page to provide additional well site details or well
abandonmcatt details. You may also attach additional pages ifnecessary.
(:gLgs RL°C7'lOVDEI ILSOFWELLIS)RF&GARANDQNED
dlrach kNrll44a5lRICli4M recordfsl f4lylllalllz /'lirMfllllple ill%2UMnWRl4Y�YL1(er �'Ifl7f1ly 1Ntlt�
ONLPlvirb llte name carswclian.'un nrc&rumenr. ►art can submil olteforr-
6a. Well Will. TA5-7
6h. Total well depth: 40 (%)
6c. Rtsrehole diameter: 2.75 (in.l
6d. Water level below ground surface:
SUBMITTAL INS1 RIK7170NS
102, Egg All Welts: Submit this form within 30 days ol`complenon of well
abattcionment to the following
Division of Water Re.w)urees, fnformatioa Processing Unit.
1617 Mail Service Center, Raleigh. N(' 27699-1617
10b. For Taigrt in Wells: In addition to sending the form k) the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Divisiion of Watt rResources, Underground injection Control Program,
1636 Mail Service Center. Raleigh, NC 27699-1636
6c. Outer casing length of known): {h) ldc. For Water Simply & Injection WeOs: In addition to sencing the form to the
addressees) above, also submit one cop) of this form within 30 days of completion
of well abandonment to the county heulih department of the county where
6f. inner casing/tabing length (if kanwn): (ft,f abandoned.
6g. Screen length (R known): (a.)
.Form GW-70 iWonh Carolina Dapwlmerl arEnyaonmenuil Quality - Dnision o(Water Rtvnurxs Revised 2-2 2Ut 6