WI0600036_Well Abandonment Record(s) (GW-30)_20230530 (2)

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 912 652-5151 or IleS'_wwwwww_
Kevin Moon, P.G.
Kansas Registration No. 912
Geology/Hydrogeology and HTRW Design Section
Z0
MAY 3 0-2023
'

Department of Environmental Quality - Division of Water Resources
STATUS OF INJECTION WELL(S)/PERMIT RESCISSION REQUEST FORM
Permit Number: WI0600031 & WI0600036
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
)Yell(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."
a 3� - ao z
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 Bram NC
FTBR-069

WEILABANDONMENT RECORD For haarw Usp ONLY
t„ WeH Cow". efur EnibrRuafiew MXIL'
Johiri G. Schappell 7a. Fojr19'Aeppw[w.1DPT or
mffl constmcdowdeptla, only I GW -30 Ws TweaAed. IMeale TOTALNUMBER of
weUs abandoned
2332-A'-.—..-..- ...... ----
Nr WrM Cnwfli mdfA* Catfiohon Numbw
M&W Elrflfirig, LLLC
('Vynpany Maw
W10600036
2weT1C.0Aqtrucfi0M Fin-MIM, -------.----'— —.1— —
Lag 011apphtabh" WCUMPOnOwn �Vnpift 0 '- UIC C.Q9610, Ank, MOHOOM 1-Mej
3.'Well upe (,check vvy,41 ase).
71b, Approximate volume ofwater remaining in weH(5)a ---- ---tZAL)
. .............. . ..... . . ....... . . ....
fftW Aincount of vwd;
. . . . ........ . ..............
7e. Soling miteirials used (c&ch all that apply):
. ...........ee
0 Neat CeNnent Grout 13 Eim.tal-me C."hip or Pellets
CGU.M.wrmal (Heatiny)('001inly, SIVIAY) Mcaidftuial Watel SuppWy (single) t T Sand Cernew Grow U Dw C.lay
01ndmwiaYCommew6aW ORP%idenuM Water Faipply Ohalrod) r..-i Coneyele GTaw 0 DiiH Cintiql
n spwalry Ggout 11."I Grew]
Nwo,-Wgier Supply WeH.- U BantorfiW Sluffy C OlMn, (cxpWn under 7p,)
UAquifer Rcchargr
1 I.Aquificr .13AomLw: wid 13 =avcry
ClAquifWW'm
OFxPainlentaITC101010sy
Woothemmi ((Nased It,00p )
nawthomra
312212-3
4. T.We we.11(i) sbaadonad:
MOTwndwalff Remwdiativa
Mracer
00thet wwLian urcder 7�!
Sm. Wei I hwj do a
Fort Bragg
— racRity MPTaff talaraataswW
FTBR-0691SWMU,-69,, bounded by. dui,
Mower, WoadrLdf& VArSJkV StraeM
11q1yezahke&q=' Cilky"and lip
Cumbelland
. ... . .. ... ..... . ...........
wofiowt No (PIK)
11b. Lathade avid twizitude W or decimal df.gre"s-
ffunR fWd, orw, Yea Aamg W1 suffimm-0
35.15492668 2672
N -78.9829,
_(q 6rRLTCT10,NjD1W1r1WA _FWV3-1AS BEW -_A&,% 5 Fin,
ff,PNLX'sndp dho,wpex ewailmdkA , akuldonmowl"POW
69. W01 [TiNk, TM -1
-- - — - - - - --------------- - ---
6b, TMAI well
6r.. Boirxholp diameter., 015
. . --"(ftn )
7E For eacb Im oteirial Nelftted abovvprovi& a MoUnt of WSWI-WS UwAt
Pordand Cement '13 lbs
7p,ftevide a briefftw.ription ofibeabindonment procedunv:
Neat, cernent funneled from top.
ttlaatn
Sq,IrwhAm. afreflifial Weil Dwe
r Wm why irroj y thap Me welltlxo arm (werej al.wndeAnu
ewcon.1twirr with 15.A AlAr 01M) vy 2C.0200 Wrdl
rtna Maya rupy offfi)v recont hav fpsynk prowded In dw well mppw'r
9. Site diagram or am didanO weH deWh.
you njay use the MA offfis puge� to rwovide Adwimnal vvtdl 9itC dCM66- or W90
abandonniWdelaiN P
11" ERE -A R-MkMat Subilug Tlak forTA MOM 34.) dap of C=pk1jon of vlrefl
*Andownent to the fbflo%)oeng,
y.wivisi6a gifWateiir Resource& IWwnffuorwuntanlisaam Proeftsing VaiL
11617 1,Mafl ServiEvi"enter, RaleighNC.2769'k 1617
I oh, jjr [wiLedjan P. I - finaddiwn to sending flie flonn W dRe addrwwa in Wa
.,dj.
above, shn submit one, copy of thw (brm %itMn 1l7 da)i of -.Mnpk6o" of Nudl
abqndonmelk, to du.'� TbRalwing:
OK"Wrt ar wal't ir Resource.3, Undeirgrumad 11[n,iftedon Controll Progralla.
1636'Mail SeMce Cqwtera %Wgb, M276994.636
I OC- ED "AIR x ion We&: In addifinn to "'Wxndind the roan to the
jK:t
addw,,s(c�) ahwc. aba submit opM copy aflhiiS form within 30 dxYS, orcmupk!fian
,.kr tvvn to the cowky IIwWih dc-pec.1mcnt of Ow roupty wbere
dp 40,001. CRAOVAUbin? ahnnftned
, IrAgA (if known). . . .. ........ (M)
&P, Scre"I lengsh (if known);
Form Gw -30 Nuith Cwova DtqanMmk mat FA%qwuR)Lntd Quahty - pa omn 4%Vwer Re"urce, Res mead 2-22,2101h

WELL ABANDONMENT RECORD
V. Woll Collotmetar informRHOU.,
John C. SchappeH
Wa Nww.. (ar v4H al pftsonaHy abandanitog IveH wo h�dlwr prop")
2332-A
14C well Contrwqx Colifiranon Mul
M&W Drilfling, Mr.
c4ropuly INWO
"P W106000,36
7. WRII Construction , trawit #,. . ..... .....
Uw 40 as IWO eflum"w1aft jwMius (I.0 UX Coway. Stage, vanamp, rec') V ATMI w
I Well use (cheelk well ae):
ClAgricultuml ommmapaMpublic
Suppky) Mmidefidal Wales Sappdy (single)
Mesidmdal Wall= Supply (shated)
A 't
0qUiftr R",jjMr
ploy mandwweT Remediadon
13Aquifix Stomp aml Ra.,,ovecy
rMalinity Baffier
Dmitzge
O%ubsidcncaContw�
0GwU=.wW (Closed Loop)
0,171aver
O(kmffiemid 0.1calim", C."whng, Mum)
OCHheir (explain uader'7;;!)
rp". Well lamwill.
Foil Bragg
Fmllilly?Ownw, Mane NeAty IM (ir�,11ppkable)
boilinded by Knl Butner, Wcmdruff & Varsity Streets
Thy.-.,,W Aj;,"r7
,,.;, 472y, wd Zip
Curnberland
ll Edcn011mdan No, (LIM)
5b. UtRagda mid lospinjide bN or decinvial dtj,�rees,
(nFwan anal One One lainorg is suffi6cw)
3!5',15792267 -78.98234736
M;�jj_( Pf.MUMMIMAN—ate NED
Alfarb rffrmd($rcH ffowvdahk,
(M.vwfdh Mr.&O"Ov. Iva nosy SubnIf l
6a. Well My: P-1 1 ------ . ................ ___
6b,. Totai well diopill. 40
Ae. Burehole.diameter, I__. - - — -fin.)
6d. Wmer level bdewg 'roand surface: . . . .... .. . ......... .. .
'For lmeTM Use ONII
72. Foll!.L(,.eeproben)lq"avC.3nieid4.,inalb Geollbennal Wells INauamundg this Swe
weh m bu r as gaaaua d kg0n, only I GW_30 is needNi. IndicatcTOTAL TANBER, of
wells abandowL,
7b. Approxionte volume ofwalleir vemainft%g in well(s):
M_ iiT,R5W7A;J It S1
"fie Type afftinIngtant wmA.,
7d. Aniount aftibli&.daint used:
. . ........ .. . .
7e. Staling materhalls used (ebeek Bill that apply)'
0 Neat Cemern. Gimut
0 Renlonke Chips or Peflifts
El Sand,Cenneat Giew
0 Dry Clay
13 Inmemip Groui
0 Drill Calling
ID ST.wilaky GrouM
0 Grave.1
0 Benmiite Sktq
ri Othe 'r (CAJ)dcjjg UrKier
11a ftreach material valeefled �abo,ve., pill
Poiliand Cernef"A 18 Ubs
7g, Prwide o bridd"aiption of thenbandaurneult proff-thilre,
Ill celment funneled frorn tqp.
312.7123
Sglwflwye Offegiffied Iffell 6w, Me"Idi" Mitt
4y'vgning this firm, / hamA), fxrqfi May l we'IIA) v%a (wede) abandwyed al
15,4 Well
O.-SiW diggriam or addifianal welled :
You imay use the loud offliis page to pwide addificil wdl sht demb or well
abutdomnaitdcAw.k. You may allsoatlechaddiflonall parm 6rnarr.',Lsaxy.
S w I URMI 171, ANSII 11
jffim. F ".
gl-.AJ,Meft Submit thh; fi= vdthin if) days rend' remplefion of,well
abandonment to the fol liewing.
Division ProcesOng Un",
1617 Mail Stwvicv, Cenkw, Ralil NC 216,99.41617
110b. Wdls,-. In addifion to sendmg Iffic fban lz dw addrLss ifi 10a
above, alsosubmit one copy or this fonn wMin 30 days ofwmpkfion ofwdl
aNnoonment to Ox CoPowing-
My6lon of Watar Re-vaill T.Indergil Injecdon CoutM Prs6 umuxaa
1636 MaN 'Service (,,enter, Mileiph, NC 2709-1636
fit, Outer owing length (Til known),
addil, sl(aaNwc, also snd ulinut qw msarrcopy ofthis pu ro-in tuttwithin36fte�uay.sorcomplaau inn
at w4 obandnwent to kl-m coivay hWth depluivient of ffie caunty where
6L Inner CftSh:w itaWng, length (U known): ebmlone d,
6g.Screen laingth r1fknown). -- — ------- -
Fw M avyr-30 11,bah 0v*hnaDqmnffwm cfEnviramnawM Quahty - DjVl%jO0 PrWQjIff RW.Alll Rcvi5a-12.2206

WEL1,ARANDONME NTRECORD
T"Well Cautmetar Inforclatiew
John C. Schappell
NOW Ow WeUeWUi-FPPr90MHy abindoniixgwoU rear Wwrptopetty)
2332 A
NCWdl
M&W DdIfing, LLC
CwWaay Nwua
I Well Construction Permit N., W6R6000 . .......
1, ho all applicabIr "Irli �Vrrdf �fj (rj �', � /Itz, CouexDw Stage, P/&?reanve, eit t of hwwsqa
J. Wei$ ase (pher. k well ust)!
. ............ ....
�_.,Far Internal Vhe ONLY.-�
...... . ..... . ......
L%VENNT DUAILS
7a. Poir Geoprobe/Drr or Clased-4.4ap Ceatheraml Wells ha�ving them nle
imil ennshinubon1derAh, on,ly I OW-30 is n,aeded. Indicate ItyrAl. NU, MBER or
wells, abmdane&
7h. Appmximste voinme ofwater remining in weliil(s)- _(gfij„)
FOR WATER SETPLT W.ALLS ONLY:
'7c. Type of disinfecianit used*
7d. Amount of disinfee Unt used:
—J
WaterSupply Well: - - - - - ------ ---- 7r. &.91ing inaterials wmd (check all thig apply)a
IN Neat cement(3mul U Berdongtchi psor Pellets
["Meathamal Al ufi'nn +C'aadlang supply) ED tc&deqlt"d Water S uppiy (single) [J! IPmd Cement GTow C Dr�, Chay
0 F.ndustnaVCommr.rcW ORP-sidenfial Water SupTAY (Aared) 1: Concgete Grow r-, DriH Cmhqgs
---------- C], spM.Wkv Grokn C Gravel
R;;WwatcrStippt•Y Well- 0 Bantownte SluMQ 00cr (explain under 7g
l']A4w0x, Rcc.nr�
C Mxjudig-•Storago w_d P,,�,,cavery
CJAquifei-TR zt
E]Geodu,Tmal (Closed Loop)
DGeathennal
4. Date veeffi(%) shandoned: 3/22/23
P-Groundwager Rcmk�batwri
-.J80nnN,vate,-, Drainage
G.Subsadanm CNiwrol
ri, rracer
E...10.hertexplaiD under 7e)
5S. Wen. ImIxtiew
Fort Bragg
'F=---A—hyi D'#(if aprplic,PA-b"dlp-,-i-)---"",,--",-
FTBR-Q6,91SWMU- 69, bounded by Knox, Butner, Waadruff &Vsrsdy Sireefj,-p
PhysfoW Affilocz, Cky, ango ?p
Cumbedand
PaTtd lfflowr=don No. (PIN)
ft. TAfitude and lonpdtude in us- ileawz] degrevs,
ffwwA] fid4, om
35.1564-2765 "'78.98114-171
CON
ONLY "ah e& saimp ran at_twa ra"nobnO amejurar.
6p- Well 11)#s P 3
6b. Total well depth 15'. (1114
4c. Borehole diameter; 0 75
6&'Water level below ground surface: _ .. . ..... . ........... _.(M)
Til For each matelalselected 3bove,, provide amount of zzwtvnala a4cd,-,
Porfland Cement lb,
"Fr. Provide a brier descripfian of the abandon ment proctdvrt�
Neat cement funneled from top.
3127/23
dWw1kcr boar""
Rv V9 e IK 4, 3 was ire q Cha daned in
". ning thisfiorm, f hel-eby rerlq�� 1hae 117 � flf ( r) n
aecvr&wnce Wth 15A NC74('02C` .0100 fv 2CAM0 0`�Jl Cansrrza.von Flandards
and Mal a calp)rq f0m reervd hav beenpreyvided m the,�vell rApner.
9-Site &Ngrans or additional vvell detads:
llrour nully uv: ffic t=k. of 11fis page to prowdeaddiumial %dI site defiuk or uvV
jb9ndonment deWls, You may P9so stlach addkwnal page. 0 nm&ssary
..............................................................
Wa. l ell tw Subaul dus fimn ,vuhgn .30 days f,,Xcomplctgan of we.0
abandon.nient w khe rol Wwing
Division of'Water Resources, Infovinsfion Processing Unit,
1617 h1ail Semice Center, Raleigh., NC 27699461?
10b. t_or In addftwn to sending thelbnn to %he addnnv in 10a.
9bove, tflsa lubmit, are c4TY of fllls fonn %,Mhm 30 da.vs, or qmmpletiov, ofmreH
abandenumni to ft fbHmving,
Division ofWater Resources, Underground Injectfim Central Prop, 'am,
1636 Mail Service Center, 11aleigh, NC 27699-1&%
6z Outer casing icingth (if known): - — ----- loir FA 'WAILrsu lvdjAlleaMMb- In add Nuon to smiding the fimn to the
. ..................... addres . s(fs) above., also mhbrmt i'me copy afthis finrm vvAn 30 days %,uf cxxnp&euon
of %%,Al aahandonmero to the county health clepadment of ffie enunty mbere
abandoned
6g. Screen leny #ji ar known),
Form ONY.,'M XnAh C"mohma Divuwa OnVINtr Resmacev, Rinmd 274PSIM6

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John C. Schappell
Wall Canlracror Name (or Well owner personally abandoning well on hWliar pmpeM)
2332-A
NC Well Conteacmr Cernficauon Number
M&W Drilling, LLC
Company Name
W10600036
21. l lit alllapplleab Construction
mnsmrclTonpermils 6* Vic Carmty, Slate. Yariaece, etc.) It(mmin
3. Well use (check well use),
For Internal Use ONLY
NWj,I ABANDONMENTDETAILS
7a. For GeoprobeMPT or Closed -Loop Geothermal Wefts haoing the same
well construction/depth, only I GW-30 is needed tnd"tcate TOTAL NUMBER of
wells abandoned:
7b.Appruxurutevolume ofwaterremaininginvroU(s): _.... „„(gal•)
"Fo—A WATER SIIPirLY WLLIS ONLY:__.........m�.m���.........,._w��_..
7t. Type of disinfectant used:... .w�_....,.,... �.........�-.
7d. Amount of disinfectant used: .....,..._.........
��..... ......... ._........_....................
Water Supply Weil.
7e. Sealing materials used (check all that apply);
OAgricuhurai Emunicipalftblie 'D Nest Cement Grout O Bentonite Chips or pellets
OGeolhermal (Heating(Coolmg Supply) ❑Residential Water Supply (single) 0 $and Cement Grout 17 Dry Clay
131ndustrial/Commemial OResidential Water Supply (shared) O Coha eto Grout ❑ MU Cuttings
NM
OAquiferRechatge
OAquifer Storage and Recovery
OAquiferTest
OF-xperinrernal. Technology
OGeothermul (Closed Loop)
4. Date well(s) abandoned: .�.L..... /23
01Gmundwater Remediation
OSalinity Barrier
t7Stomlwater Drainage
❑Subsidence Control
OTmcer
5a. Well location:
Fort Bragg
FTBR 69/SWMU•69, bounded by Knox, Butner, W)
oodruff & Varsity
Streets
KrAicat Address Clty; and Zip
Cumberland
t:aunty ...__.............. ...,.„_....w_...._..................... Parcel�,,....._............,e..,..
1denlitirationtion-N No. (PIM
9b. Latitude and longitude in degreeslminutes/seconds or decimal degrees:
6twell Iitld, me latilons issu@icrem)
35.15996340 N 78.98112293
❑ Specialty Grout ❑ Gravel
O Bertonite Slurry 0 Other (explain tinder 7g)
7E For each material selected above, provide amount of materials used:
Portland Cement 10 Ibs
7g. Provided briefdescription of the abandonment procedure:
Neat cement funneled from top.
s. certir► Q ri�
3127123
SrbmateoCeruHed4ridlContraekorore11S watt
urDare
By signing this form. I hereby ewaff drat the tvell(s) nps (,ywre) abandoned in
acwrdzzn a wah 13A NCAC 02C.0100 or 2C.0200 Well C.andructtnn Standards
and that a copy a%this rteoid hew heen provided If, the ueff 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.
�CQNSTRjjCTlMD9TAtLS OPWELm S SEINGA ONEl1 _
(s +a7leble. Farmvla cur" camlorrutr-rvafrrrnpp(vtrellr
ONL r with aesamc twwrualon abamlamm6at, ynu can slrhWl ana jnrrn.
6a. Well IDII: TA5-12 �^ m
6b. Total well depth. 40 .. _ _..(R•)
fic. Borehole diameter. 0. 75 ___na.)
6d. Water level below ground surface:_,,,,,,
CIBM AL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion or well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mai Service Center, Raleigh, NC 27699LI617
1 Ob. For In(gcr Wells: In addition to sending the form to the address in IOa
above, also submit one copy of this form within 30 days of completion of vrell
abandonment to the Following;
Division of WeterResources, Itndergrouad Injection Control Program,
1636 Mail Service Center, RaWilt, NC 27699-1W
1 Oa For Water Suoolv & loieeden Wells: In addition to sending the foam to the
6e. outer casing length (if known): ,w,,,-......... .............. ._ (R•) address(es) above, also submit one copy of this faun within 30 days of completion
of wit abandonment to the county health department of the county where
6E Inner casir g bing length (if known): _.... (S.l abandoned
6g. Screen length (if known): �_.w .. ................._.. �.............(D•)
Form G W-3t1 North Carolina Department ofEnvnuaroenld Quality- Division of Water Resourocs Revised 2 22-3n16

WELL ABANDONMENT RE, CORD
d. Well Cawmmtwractunn find arraaaturarwu
John C. S a ll
mall DmarH i N a (or w,all owpar personllbr alyiaradwvauaa,i WCO an i"Vk7 pave j)
-
NC Well t.a wasa asrdw"a raga tdaa .N=Axi
i�icnimaNxr«axyr 3tiunuw
00600 36
2. WCH conistruction Permit #'a' �........�.......m._._�_..w,..._................�.�.�.�,..
dAa�°A'+aPF�R;yyPnBrt�uraaSn,�an ftA'awart.n"sroaanaka,yxw�repads(1rv.l;M�,ir'j-eagip,'N' ev,Vann,rVice,arn)afkawn
3, Well uasa l;m:hezIllm walll nod:
m,.m.m.,W.... _. .w..................m......
��r'astmr "muaaunulta a"ill„
0A. lsicuNltuN ll 113MunicipaliPubhe
W«,mgherinal (HInpiii `uaznlilrnryl Supply) Ul Mdcarailmal Vilater "lraaluq:uly l,,wua&l
lrrednn5lrlaYi taunaaan n¢6al 1:.7dt:o ide nttiaal %wet Sun, pd v (elm md)
IE[Agauif& R.c hm.sge Grmanarndww^a r Re ma dia bnn
F:Idtqauilla S'lorare ark& IRecovexy u`i'SslattnaA, Shane^
OAquiiiatTc t t7naurmmge
"r xgawrlamm metal TcaaNnnallaa rf y^ 'Su bsidre:anu°e:lConttral
R wl"aaramdnawrunual (Closed l 00) Ulmer
W".1Q,eetherinal r,t,l aknn o "'w (Ft,rra+. Rapmuranp 00diariawgrolralnu aun.Jax 7»rr^,;
l",'l uta wrmllsyan,laattau uuru tN,• /2.', 1
23
SL W'all lGrAtIMR.
Fort Bragg
t'acrNaa. trrrcar"w.vaaeom ;�n°zaulaihrt&a l`ul'mgngularutiu9req
.... r untied Iby rmoaz Buttner, l�/saod niff Varaga Streets
�"l'� t!lu�9lldllLU4a$ �umuaw .
ft siicM awaldira a k, City, *nJ di
ul"l" b lrl'ral'"ld
.rcal p&71fficam. d*2aa.(l"d'tS)..�,,,.w"
S'lv. Latitude aml lanaagmltnutlra in degreesP'iaal.mauatusd'secunads amr demimraral rdgmn°ura:
Orwell kaslaL aaroa laRalnx4 as wuuNfic4 and
t a R�riaYlr �'
7ma. For Geao-daruabcffP"r or Msi Geothermal WeM duawmr g tlnc m auaa
wwaulW caam„k:muncaiamma do aNlm only dU, -��V ��a nm, led, Indi w.. TtMAL 11'R WBER of
rnia^NWT aaln iaabufiz ed . .............. ...... w„_._
"lb. „ A•pproximrmaate vuul &me Kuf wr vter remaining ning in �aa:ll��l= �� •�
"d"Iype Di' atiwsrnffecla t vsodM ....��........ �..� ��. , . � �............................�.�.�...�
"8d Araabu ar of dlsiirffractact uu,wadn _
......rik A ....
7m. lallaa,� mruwwncrla➢� mil �4ltaa:pn mill tdaat all�lall7�t,
E 'Neat t..dn al Gi nu t
L3 Bentavise Chips urn d'cll .w
* Sand Cer¢nem GanwauN
M ldirT Clay
* Concrete Grow
tJ DO cuttuma a
n Spwialtytlrranat
1.:.: ayaval.
El Hc.,uwnde Slurw
l ld er (explain under 7S)
7E For ea cb mnna¢ltt:rlaal sel' a.ud above, lnmrnwlde swouamwd anffrsmaaterii als n.g. eda
7W Prii%idewalanenleseriptnwmmnaeffthealw°aantdraurameal..,urocedun:w!r.
Neat cement f unneI A frai top.
ld C rfirsa.sµClq n
n3)27/23
si gusaRuuar:�n'r�`rmsfigd'tR!'ai-91axvaur.+i: rraa nuu'ah7cPN Paarrrre, .. DOL
fdY . "narz? mfnrw° fomxa , d hereby a'crgfjir ehat ulna= wue11(i) wwat ewerq) abarwwdranfed rue
uzr.rsa dmuwarrux WWI f5A AIC.41C; ifP2o~ 01110 gar X: ,4200 We D V""raaastnuaahan Standwmfe
r.arrcwi Mew ra e,,...7y na ediurd Arras: l eim 7;rrrrcrwuded in the veld au maws
9,. Site diagram orad al'ltlraunal welt details:
You wrrra7 unsc that tnrack off lunls Ij'4So to prow ide odditurni well sttc dc*ft or well
W ab atndonnanmant dataill.s You may also atta ch aaddutoaneail psgm iff inezessawzl
W"ltdN IDULA_ ;' WELL S BEING
ddPas�Na aiamkn sna�aaaa�wN,e�o.r�snvazdg2ryq ti�'sxvr,�Prutad";u. ;7^maa•uaur�t6{�bka uyr,:�maarrerandzaam•m�unaw^!tua�wY,pa uwr8lw
ONLY.Oh „Mt cam wardnraar'a navmaAmrar
~aa. WdIl l,,, "r -11
fella. Total we" depth.: '40
,
75
6e, lR arcda¢alc dhimeler; .. .:
6ad. gh'lVanler lever below Smaamned ruarrfmcca
dlWa. Naar .A.dN ° oxllm aunlbranut daus form wwllMr dffa days of aamea plefion vii'%veM
Ealia nallewawauanal le $L ffamllewmbrS,:
TMnrl•sitrua uaff'Wratar R uuanrcei, lfrmt"uan namlrwra Prac wWDg V ah.
16'117 lataml Sery iep Center, Ilaalleigh,' C 27699..'161l'
Ift Ea a m,. �ionn lanaddition to actnnilaS Nlae^ feTm to dawn aarla9mcsw nnn Ida
a rc, else Axbsuaat OW COPY u f thus Form wwmiidrmn ;Nli dabs or crsnna,pieti anre riff awal8
abannalr"urnmmcnnt to the ffrallrawvn g:
lwlmslumru unff "arar Rewurcw4 U nder,liruuuaad Ianjcctiou Control Program,
l636 Mail "mar e.e CentcT" Rafclgwlaw NC Z76994536
„ dlla �"aar ` r Sau la" ctu ire ml2 n tau addition arch sa'awmdmga the ffcrm flue floc
t7na»A a cas lie lcr l�a Off known). � _ �. addiresmes,) sWvr nalse mdnrwnit One CGPy ORNS ltM ha°altaiia 30 OaY. S, as cawrnn l hlaB a
aaff wwadl asbando ni na n in Mir counlvr Wth i or A.he, raaesanla^ where
U. Laaar WRigtQnfflaraaawwn)) ___ ......f. ➢ abandoned
6w Screen lcngllw (iffdsanwwun)t m........................�..�,..•
nPaaMR''M-'m' "4mard@¢ rcs:ralaroa.ICYurvwnuab7��cauaa�»a 9!'r�xrvarce'niinrov ot8 't„,aaa9pw;y."uw+aYwnwarcgw'u''l�"waGu:rRasauirwT Yirevitsred2-Z.,-2.01d

WELLARANDONME NT RIE WORD
L I'VeLi Contrzewr 1ifformat.low
John C. schappell
- .............
WA.,111 ContmotarNarna, (in, wMimmer perronal1ii, alga n&riangumM un hi%lkw pa.)pniy)
2332-A
Otte'. Wdl Couiradror C61AC6160111 Nughm.
M&W D-Uhng, LJ C
2. Well Construelion Permill- s"r - W�10.6.09.036 ..... . . .....
LAI OU ap'Njughle mi-11 QJuni-y Malf., I"arfulwe,
& Well, Its, e (oheek Waft use);
ClAgicuffinal CHAunicipaUllubfic
Meotherrul (Heating a a, ,iCoofiqV.;,Supp1y) CMesidailitial WaWr �nOj )
OWUAMBUCOMnlerciol E]RIL-Umfial TvViata Supply Nwed)
N011W.-:10fater Supply Vl
C]AquMrR&h:NgUr
04GtoundwMTRemedisiIion
ClAquiftr Stunige and Rerialrety
Usialiflity BwTier
ClAquifer Tmt
11 Monnwahr IDr pipe
Q Expvftiurdal Tathriabgy
Mubaidrxv. CcaftrA
Modlixxnal (Ciused 1-clop)
Urn=
DISmotherimid (fleatir p, CooliTilp, Muni �
DOLItm. i irqiMin under 7V
4, Date welt(,iialtrudened. 3,12.11, 3
5& WL111 10lation:
Fbd Bragg
i;;iltyA)'AFfRff —NMIC Fna.q? tv# (WoppliqlML)
F71131R.,06919MU-459, boUrided I.Vy Krim, Butiliar, Woodruff A, Vairqky Strpets.',
Rhysiail Addmis, Ckyk andZip
Culry-Itiedand
CDIRWV PwrtA Na (111Nl
501. Latitude and 10ingitude fill. oir derim a I dlip mks.
'35,16000260 N "78.98120 139
ONLY twith the same )vIk wy x1dwil One foAr.,
'rA5,--10
fid.'Wall MA. — .... ......
6b, ToW wdl dep&40
0 715'
6c.Boix*Wadiumeter-� ka.)
sad. Whter lewd below ground isir-face.
.. .... .. ............. . y
.. . . . .............. . .. A"-
*AiarL
"' . ..... ...... . . . . .... ......... ...... . ...............
NDOWE-MULTAW-1-A
weill. anamictiarildepilk only I GW-30 is neoded. lindicate TO.TAL'hUMBER of
waills abandoymd,
7b. Approximate vWuirue of wah,,r remaining !In vyL111W94 WITMUS ONLV�
7d. Aminuiul of (fiNkliurts at near d:
. ............. . ... . . ........ . .....
7e. SwUng materials vaif (ebeck,afil thgtapply)!:
a N"t CpMelift Moat
n Dent write Chips cx Pallets
U.) SAnd raMCIA GWID119
0 Diy Clay
* ConcTele Grout
10 DII-W Qft'Ails
* Speciafty (Rout
13 Gravel
* IBrnttaquvule ShAlry
0 Ogler(CXPWIII undeF 1g)
7E For each moteil skieutisd above, pirovide swount. ofinabs.rUds used,
Porflarid C'eirinerit 10 bs
7g, Provide an brief desairiptins of the absindiiiament proms; orrmt
Neat cermmit funnel M� from top.
S. Cerdfic� t' W U2.712.3
sistizimfe 0 C&'&dQ WcH x.rn r ov- WoU Mr
Hysignigg handoned in
Iffis Jorna, I kurr,.Iby awijb, Aw the ivefl(s) oa.r (;Vorp) a
ulfth 15A -N(--AC0.X` 0100 vr2(,02iM Well C'mmmuctlian SloNdarda
awlthai a cqpy ifthe reeordhem hem. providedle thr mviar.r.
9. Saline dHarralto our sddifionaIl weil detaiW
'fou may uSO the lack of flns papp., w prDvi&. leddIfiaW w.A she details or well
W obandonmentftlift, You may z1vi athich additional pagn ifInftesBoxy.
Mai. AjLyyp 11p limp ink this ronn wthin 30 days Of rclilriple6on of well
abandonment In the RAlowing;
Dfvftion ef"Water R m— urcM Warmadon Processing I Irlit,
1617 Maill. qervice Ceuirir,,RallrighTqC 27699.4617
101). LZar Injection WILB: [A adififloti coo seriding the fbffn to dic addyess in 10a
nbovo, 00 STAMA, One Copy of thIs. forin vothin 30 days ofamirple6on afmt.-H
pbandoripnrM Ile the fbilening:
Division ofWater Underlymulad Tmiection Cont.mil 11rulell
1636 TWRII Service COuter, Rallefth, NUT7699-1636
6eoutarcasing kil-Axth (if I pier V In addition i0mmding the fQup to tho
alinve, also small udi 011ie oupy of phis fcM Wilhin 30 clays of"Cognpletial
af'm,pll ahandrinfrientr to thin; counly health dcWment of the county vwUnwEp a;
(if known).-- abandotied
ttnpscreen Jeapth (irkrrolvu)u
form CM-30 C7Axpifina Uhj.,arlamt a1'Enyiiq-onqwnW Qualiq, -Vvown fffWatev ReMaTcai Rev?sod2-17.-!n1fi

WELL ABANDONMENT RELDRD
L Well C,'antractor Informadon-
John C. SchappeR
wN;—Oi N-P-nr, (ar %efl awnff puzonally aWMdOvHAf %%IT OA his&PF PTOPUAY
2332-A
Nc wefl canlr=or CW tfi cation Number
M&W Drilfing, LLC
- — — ------------ -- - - - - -
t`;.T.p�.ny Net.m.
W10600036
2.%Ve111ConstrvcfionPerMKN� . ...... . ........ . . . . ............. . . ......
1 Well uqe (irbeck wO use)t
.. . . ...... . .
Water SUPPITY welh
DAVicultural
OGeatita.rinal (Hew mg/Cool nig Supply)
0 WitishWICOrnmeraitd
DAquffo"Rec,harge
DAqw fm SIDtagr arid RaraverY
O,Aquff'er'Fvt
Ofi'mrntalone igal ToOmelogy
0(Omherrnql (Oo.nd t.'Pop)
'1. Vale wrill(q) ahalAoitwd' 3/21/2-3
EEM
FDr lrftrm, T ViL CNIN
MLELLI�tA -1. 1
7a,, For Gm ptxC
Db&DJ1T or hiqed-Loop Gmtherawfil Wells 1MV iM :same
e
reconsinic . non/dq^ only I GIN 30isweAed. qndiaate,771AL NUMBER of
%wAhs abandoned-----, . ........... --- — -1
?h' APP 1-0 % i mate volume Off wo to- remaining i a vrpJlir�):
- - -------- - -
FOR WATER SUPPLY WELLS ONLY:
7c� Type of a isi n faefto t =d : .
Td, Amount (if disinfeckant used;
roaterials used (cliev.1k s1111 that appIF).
q New ceffielit Give. 0 Be-nio nae Chop e ar PclleL�r
ORandenbad %VatiV;Pod V1Y (aftle) 0 $and Cernenk GmW. f.3 Dry Clay
CjRcsldmual Watr3 conurea agmi, 0 DnIl Cutting%
MIGroundwatox Rcawdufion
OSahnity Baiwier
f..-2S1OrM)Waer Dminage
OSubsidence Cono ol
IDTracer.
00diex I -o% o Uain under 7o
1 .52, WrIll 11mitio"..
Fort Bragg
Fnifiry IDO VapphrAhk)
t I —'r 6 w —= 'N ......
n'8R469/5VVMU49, bounded by Kninx, Butnr-Oftodftiff & Vallaity, StffletS
Adban, COyj and Dp
Cumbefland
WPamen Nawtftwimn No i PINI
5b. Latitude and tongitude in dmimaVminateshweOnds or dgwknal ale greima
idwdl fi.Ad, one 60kmg issufffiwferO
35.16003631 -78,98123525
. .. . ............ . . . ....... —
0 speemIty Oren 0 Gravel
0 ReAtomte, �.;Iurr'y 0 OtheF (explifin undw 71p
'if, Foregeh
Porfland Cement 10 lbs
7& Pruviden bnIcHescrilpfion
�Neat cernent funneled from top,
3127/23
canunctay w wd, Dam
u' V snnagg #&sJonn f Aereby oerlt6, ehat The wefl(,w) wem (wvre) ahandaned w
accordcvxe wa*?:5A PVCACQ(.",njOa or 2C.0200 ffefl Chmy ruct win Sgandbrds
undthat id vwpjafpl efu% romydhamheen prowdedin tkv well auamrr
.9. Site d6gram or oddlifinimal wefl dela&,
You mrny use The back afthisRorie in provide addihoW weH rate deWb, ray well)
abandontnent deiaih;, You may &t%o attach addifionall pvggs ifrmce,,&iq�
(,X&N,T— QkILETAIL&O�A SJBEVNGAPANTJQ,'jEP
�gllit&tfl7A L
I il SohMn Ajoi fbnv vvithin 10 days ofemmpleOrin of lwdl
6hotal well dentb- 410---J.ft.)
6c. Sorchok diamfAw. .0,� 7 5 fhu.)
ik). Water Ilewei below ground qurNgoi- _(ft.)
abtutdonment To the fbflawng
Division of Wmter Re,%.urce.s, Information ProcaRimig Unit,
t617)''V8dil Servive Center, Raleigh, NC 27699-1617
In addilimn in rwjitdiqg the form Io'ffie addmss a n 10a
W.aM, aw6�a %jibntit one copy of thm fomn, %WMm 30 of campkfion nFWcfl
Aaxionmulid to the [b1h)Wim4
if wision g) ir wntt r Rewu mx-A, V nderground In j aelio n C'amtro I Program.
1636 TwWail Semice Cerikr. Rxleigb. NC 27699-1636
I � VOIN;
........... L�, jL
611:. Outer easing length (if known). Adiiem(a-�) above, aho swabini4 one, copy of this f"orm vnibin 30 days ofi,,,ompkiimu
of w,,etj k1l:,andwiment to the county healdw deputnient or o-ke ctnjnT% cdiere
6C. Innin, amshtgjtubiap length (iflutOW01. abmdontoi
6p _ Screen hmgth (if known)___ .... ..... . ......... . ....
Form OW-36 N"Unh Carolina Dovaarnent ofFinvuonnvowl QuaNv - D-swn aftftinf Ita"%wr—

ELL ABANDONMENT RECORD
1. Well Contractor Information:
John C. Scha_ppell __ _
Wam all CanuaetarNe (arwell owner persanally abandoningwell on hL-A.er ptopcny)
2332-A
"NC Wall Contractor C"ficsnnd Number
M&W Drilling, LLC
Company'Name
W10600036
2.Well Construetion Permit #: _ .__ _..._ _._ m'.1 ,. - I'll. ..... .....
Llsl all applicable well construction parmtts (l e. i1jr» C;amnty. &xg; Variance, erc j tftnawr
3. Well use (check well use):
Water Supply Well:
[]Agricultural OMunicipaMblic
❑Geothermal (Heating/Cooling Supply) 1311esidential Watet Supply (single)
01nduslrial/Cotnmereial 011esidential Watet Supply (shared)
❑lm,�a tion
Nan-W..�....,ly Well: _-
...... .. _._...
ater Supp
©MornatoringjeiCon Wr1li .. ............................ _— DRecovery T _.
❑AquiferRecharge IgGrotmdwater Remediation
[]Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test i3StormwaterDrainage
i7Experimemtal'fechoology PSubsidenoeControl
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal jli„eann,.,Coolim Rctum) 130ther(exlelainundcr7
4. Date well(s) abandoned: 3/21123
Sa. Well location:
Fort Bragg _
Facility m#Qfe"ficable
FT R-069/SWMU-69 bounded by Knox, Butner Woodruff & Varr.4 Streets
Facdl I�onerNamc
Physical ndaresa city.audZip
Cumberland
County Parcel IdenlifimienN.(P
Sh. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(iiwall field, one taUlong i:; sufilciera)
35.16007112 -78 98125771
... N __.. _.._...W
Aril eh l carsrn �N. CAM GE_W �
Fk B1�tANDONED
rcnanreconl(rJifmwffo6le. nitiplrenjaeYranorrwn-watarsupplyrratts
Oft Y with rile some canttrnedvatabnndlann+enr. }nu cansmhml/ one form.
6a. Well ID#: TA5-8
6b. Total well deptk: 40... .(ft.)
6e.Borehole diameter: 0.75 (in.)
6d. Water level below ground surface.,
For Infernal lira ONLY
WELL ABANDONMENT DELU S
7a. For Geoprobe/DIyT or Closed -Loop Geothermal Wells having the some
welt construedon/depth, only 1 GW-30 is needed. Indicate TOTALNUMBM of
.yells abandoned • _.
76. Approiimatevolumeofwater remaiaing,ln well(s): �,,�• M._,ITIT��...a_,{gaL)
F_�._OR ..� �.. .................._..�SL.TRFI,_�_�ONLY: .Y ..� .. WELLS O � �.,..........................�..�.........---....---.......__
WATER :
7c. Type of disinfectant used:
7d. Amount of disinfiectant used: _..... ................�..
7e. Scaling materials used (check all that apply):
R Neat Cement Grout ❑ BentotliteChips or Pellets
❑ SandCementGmu: ❑ My Clay
O Concrete Grout 13 Drill Cuttings
❑ Specialty Grout ❑ Gravel
Q Bemonite Slurry ❑ Other (explain under 7g)
7f rareaeh material selected shove; provide amount of materials used:
Portland Cement 10 lbs
7g. Provide briefdesfxiption oftbeabandonment procedure
Neat cement funneled from top.
8. Cerl- tm�asn ,"1
n
of a reiFcd W f27123
,, 3
5itmar ell an eororWe 'honer Date
By ,signing this form, I hereby cerrrfi_ a Mal lire well(k) was (were) abandoned in
accordance with 15A NC.RC 02C _0/00 or 2C .0200 Well C m rtruction Standards
and that a copy c!fthts record has been provided to the well owner.
9. Site diagram 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 ifneccssary.
SUBMIXM INSTRULMONS
IOn. For All Wells: Submit this form lvithin 30 days of completion of Weil
abandonment to the followmg:
Division of Water Resources, Information Processing Unit,
1611 Mail Service Center, Raleigh, NC 37699-1617
10b. For injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this Farm within 30 days of completion of well
abandonment to the following:
Division of Waterltesources, Underground Injection Control Program.
1636 Mal Service Center, Raleigh, NC 27699-1636
be Outer easing length (ir known);{;t,) 10c. For'%Vater Sunniv & Iaie(!don WeHs: In addition to sending the form tothe
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 easing/tubing length (if (mown): _jjt) abandoned,
4 Screen length (if known): _.........................._ (ft•)
Form GW-30 Nonlr Cnmlina Ot partment arEnrironmental Quality - Division of Water Resources Revised 2-22-2016

WEL.L,A..BikiNDONa ,NIENT,ItF,CORD
1, NVOI ContmeW, Information:
Jol-in G, Schappefl
NC WeR contrwICAT cenifivam" Numbeg
M&'VV Dirifling, U .0
C"butryany Nome
UVI all alvricable Dwif vam"wMan Parynd, A e gMdv- Fkrxvm4k.) yr*$zFwt
J. Well use (CheAwelIll Ame):
0 Agneullftual
NODAVaTer %pplywell",
OA,quiibs Rucharp
ClAqw,littrSionage ard Recovefy
OMwfer'Tcst
Gapc6muntal Twlnlalop
0(awthemnal (Posed, 1,00P$
4.0site well)(s) abandoned � 3/21/23
[:'.IMumcij)8VFUIblir,
Pot- Wernai U'se ONLY
AREIL AR&NIMMIMI&M
7L For GeoprobeMPT or Oosul-firop Grothermal WeUs haI6 ing 11TWItle
%ijl cf.)nqTucbanffa� AJL aujjy I OW-30 is neaded. Tndirmv!:T(YrAI, MURNMEP, or
wells abandoned, I ........... . . ...........
7b. Approximale volume of VMtke ramftim ing Ift wall(SY
. . ........... ..
WATER SUPPIS WELIS ONRA".
7c,TypeofilkinfrMint ustd.,
7d. Amount of dishifedant woed'
"fie. Seaflog iinaterigli ared (rbeck Bill Chat apply)'
a Neat Cernecit Gmir. 0 BeTunnite ":"Villas og PrEek,,.,
OResidm0al WaterSupply Olingle,) 0 Sw—d C'emiimt Grouk a Dry Clay
ORmvvdrnbal Water Suppby (9,wod) � 0 Cowmlae Grout 0 DnP Cut"Lp
SGroundwatef Rommfiflfion
USdlinay Bani"
astagnmuli-I rjrawaj!a^
O,Sub�,ideroe Cantra�
EITIacer
Uotbei oux,,pil under 7v
Na.. Well la raflfen,:
Fort 1.3riagg
FTSR-0691SINMU9, bounditd by Yjwx, Butnal-, Vlcadruff,& Varsllty Sfteets
Nimsical kadrass,, Cay, and Zp
Cumbedand
.... . . .... ....... .. . . . . ............ . . . .
catody K11CO leawfilm"Um No (KN)
0 Specialty Graw r.3 Glaval
o Hentonke %uM 0 OffmT (cxplain undrx 7g)
7E Voregcb mmerial seleewd above., pnivideatnowistofmataiamused:
Portland Cer'nent 10 Ibs
7r, Pirwmide a brier tiNncription or thealumdonment PrruerAIPIAM
Neat cement funrided frolm top.
&
."y
P 3127122.3
Q," canuaam Dir %Vc ww rate
fl�y eba jorm, r hcrehy wtM,? djar ilie vw&q was l'wrra) abandone dL era
acuordlimax, wirk 13A. WAIC 02(- . 0100 ar, A'.0200 TPev
and Ikof 42 t.,qpw 1�.�fddv mcnlyi has been Pro pseh-dio the well o wner.
I Sh. I.,stinideand longhude ho oir decimal dwrws,:
(&%&,c4 AJdon. k0aag, usw,frww�,aB 9. Shj,: drisgram or 03difibInAl Well defalills'
you nnuy use, lh4 hAck of ffis page to provide addmonall wgIll site 4.1emus or Avivill
3& 16010621 -7��98127716 w - tdunmm , ifne �, affy
— ...... . . . . . ohm I def.ads, You �nsy also, aftaoh additional pages cen
ffK�
C j.A.gEALL_,EL.I.;j UIN
_Ydid TAk RUC,.'
P,
onrvwk llw.sawa cwy w0we 04reffir'n 102, &Z-.4,U-w v submil Thfia ft-irn vothra 30 days w cm,npkaun of wel',
AL
bi. Well IDP: TA-5.77
6b."ra1vIwel%depIh_40
c . . .......... .
6e. Rorelhok 1113MOU.-r-, �7L--oo,&
6d. Water level belaw Woand surface :
Dlivision afWawr Rl Falfarmadus PrOc4s5ilar Unit.
1617 HWI Service ("Vater, Raleigh, NCZ'7699-1617
I (pb. O Ilreareuaa swn e9Na. In addition aura svT,adinp the lbrm h) the midress in 10"a
above, idso Rubam One copy ofd-.ls form within 30 days of compkfion of well
abandonmmd to the relinwm-g-
Djvj%ftoa Off W8ttrRMurcvI, UM, kr�rf(,UiHl [FtjCCh0T# (volatrt)l IUtauqrsan,
1636 Mail Service Center, Raleigh_KC Z769q-1 06
i flw_ �,��S%K , I�P'ecfion %Vfflfei� In addkion RD 1,encing. tha I b.nn to thr.
6c,Outer casing, l (if knO'wifl)' Adresvei� abovc, Aw submlt onc cojt�, (AIlus Atrwn w�thhA 30 dalys, of romplefion
of weill abandonmwt to thL counlly hw0h cIcpwwmrlm of Elie count'v whem
6f. Inner eashawtabing length (if known): ---_ . . .... abandoned
61,, Screen lemoi h (if kno wn): . ....... . ..... (ft.)
Fow UW30 Nanh Carah,u Deparlaw,ft QuARY - D"wwor, O(Wwef Rrnwd 2-21-N u 6

WELL ABANDONMENT RECORD
1. Well Contractor information:
John C. Sehappell _
Well Contractor Nacre (or wen owner personally abandeniug well w hiail Pmparry)
2332-A
...
NC Well ..,.,. .... .......
..m.Connector Crr0ficaUoaNumber
M&W Drilling, LLC
Company Name
36
Z.Well Construction Permit# ,.,W106000
.s_.._ _ .... ....... ... ...�-
Liar ail cWp1lmhle weR consinwOon pc;J (.,r L'IC, Carauy. Stan; rMigam eta) 000"',
3. Weil use (check well use):
❑Agricultural OhlunicipaliPublic
❑tieothermai (HeatirglCooling Supply) QResidential Watet SuppIy (single)
❑lndusttial/Conuncrcial ❑Residential Wates Supply (shared)
Non -Water
OAquifer Recbarge
sGroundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
OAquifer Test
OSlormwater Drainage
❑Experimemal Technology
OSubsidence Control
❑Geothermal (Closed Loop)
❑Tracer
Menthermalilicafinn,!Coolim„ Return
❑OtherIexviainunder 7,0
4. Datewelt(s)abandoned: 3121/23
So. Well location:
Fort Bragg _
F�ditylOwnerAlame Facility iDa (ifopplicable)
FTBR-0691SWMU-119 bounded by Knox, Butner Woodruff & Varsity Streets
Pbysical Address. CiV and Zip
Cumberland
county
Parcel Tdaaaficatton\o (PIN)
5h. Latitude and longitude in degreeslminutes/seconds or decimal degrees:
(ifwell field, one laMour is suH'ivanr)
35.15993380 „i-78.98112293
Par tnlerrmi Use ONLY
WELL ABANDONMENT DETAILS,
7a.For Geoprobe/Dll or Closed -Loop Geothermal Wells having the same
well construction/depik only 1 GW-30 is neoda indicate TOTAL NUNMER of
wells abandoned- _.._
7b. Approximate vo[umeofwater remaining in well(s): w•_ _
FOR . • _. m ..
7c Type
e
TER SGPPLY WE1.L5 ONLY:
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 Gros[
O "Dry Clay
13 Concrete Great
❑ Drill cuttings
El Specialty Grout
❑ Gravel
❑ Bentonite-Slutry
❑ Other (explain under7g)
7L For each material selected above, provide amount of materials used:
Portland Cement 10 lbs
7g. Pro-Adea briefdescriptfon of the abandonment procedure:
Neat cement funneled from top.
S Cert7M-1-
3127123
SigsurmreofCenifiedWatlContractarar ie loner Cline ",..... _......
By xigning ihirPorn; i hereby eerify Mal the we11(s) was (uferr) abandoned in
accordahos with J3A NCAC 02C.0t00 or 2C.0200 Well Cansuxtction Srandar&,
and dial a cppv ojihis record hos been provided to the well owner.
9. Site diagram 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 ifnecessary
CQVS'KR ' ON oF;).'r)r, ,et,., WT+), MAIKITIG AB NMQ_( NEb
haochuelicara+menarrstwtd(sJljmnlfuhla IQrnndtipleinjeztratearrwn•reararsupplyuells
ONLY with the aware cr+rstrrrcdoatalwndanmen4 ymf can rabrMt aitajoML
6a.Well iD#: TA5 6 .
6b. Total well depth: 40
6c. Bareholediameter: 0'75
6d. Water level below ground surface: ,,.,,,_,__- M.)
SIMMITTAL INSTRUCTIONS
lea. Par All Willa: Submit this form within 30 days orcompletion of well
abandonment to the following:
Division of Water Resources, InformatioaPracajiing Unit,
1617 Mail Service Center, Raleigh, NC 2769M617
10IL Nor Iniecti n Wells: 1n addition to sending the form to the address in ltla
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Divtston of Water Resources, Underground InjetdOxi Control Program,
1fi36 Mail Service Center, Raleigh, NC 27699-1636
6e Outer casing length (it known)* „ (D) loc In addition to sending the corm to the
,For W ater Suq l & Inyectian VYells:
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.Tnner casingltnbing length (if known): �.�{ft )
abandoned.
6g. Screen length (if known):. _...... ........ _ .(FL)
Form GW-30 North Carohns I?epartmew ofEmvironmental Quality -Division of Water Rascaress Revised 2-22 Ze16

WELL ABANDONMENT RE CORD
1. Nvell Contractor InforgNM60n,
Johin C. Schappell
WcH CuabactuNaxm (of aW" owflep g rx a aaRtp RamaMUnunvaggyw m8t ORR kwlmr Fropedy)
23322A
NC WVoCor4w;x"tor C'effiuzbsn Numt3tr
IM&W Drilling, LI.-C
(.'Umrwry NRIRg'."
W10600036
I WeN Construe.0014 Permit 11h.
fJxf all applfc4dite T'Nell at Vage, Mangwire, ar-) yriomw
I WeR u,.x-, (check Ravil ww).
Water supp&;v %vell:
ClApcultaml
CiGeoti1r. mW (Hearinwroofing SuPFAY)
0]hduMrRaVCarnmeTc,W
NORAVater Supply Well:
MAqw&r Rem-31AMe
CAqufficy Stoiagr: sFU Rua, ivcq
LlAqwlki'rest
Tgrfinoklgzy
L DC.,kotheguml (Clmel LOOP)
CIGeAtherma 0haIIrkg'C0ohm4 ]Wumi
RI. Ewe wcll(s) qbuyidoned, 3121 /23
S I M WeR lotmitku.,
Fort IBragg
F&AnylChNnex KaRna.
C'MuniclIPWIMMM
aaa ]Oteman Um ONLY
UF 'LUFUJL�%.
7s. For GcoptobeIDPT or TiAup GcothcrwaU Wells having the Sune
FOR WATER. SUPPLY %VF LIS ONLY.
........... ....... . .... .. — --- — ----- . ...... ..
7e. Sealing RnIterial.4 ured (cherck all Mat apirly):
M Neat Cem-nit Grow 0 Sentorule ('Mps or pefliets
McMdendal Water Supply (Mingle) I 0 Sand Cenicra Groia 1.1 Day Clay
ORPmidalflal Water Suppty (5b,") 0 CMAC GMW m ofin Ojtfings
Sit=Iixh.v Offout (D Gravel
0 Bevionre Slurry G Otficy-("plwn im*dLr 7j..,)
0saliudly Bwru
O'Stornwaw Dra-mage
OSubsidenceConbait
n7ra' cer
FaAny Ma (Wapphf-able')
F'TBR-4)691jIWMU-f59, bounded by Knox, Buili Woodnff i& VTIM�eyTS
. .........
City, wS ZAp
Cumbeii-land
Qxwy
Pard Idennficalain No (M)
5b. Latitude and long1tude in degmn/minutestseconds mr &Rzimal degn-es.
V00 Ilamld, tinum h%larg vssufficaLm)
35159952.43 -7&98116250
KVNI..Q�I_IUCEqN ffi 5 _ NRQM
QIX UNG ABj JAF
Formalople iqjrclvvv y
Qffl'y '4M Me some,
6a� Well IDN- TA5-5
..... . .... ... ..........
6b.'rnui wvkm iilimptlnn .40 ___ . . ......... _(M)
6c.garelutlediamerera 0.75 (i%J
6d. �Natrr lexA below grouund sinface:
7E For each Rnate4sg WerteA above, pxnvildc Rimount of mobwWs Uqed-
Portland Cernent 10 Ulm
7g. Provides brief,descripfien q9thenhaneoomwFirocedure.
Neat cement funnelfromtop.
327/23
0,
,jo Ora xhu, we,;I(v) was (were) ahanehm.d
arvardance avast JJA JVCACO2fL',0Hj0r;r 2C.4200
ymr may use ait,aa hac� ail this page tD prowdr. ad4fifionW urelt matt d0ads of lydl
abandonmeadoads, You mavaisnattarhaddifion',411
MAU ZIMIL-111VITMI) CUMS
I ga. fgr Aft.3"Vj&, %uhmit this ftwni eNithin 3o dayr-, of rornppefiiml of weP
Amdontnm to the Momng
Dtvisiaa ofWater Resource.% Inromation Pirnemsing M4
i M I Akin Servk* Cem fxr, RMeigh, NC 21"1699-1,617
huddibon Can sending,,, ffiv rona to ffic addmss m Ma
above, Aso kuhmh ane copy of lhis Corm %4thm 30 da%s of completion air wcH
alrutdonment tro die CeHowing:
INTI"don of%vater RtKRUrces"Uniderrivound Inicirtion Contml Prograim.
Hafi'dafl Service CcMer, Raleigh,,Sr 2769D-1636
�n arhinimi w sendin� dw. fi= ft� the
Cam Onter essing lea th (if knowa'y _... Cie.) -I—
al90 "Ulifflit one copy of this form, %OkNn 30 days ofcompWivn
or %vcfl ab"drAuvent w IN! counly health deprountat of dic Ct%Way where
6E )tnarr caningAubing i (if known P . . ....
6(4.18eireen leopth rd known)-
?am CAV-,N Xonh C'it�xchnaf.)iir,,iay.mLnf,O'F4avlgi,np4evaoI QoalAy- Rcvqmd 2,22 21.) W k

WELL ABANDONMENURE CORD Itnernal Use ONU
. . . ................... ..
1. well net andims•.bdayffinflow
John G. SchappeR 7a. For Gcaprolbefflrr or Clased Laop Gentherm2l Wegs having the swc
V,rdl CantroAm Niam (a ikch awner pasonafly abandmiqXWO oahaftT 1property) well only I GW-30 m Twemda �ndicalz TOTAL NUMBER of
2332-A, %Pedhq abandoned,,
mc, WaIl conwadow cmii&abaill No . mbnr 7b. ApproximateValiusneof4mter motai%e1bg in
M&W DrMing, LLC FUR WNFER SUPPLY WELLS ONLY -
Fe
2, weill Cogstruefien Pcmiltlf. VV10601D036 ypenfdW
7d. Amount of disinfectuat used. ..............
1'%,4111 u%e (vhLek w6ll ose):
Water Supply Well:
ElAgriculfwal 04kmicipWhlblk
ocwhatral (Mgwil%wCoofing supply) E.11tesidenfial WflteT Supply (Sinsip)
MesadenfiW Watu Supply (shamd)
M331EM3=
0,&qWer Rechaqr-
waroundwater Remedrition
C"'I,Aqui fer &xym ge mid R=owny
0SAnity Barrm
CAquifi-rTmi
C'Nstprmwater Dmig%ge
OExperintexb1'rechattlow
oSubsideow. Coutw]
(0ow'd Lcql)
ElTramr
E30ther d ex p1min under 70
4, Daft- wefl(s) abondoned: 3/21123
,59. Well lamifion:
Fwi -t Bragg
Fnefifity 01 (,',f app6.A,l.j
FTBR-0691SMU-69, bounded 1.)y Knox, Bubier, Aftodniff & VarWty Streets
. .... . ...........
111hy.wal Addo.,% CiTytas
Curnbedaind
Fa reet tdarfirwatkm 74m (FIN)
5h. Latihide gad loagiWde in k1wrestminuteaAccands or deriniall degrees.
(Rf wO fi0d, ona taloonz is taffiment)
35.15997354 ,, -78,98120273
rAU,3 01Fw—K-f—,1-4ZJj Of- A vED —B
go. Well IDN. TA15-4
40,
6e, Borehole diameWr� 075 — 00
7t. Sea fin g mate do III Leh etk allf that up piry):
0 Neat Cement Grout
C1 Beinon0c Chits or PeUets
[3 sand cement Gfoul
0 Dry Chry
* CbDrrde' boat
11 Dri U Onknip
* Spe.cWtv Great
0 Gravel
* Bantonfic ShArq/
uOffirf (explain unler 7g8
7E Fair each matewial 4rJectmi ijbvvIprovidegiinount of mAterials md,
Portland Cement 24 bs
7k. PwAide a brierdescripdon of the ahandeumml procedianr
Neat cenneint hinil eW from top.
l3. Co si is to
7 3,/27/2.3
. ... .......... .
s.
r[PlAwa
fly "agning dasfix-fir, I hcrebY tywqp Mal the welf(r) was (were) abandoned rn
arcordonee "Ork IJA MCA(: 0,2C,0100 or 2C.0200 HIM Camsrufumn Seandanlv
OPW rhal a ro1v qrMe., Freard firm, beenin-m4dedloffie wet) owntr
9,. Site ftgrsins or addiflonall, well detnikz
You TIMY u.w t the lml- of ihis trage lo provide addAW411 well site dem�IJs or wM
w uhandonmentdctads Y'numay elwuw atladlodaaltfolacnnol l ifn=mswry.
�5upmL �,RU
�A
%yAr- Submit. dis form wiihin 30 deft. o,f compleVon of wet 11
Ulna. llt,mA
abandanvilent to file fdffowrng�
Division,of Water lift leformation Processing Unit,
1617 M01 Servict Center, Raleigh, NC 276994611
14)1-1. &r In'ea r. V I : In addhion to ni ndin flit foffn to the addrms in 10a jg_j� U&tU 9
above, a6g) subyrft we cagy of finis foraw vyidfin 30 dAyr of complaton of well
Rlymdwimemf to Il w rollo%ing!
DiviAlon of Water ftewurce% UndiwgrMiUrf. RD ftfiGn COHU'01 PI'V.. M1
1636 Nfail 9twice Centprp RnleighNC 27690-16:W
I Or. L� qj.NjbM§uA,§2 jl_ , In vddftion to mndixig the form to thL
tit Outer Min, latgth (ir knawn).' submft nne copy ref" this F(wM within 30 &4Yr, Of0=00ilan
or well abandmimeni to IN county Nahh departmmot: of fbe county %Nherc
6C Inner enabig/tabing langth (if lwmvnId. abandoned
6C Screm length (if known).
Funn OW-30 North Carolmn Deautmem orenviinninental Quality - Division afIfflater Rewourcu Revised 2.22-2016

WELL ABANDONMENT RECORD For kwM81 Rik e ONLY
1. We'll ("Ontiractor TOM111-wathyn-
Johin C. SchappeH wdl Cowloy NameoM01 mkqermraNywdgifingrH hidp'dClo.&LoopGnalbii=M NVeHw b7nmgItc some7a. For GvepmbefflFT or
w snM) m'ell constunroonp,y I GW-,BAD w,, neaded. Indiratr TOTAX 1141)MBEM of
2332-A
7b. Appinm,hpate valigme *fwdw;,x remainin un
NC %W Canwroctm Certfirmhan NugnbcT
M&W DrMing, I LC
2, Well Cofistruction Pm -mitt #W0.600IA' 36
UK'., f"awyn, Slate, Faffmn=
S. Well use (check well[ use):
10600thcr=4 (NImatter V/Cooling Supply)
11:31ndustfoldCommeroa9
NMIAV'ater sappllr well.,
OA.quiftr Rfxhwwc
L]Aquirri Stordge awmi Reruvery
Orxpwaimcnial 1Cc6aDobgf
(Closed Loop)
4. DaIr ivefl(c) abandonedp, 3/21123
S&' Well locadan:
Fort Bragg
ill';9-is'Y-15--;rr-T'T,. -- —"--
MAakpifflubhc
)R WATER SUPPLYNNFLISOMILy'-
Type of dWn reew a t Used -
7d. Amount uNisial'kasiat
. ................ . ........... -- ..... . . ..... . ................... . . . .
7e. S—ading materWs owd (check, all that MPP11Y)'
M INot. Crment ( imul C.) Bentordto Cbips or FOlots
r.-,Re's1&6A1 Mlatex SuPPLY (mnple) 0 as cement Grout I Dry Chy
Residential Water Sqxply (skuned) I n Concrete Grout 0 Drill Cutunp
01, Specah, ' V Grouj l � Gravel
Q 0 nm.ttnile Stony Q C')dver(cxpWnunde0g)
Muraused,ower Ramedistion
113%lfirlinv Barrier
DM, iMg!d
con#14
Facilky IDO Of ipplicalik)
FTSF-1-069GWMU9, Wunded tiy Knox, Butner, Woodruff& Varsfty,SN'M�15
piry-iwgLAMMSS' City, mxl Zqp
Curriberiland
COUNIvy
Pam,d WnuftWion No UINI
I 5b. Latitude mid loingitude ln &ImgWirrinalesIcecands or decimal degirew
(RF "Ve" field, ant lwRm V 6, k•%liffirclem I
35.16000753
US6 - B
—COSIMUC�, D A, T, 1)
ONZY'wldl ffidsome
6s. Well IDO. TA5-3
6b.'lrow WC111 depth: 40 --(ft)
6v. Bareftic dismeleir 0'75 ---- — _ 00
6d. Water I r.v#.4 Nbw p pround surface.
7L For each materlMl sdeeW, abqrv1a,,pro%Ue amount of maWials used!
F'."ortland Cwneint 24 �lbs
o& Provide a briefdmailnion aStbe abaindonment prox.rdwAi
Meat cement funneled from top.
Ctprflt 3127/23
eriTL
I DW
ltvxiVring fhisjbrme 1 h(weby cardfil rhal Me Wedfk) 1wj-T (M-) in
accardanex Weh 15A M-ACO2CAMO nr 2C 0,100 erlR: rasa ma aresa.SusuRefliurlm
rasathof ex ex�ry q,' Mir recard /wv beva, providtdto lh(d well
9, Site di2gram or addiflonO weill delviW'
You may w4c the back of this page to provide addifional weil site &Mils or, weU
ablindensnartdcW6. Yaamay:11 m riffach addilianp) pago.; if w--Coq,,My
4S t I J �NLj q, LN RUC Nr EL—RO -A
1% Subma 6A fimn vvithin 30 dw s of tornpenori or vmv
to ft CoNN-4inir
Mision of Water Resources, Infaroostion Fromsiag Vwik
r
di 17 Mail !,krvice Center. Ra"-leirls, N C 2761 n'T
I Ob. Ear IL th em, u 102
qk1fian 3y to send"N IE fON m w � he widr iS H SA: bi addrtiw g
above, also submit we copy or this 11mm mfti% 30 days of Complefion of' vV0411
al-wiloinment to tbr-li-300vAng-
DiAsh)n ofWateir Rmources, Undcrgwoued InjeCrian (Wnirrol Program,
636 ms.ii se"ice center, Fwpigb, mr 27&M-4636
6r� Onter Casing �Crgtlb (it known), loe, jlp � In addflmn to 1,ending, the 9bM to thir
addmfa above, alsorubraft one copy of this form willhin 30 day.,i of cornpletion
or wen a6ricjnnanent to me wur,6, livAb deparkmml. OF flific County, where
6& Inner caMagAubing lengdb (if kTwwn)� abanduried,
6g, Semen longth (ffknown) - - ---- ----- - — ----------- . ......... . .
Form Gw-:M

WELL ABANIDONME NT ]RECORD
I" 'WWu^1l Counfm'aefor lafammamsfio n.
John Q. Schapplefl
_...� �.,
WNm WD d' euua2.arcem zuuae, nmx vfflnq uaWnv..0 Irm e lty » aloe wm ma edD unPh nuaWDmwr pa re peal d
3,2-
NC WO C'ea8¢a or Corti irat an N uuondaame
C aurrupany ihNu
» m df::oms ''uaeduurrs d mmanaitfia 10600
036
rPa.. a�p arar(a.av" (W d'�rneaatir Wa or. v°aa�r crane eaR.)!f7U�raarace.�
�'u'r��d'paaafdxcad`uNa^DW°at9a:reaaararta�mraadz
t dtpdoumllD.aDu mp N::pMhuaauogpamdff wpbdao.
fdtluwFatheammusp 04aatiwq#r aoddra Supply) n" Ressdudnenfirad Water Supply ly (saalydm)
Supply well...
OAqusfdrRethos e
LC'n¢auauundwwalerytemmecddalion
to A quirer Shwage ami Recowrgr
tysafiTuaty Ibrriex
cyaD..panfatr Tvs%
O o-trewnwaaater Draabrag 9
Pf w raaam areq s °p' �aarxiampnro
n' %uulw;;,Awsm l
Y:dfi:,ouu bermaad (Clas d LOOP)
O dhwee
b.::Dl[rrm ptd$ rGa'�al QN 'k&&qmF,",`I�: #YtI�@q'YwF. �.'e"hAH.r4ll.�
�BOWhe�'��cxjv�uPN,i WIa
.., td�s pH�mLNU.'pU.fladT&6".Ht; n.` 1' 1di m"a
5W.,, "Weld Docatiom
F- ort Birigg
t"awmffi /Omwr Nam, 1F"aamfityr Will (nfapplfcob e)
I rn3fk°cd9mW+k'n u-6 bounded nape nfauoat Butner, er," rcvmmu9mi & Varsity fAreets
_._.
Physical Adduv sA, Cqy, and Zip
ld
u robed n d
Coom . ....._._._. f'aa N c'o.•arAmrr� on Neff. (,&a .A..._.
—..w. ... tDW;
n . Latutuudeaaumd longitude in t Nma JuTsiiunmwtesda aama&m or demlitnasn degyram
ffmNll &tad, aURt Invio4r, am suamtrensmIll)
°fLDmd"t•1'f LlCIi"fgdtNifyEILM B I—AIIANlllD@"y1AiE
,dneer9n wed&m°aupaa:daveeGaaaau au eaaaaljn%� B�"��nhrag8exda�rt;;. d ear rrarrFPsaaBsa arap��dOPa�uaaare°reutaaa uwdrePr �a"•nasa�a6pa aa�c.dkfa•
�fRd'bpu�tm°Yan7m�Pmr��kn&paaa:¢�•szrerymaara�swdiru�r�adaaraa�durNaaraoaauaa�rre„ „;+mttr r,�aaa xpr,�,unua9 reaaxs:,�apwn._
fag. �iY'4 G.H W a'JKh4» n>ua ....... �...
40
b. Toter Weil d'eptin. —...-00
de. BaTrekolle diaana;-r«rry �,�" ��i .....»»..0asv;p
,teed. Waternewrmat'Wow F�"ovind mumrt"mm eft.)
.m..._.
Fesa' lu5ftm`Ppafint t.Y e ONLY.
7ma. Fox, 1"a oopwwo befllrf or aC la ged—L uep Gkolhemmiml Wells bavang The Sam
well i4,auuasV:aaacftaia Wdel l:h, only S 4:F 30 it nmWd Indicate TOTAL l;CVA BER, of
wells uudwandoauo.d � � ......... � . .....
711am ��u�aa�ax�fiurm�arnv.araaIluw.u��aaf`nnw�f�x� i¢w�rnm��o-aliiDm���„¢nn °�����ft.„,..��.._��;"�a.�
yypp�����qp�'µµ�� +ry'.g.�.q..pp�p;�p@ p�„ryg ...�,
111:'6 R'M 8'11wriN'4u �i9ll'.,�AIWLt.6.0 l �V'«'.iR:ulA.uq.s 4Mll"U Wa'�Ma
7a;. 1`ypae umf atmPfifo6"eu:dmmmmt taaas
7d.Amrruuafth7mt N`disian.farBnt¢anDre r
7e. wa Rog mmuateu uuallla aased (rlmmard umn.D that apply'.&w
Nowt Cement Grout
in Bm'tm nfle iC Chips or Tlefleis
Sand Cmoramsnt Choust
Cl Df W Cllay
c mrrca.mfe iC. r flan
Q ))Till COUTtldffi
0 sp uJanty f..Rro ut,
d.�.D CXTY,awr«t
t n'.louaDaawreude,"eporrgr
13 Otd4" (eg.:da'un under 7tn.,)
X Fo e aada aamDuWrm!e`W rsa lertvl mall!mmw°s' u a rGd asuTpNaftmutt of aTmwmiak used.
Portland C.,'e ent 10 Flo
7g, Provide ia tnrpod"rdmm criptdman Dmd"'the utfauamdaummun mt pinmVe edema.
Neat cernent funnel ed from top.
t rc«m'd�e taouu 1 ....e.,� 312712.3
:mn9lP�tluta` ; ef4]a,.yparpr;d'b' GH C'eanftranftorn"wed „a,w ", R Date
By sla d�u� da v,lbamarr I dar,^avh°,gP-.wrrryghat ksaa mrsrd"tn.�;i Was farm rq aba"darrel ear
airazowRaraswwa uaam>nu Sit (AC i1d,w -J)Jt 0tw f:',uk ty�9 dd"arfl2 TaaTmrnr daaa « Da muf arfr
anud tsuaer ar copyof&Ps rucord has brow yav'man«ado d io t4ea well a u-ner
9 She ding'amuar aar auuDad flonal well tdetRITmu
You m2y use the dmx k orthis page mcu purovrddo dddilfinwal wmedd site details or wrredn
abande nmentd de.radd_ You u may alsoathnell aaaddifl onai pagm d,fmoosmry�
Srild! N—M. AL 139Sd"d'tddt TION
ids. .'2E nwufauuw'ft ors fain wwid-th�r',30 days orconapapetdaan of well
edkaaaa%mummment to the fumddaavasausp„:.
Division n, ofWater yt. uureu:.ay laalln urmmation Promsfirig Ua k,
1617 P.sduail Service Center, Pakigk, NC 27690-1617
Dodo for tTuppefnoua %Wedpll. ICuu ,,rdmddd,Wn to uffvuuuudu"auy, tdnwt foam ao the threes da l0a
above, also soiaaawat we copy of dvis fasavm mtwo :dp dn's of m�aaunnda9etriaaD of well
abandonmeml to the fallovem&
Division ofWawr Iftewftnra:a%'Undeurr;,urauu ad Emjeedon Conaul Program,
1636 Mail Service Caanteur,, Rokiggtau 7ff 27699-1 (m,
pe. dClum oeafxu �d Nn (if known)*- d„ DtR g om ha arBv m laa`r aMa W a ,u In aua, difior Dau seaaing the foiarsa to the
�_ addmsspamsp adaowa,, adhamn sautnamit ow copy oll: this fdann ww uNDafm 30 dayaa or commup.dedw
or well abandonment In due arm»mmaDy health deVartinuat of Edge county where
e da (ill'
fro #ft:y audmPa.Cudonol,
fuf:. fatmaanr m:mawmun tuadnuuna,„ dskum tdr Dlli`
6g. So -ma, lose ydu (if kmPrcsw4t ..� ..� �.., ...._. .... � W
Form Cil Noah Carolina BNpartment afEavirmsmH al Quality - D imiom or Water Rosourtty Rowed 2-22-201 B

WELLARANDONINUNTRECORD
L %VOT Commetiair Whrlonifinot
John C. Schappell
Wi-M C*avawor'Naw (w %,Ott ommer pemandly ablindonmg wull an Wher pwrem)
2332.-A
M&W DrWing, LI C
060036
2, %Velj CalwitruM W10
ction Pep ....... ...
List aMappilaWr rLe,. UIC, crwqv Slaef",
I Well Vic (check well usel:
F Kgricililtural DMarircnpaVPubhc
C]Geoftrmal rjHeM4rdCN)Uag Snappily') ORcudentiM Water Supply kwngle)
ClRmmidenfiai WatetSuprIv (sbared)
NOR -Water supply,well.
rIAqififer Red,,Wago
MIGMundwal"
ElAqwf�,m Siovigeand Recavery
O.Uway &M-wr
r .JAqwfeTTM,I
[19wrinmate"r Eftailage
ORM,7ZI11mgwal Technology
Insubsidence cong"A
naeviliennal (Omej Lwv)
Q Tracer
CIGcolherinal UoWm Raiami
r3C)jbCrj,4,Lwn under 7z)
JDa ir w6l(A) abinndoned., L/;�!�/2 . 3
50. Well WfAfioa:
Fort 13regg
F-unifty TDO
. . ........
apafrpaawuaw
F-MR4601EMMU-69, boumled by Knox, Su"r, WiDedruff L Varsity Strlro6-
.. . ........
Vhpmni Acklmxi,, City- and Zip
Gumbeds nd
5b, Latitude and lonigitude in degran/waiwAlsa0deAmiads ar dedtHal deigreeba
(if wtn ficId, ata n odflowal
35.16008126 7&98129929
...... ......
Oft y wh I h &v �velm P CoP.Th wCdo" ivivlo dah j at 1, pon vr" V4bma I one. � fonn
6a. %W1 FW, "rA5-1
6b, Total "ll depth: 4,0
6,8orehMediameWri 0..7�5------610.)
6d. Wiaer level Wow grouind surface.
- - - - - .....................
Um ONEN
. . . . . . . . . . . MI'LLet. LUOND—ONATEU, DIUMARAIR
7a. For GeoprobOUPT or 0owd-,Laaj[D Geothenn2l WeRghtiving ffwwred
w0l conshlucTmnldupth, VrMy 4 GW-10 as needlid, Indiasie'rMAL NUMBER. of,"
wfls
7b. Approximate valumeof water "2"Ming"l We"(6):
IM `iv. R St TPLY M11 Is Ohl Y4
7c. Type of disinfectant wwwds
7d. Amount of disilifWant Mud:
. .... . ..... . . . . . . ................
7e. Sealing materiab w" (ehwk afl that apply):
" Wet Cement Glum
0 Renwnftchips sc-polev�
in Sod Cm.enf Grow
QDjr Clay
0 CDwere. Griout
DnH Cuthmp
CI STIMwhy Grfw
Otavel
0 Hwionkl,'! Slurry
ir Other (explain ander 7g)
7c rat upt swierim pn3v we aluount a r Materials Used:
Portland Gemer-A 10 Ibs
7? Provide as brid dnsm.,pwian of thesbandairtmmn pirece9himz
Neat cernent furinded fron'i top.
3/27/23
R.-TWE conlMckay or WMIl Chwnff Date
By vipwag tha forng, ; hereby rpruf y Mae the wefl(r) wxv irwere) abontAmed are
eweavdance wpoh 159 ar 2C WW" Well
andtseat a cppyqfifts eveard hay impip prmwiedOw (he well owner,
% Site dlegraim am addihonall w0l dietaih%�
You nRy ust, the hict< of 00page to prov;de aMWiW weh site deads or wrfl
abandonment details. You may alto idusch i(kIffirinal ltshms Wneceswq
Ma.aLI AtI- ubmt Ihm (brra wilbn 0 drys of cwl�etkork ofwe
V
aw. chin meant to 0 M ft4IO-Arot8-.
Dhision ofWater Resources, Inforlpation Processing I Nift,
1617 %fail Service Center, Raleigh, XC 2769.94617
I (W Fer.1n �M& qK&.pun ae � pun to sendi ng tthvr fami ic the addirss ill INN
........... ! 1 y_
above. autism ,wb mil Ono Copy, of this fimn wrWim 30 dAys of completion of =11
abalulariment to the flftwinig
I'Mybdom of%VaItrRmourl,,r-% Underground InjecOlon Calirrol Progroul,
1636 Mad Service Raleigh, M' 2769945W
I fie, Uq pmadddw to sendaig Ilm Conn to ft-
6P- Outereasiar lengAll (if kllawd)*� addTaWos) abovL, ahm submit one only of this formwitNin 30 days acomplcfian
(if, wrfl 11bandonmelyl. UT thu counts heaft, dqarime w of he County where
Kd awuer rrnssmap ffmufawua leap th (if abandoned
6g, %crren Itingth Of known)- . . . .. ......... . ..... .
Form GW-3a

WELL ABANDONMENT RECORD
1. Well Contraetorlaformation:
John C. Schappell
Well Contraaor Name (ar well owner personally abandoningwelI on histlier pmpeny)
2332-A
NC Well Contractor C"ficadon Number
M&W Drilling, LLC
Comfy Name
L Well Construction Permit*., W I0600036
Gixlsr/1 o/+plicab7a well c4n3fytretroti pN'elits (•a. U1G Cmoay. State, iroriwtcr, oral ijkaopn
3. Well use (check well use):
Water Supply Welfc m
OAgricultutal
❑Geothermal (Heating/Cooling Supply)
❑lndustriaVCommeroiat
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
130anthermal (Closed Loop)
4. Date well(s) abandoned: 3/22/23
OMunicipaRublic
oResidential Water Supply (single)
❑Residential Water Supply (shared)
!RCiroundwaterRorcediation
❑Salinity Barrier
0 Stormwater Draitiage.
❑SubsidenceConttol
❑Tracer
❑Other(extAtim umler1`0
So. Well location:
Fort Bragg
�..�m -.... �_,,.._�__...._......
IitytQwttrs Name Facility 1D# pf applicable)
SR-069/SWMU-69, bounded by Knox, Butner, Woodruff & Varsity Streets
Physical Addles, City, md'l-ip
_Cumberland
Caunry Parcel Identification
calion No. (PilvI
5b. Latitade and kingitudein degrees/minutes(seconds or decimal degrees:
(if well field, one Iaillorg is sufficient)
35.15839852 78.98309939
Foe Ldenrel Use ONLY'
w...........
WELL ABANDONMENT D
7a. For GeoprobelDPT or Close&Loop Geothermal Wells having the same
well oonstruction(depth, only 1 GW-30 is needed Indicate TOTAL NUMBER of
wells domed: -- - — _._......
_
7b. Approximate volamc of luster remaining in well(s):
__...._... .... _.....
�i011 WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:..........._.... �.......... _.
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
* Neal Cement Grout
p Bentonite Chips t:r Pellets
O Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Grovel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7L For each material selected above, provideamountofmatcriats used:
Portland Cement 8 Ibs
7g Provide a brief description of the abandonment procedure:
Neat cement funneled from top.
S Cent 3/27/23
^ben:
`w r ,
of
Signature Cefified a J ttraeloif Well Owner bate
By signM this form, 1 herehy certify Char the we11(sj was (were) obandnned in
awortlance with 1 JA &AC.' 02C A100 or 2C _0200 Wdl Construction Standards
and that a copy of this record has heea pmuded to the well,owner.
9. Site diagram or additional well details:
You may use the back or this page to provide additional well site details or well
W abandonment details, You may also attach additional pages if necessary.
CONSTRII MON DETARS OF WELUSt BERG ABANDONED
Alfochue!/co��efrs�crionrrcoal{r)ljarollnb/e FormullfpleinjecNarorran-iwrretsulrylVuelLc
ONLY avth the saiaM eaastn dranroFandanfttenr, „o„ aaaaahMM nne faro.
62. Well Mff- TA4-10
6b. Total well depth: 25 (ft )
6c.Borehole diameter: ,_0.7J .._ _., ,..(in.)
6d. Water level below ground surface:,__ (ft.)
SUBMITTAL iNHR11CTFONNS
ills, EnE All Wells- Submit this form within 30 days or ccmpletion of well
abandonment to the following.
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to Sending the form to the address in 10a
above, also submit one copy of this form within 36 days of completion of well
abandonnitatt to the following
Division or Water Resources, Underground Injection Control Program,
1636 lllail Service Center, Raleigh, NC 27699-1636
6e. Oster caging leregtb (if known): _v_ ,...mm,1it.) 10c. For Water Sunpiv &-Injection Wells; In addition to sending the form to the
address(es) above, also submitone copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.lnmeree6ia tubin length ifknown- abandoned.
6g. Screen length (if known)- ti.. m„ „ (R.)
Form OW-30 Noah Carolina Department of):nviroomontal Quiday -Division of Water Resmiram Revised 2-22-2a16

WELL ABANDONMENT RE CORD
1. Weh Contract Isferinalkn,
John C, Schappelli
WeA Conft'WoR Name (wwrH nwwji'P.TMn*UY W10TWOMM—H an
2332-A
NC WO rnatmaw Cw1iw4an Numwr
M&VV Drifling, LLC
Cbmi.mny Namr
2. WeIll ConstructJou I'lermit k: W10600036 . .... Log o# 4pryficable Well ram,"Nedian P"' rM4 N a,'- UIC Gmfny' $Iaer' Vanance _eerj if-AM"un
3,.'Well use (chedl a well use)u
OA,Ocuftuml
Mcodliv-xnW
ObidusMiallCormnemial
NOM-Water supply Well-
CaAw4ulifcr Recharge-
OAquiferStocage and Recovery.
0AqiAR.T'rW4
O'ExpedflMMITCOhno1logy,
uGmi,hermW (C osed Loop)
MEEMMM
!Fair &VnM Vu. ONLY
7a. For GeopnibeMPTar Clowd-111,oup GMhermalll WrIlls bavmg ffic mnlini
vmffl constructioWdqAh, oxilly d GIV-30 is needed, bufica?xTMAL NUMBER of
.......... . . ......................
71C�Type of d Isinfeellant ose.d.-
% Stalin irrasterdaads wad (chvckall AM apply):
a II ceumnl Grout I Rentonae Chips a Poief's
Okonduvlisl Water Supply Ul sand CrAnent Green D Dry Chiv
QlRcmdenfimd %later Supply (shayftlI � n- Concive Grout D DdU Qilongs
08ubij&n(m Cofftul
0 rTICIM.
in, Nvell 11 lacsflou„
�Fort Bragg
raa4iily/Ownz ft"a F=16q Mel (if OPP111C31I
IF rBR-08q1SWMU-69, bounded by i<viox, Flutner, Woodruff & Varsity Sbeeks
Phyvod Addrem, Cityand 7ip
Cumbefland
FI.—.14 Px=1 IdenUffeWmn Ne (PIN'
Sh. Lifirbide and kl(pgitudie. in degrw.slawhiLutes/hecovids or der.11mal degmves,.
35 � 15842292 78.9831071
. ....... . . . ......... --
FA4-9
6& Well [DO . ........ . .
6b„Total whql delith., 28.6
6c. Bomhf.lde dia Meter! 0.75 _(H)
6d. Water fievO helow grDund surfhee:
n Sp=Oaiq' afoul[ 0 Gravel
0 seamMlesharTy r-, Other ( crphfira tinder 7gp
7f. Foreachruasteu st de a xd ablimvide amount afmaiterials riwgk
Pottland Cemerit, 7 1brS
7g. Provide x briefdowripflon afthe Mandonmemll procedinet
Neat cement fun Inded ifrorn top.
8. Cerl CA16ow
3J27/2.3
%;
PAW
qY.Ogninglin's form, I hercAy o"'Fivy thof lite weflj"I) was irwwwv aba"JeRneue In
rjcxv,r&jnv# " AIM M,74C fjU' MO or N.",6240 Weil CmiOnselsOn Sfawledydy
ifagj $jmjr a cwpy Of dW rec.'dmd hin 6,-E n ppovidedlo Me well. awefi., r
9. Site diograim or addidonal %*H deloUR-1
' W You may mse the Inck at lhis page to VTomde addkiomd vixM Bata delaffis Or %VCJI
5!jA!Mjj:LAf- IN.SIHEC,E�II' N, .
102. Eq&a WL&Subirnff. diii Rm-iin within 30 days afeinnil of %1-61
abandoinleruit to *Jie WW%Ying.
Divishiri of Water Resources, Tgfonmat'wn Pirocessing Unit.
V 617 NO Service Center, RalekLb. T9C 27699-1617
10h. 1; v �1- ' uM "a"dh . In addhion w sendmg the form to flit address in 10a
nil 0,,la sulovk one copy of 1his form wflNn 10 days of cmirp. lefion uf —H
MrAndmunent le Ihc fhUmvirg,
MAMon gaff Water Resources, Underground Ini6cidon Control Progrant,
16MMMil ServkeCenter, knleiph, NC2769946-15
6e. Outer emiinr kagth (if lknowu)� 10c, &LMWR�a" y &-in Lesikalwb.o In aMwxtosendmg The rhrm To Ow
ifte.wes) above. allin %iubmit nne cap y of thrs form vollhit 30 ckys of Completion
or t%ull alydndwrmeal to the coimq hesith dqvnmenf, (& lihe cw&nV where
6E Inner casin p/tubing length, (if known)'a _j ft'.) abandaired
Form OW-30 NoMi CaKftz Dcpznwnt of EmAronnowl[PO Wdy - Mvwoin Of'WwrX Reloolve" Rtvased nY" M-204'

WELLABANDONME NT IFIE CORD
L. Well
Jotin C. ScIll aplpell
2332-A
t4c we.0 Cmumi'm
�M&W Dilfing, I LC
2. WcH C%yakracti alleirmit. Ih,M10600036
jUtate agpftaxybk upff awsynxii0a yvVrmmv gr VIC c4anly, Sme; Mwiance, we t lyhom"
I'"ell Vm.. (X.,11i Vvell use,)a
11 10cothmmal (11catinDeCooling Supply)
MIndustrial/Contmercial
OAv6&rKWhar9c
0A.qtifia FYtnmScaT4Rer.avmy
OAquifkT TOSt
Mxpmnmmwtl
OCkofficrwma) (CllouA Loop)
C Date welli abandened; M22123
52. Well lacedon,
F�clirt Bragg
rvviIIIWyK)wnm Name-
Mmicl�mlfi?%Abfic
nResidenfial W44tcr Si4pply (skig ,,Ie)
OResidentiO Wato Sirplitly (shared)
IMIlGroundwaw Remed"stinn
1:3Sallnity Banim
Ustonnm WX Ik7base,
Mutymdence Contm, I
M.'raca
Facifity IM (ifappilkabk)
FT8IR-,G69dSVMU-69, Ibounded by Knox, Btrier ,'WoWruff & Varsity Stref,
'C­'G'k'y', _md zip—­­­-,---­,­
Cuililid
rrouggy
ft=t kkofifickwn NO, (P".
511a. Luffludie. nvul tonspirado il[W
(iiF %Will fielld, amain 18111011% , m 'MAWkw)
35 15844046 7B.98313258
EM ABA IIULQNFQ
ONjj'WWjh JbC', a w Bna mrak n n rn umeaarc sd JTM cm)
611b. Tomi well depba �1 5 7 7
"Aft)
6r.Bombol),ediamciter: 0,75 __00
FFa. p111"A"Iffl
mmaoanl
M&A—RAND
7a., For GeoprobeffitYr or Clowd Locip Geathermat Wells having the Same
%vr,ft cM.stnjc]lioTijdqAm unly I GW-30 is necded. IndicateTOTAI, NUNSM of
wells .... .... .....
lbi .,Appi,aximateryciluiiiief.vfwutcrm,um iningin IMI(p) . ....... . .
1111-- .1-1- . . ............ . .. ........ -1 . ....... -
--iiii'lM WELLS ONLY:
F k" S
7v..Type of Mnfccmat used., ._ ......... . ..... .
- - ---------- - -----
7r- ScAng materlAs used (ch"A all Ihat, apply):
IN Neat Ceimem GTOW,
I..) Bentorfitr alip's air'Fellevs
0 Sand Cerment Gii
M MY Clay
Cl contrelte; GMU[
U Drill Cutfings,
SlM::illty (koul
0 Ofavel
Cill BentaniTeSh.my
CJ Othcr(exphdn um6cr7g)
X For cech mawn,41 sclecl& above, pt"Vide mount Ofiri used,
Portland Cement 4 Q)s
7gPt,ovIdF ic lands fdeKdpfiDft of ftl P abandonment pirraceduire;
Neat ceiment fi,sinneled ftorn top.
R c
3127123
gi OrCm.3 0 MA 'Ir Wc.11110mw Dam
B�,,Vigninz illiqform. I homby mr4ft 11gal the wrilts) was (vmvj 4APawkned m
arc-are.1miew meh ISA Xc':.4CO2C,0100ar2C.0700 Kroll
Yoa Tn;q. the b4ck of Ibis page to i addMonal well site de is or vvcH
abmidonmcsit dOW& Vu may ahm MlAdk addftiorml pages ifnecessarY.
_V.JLUT_j7_ALJKUM_TLC_'E
10a, EhLajL3MC&V Submit Als form vAdun 30 days or campleiian of well
itbandonment tothe Fallmnx,
161.7 Mail &xvict. Custer, Mkgh, NC 27699LI,617
10b. Txg addition is sending the fbrm 6.) ft address in 10a
abava,ahro submil me copy vrffbil fonn within.30 al' aysCar eempieflon Ofweh
abandonment to whe i
Diviidoin afWater ItcumircetVaderp ra
6A.Waler level below ground surrace. _00 umid InjL70dan cont"d IN,Qgrsun,
1636,111 Service Cmitcr, Raleigh, NC 27699• K36
6t. Oater cagirl? O.YYhaV In addifien to seniEng the i ka the
lean. (if lcnown)�� . .................... vickim(eg) Above, alsiry submft oite copy ord kis fanh veilaiin 30 days of compliclim
oil' vetH Pband,imment. to the county healffi depaimment of the cmint), vybere
abmidoncA,
Form GW-30 tt'Cafth COXW1108 I3qSMII%AM OFEMARMOWUMI QTWRIY� ­ 011"Slon OfWatex Rem"m RevvReff 2,ZT-2101 6

WELL ABANDONMENT RECORD
L'Well Contr4etor laformaTion,
John C, Schappefl
WrM ConnakiorName tr wM awwr pedw.n3hy albandamns WO all IIWLVI*f PMPm01)
2332-A
rorinonsW Use ON'LV
AjP(ffi_MjWj' D �TAMS I-
7a. Fair Gcojimbe/fif"T ar Cosed-Loop, Grotberimat WeUs having the smue
well construction/dep1h, oni%, I GW..30 us n"ed, Indicate'TOTA.], NUMBER of
weils abandoniml
Nutubw
7b. Approximate volume ofwater iremmuainingle wdl().
M&W DrOking, LL(','O'
FOR NVATElk SI..),.PPLY USLLS ONLY;
COMPM'y -Nawe
7c.'rype of 04infectaut used-
W1 0600036
2, MAI Constncefien Permit 0.- ---- . --- ......... . .
UIC, CAdn�y. Mate limmwe, eyv.) kfkaahw
U. Amount of disinfwant useqk-
J. we H use (Chech. wall ase).
Twair"S-o—pp-lyWe-fl' : .. ...........
7e, SmUag ranterints tared (check all that apply)t
OAgntultmal 0munacipaupublic
P Nod Or, Ment GuNd 0 113crIonwre Chqt m Pellets
OGwVremml (ReafirglCoohng Supply� Mesildenhat Water Supply (sinalu)
0 Seed Cement GUM i.3 Dry Clay
0 firriu.,46a VCQRV=eMLJ 0 Rt--4jdcjtral watei Supply (%baredl
E3 Concrete Grom 0 Drill Cuthng5
0 %panuaky GrOUT 0 GTavrl
NO84418ter Supply weth
0 Bentorthe Sluin, �i Men fex&m finder 7g)
UArrui&TRmbayge
0 A qu&;r,,S1v-agc seed Rmwen
OAquifer Test
OFXperifflestall "Irechnology
00"Odicuuml (Closodl.,Unp)
Mcothermal illeatim"t cnoji",u
,4, Date well(m) abandoned: 3/22123
IRGroundwriter Rpmerbabon
113846, W, Mer
0Storrn%4,a1nv Drsiragr
O'Srjbsudenca Cu irnol
"N"revur
0Other iewhan; unJor "rear
51I.Vvell hwaillon,
Fort Bragg
Fwday,`Owner Name. FkAij, Me ffaPPIM014)
FT81RmD69JSW90U,-69, bouaded by Knox, Bulner, Woodruff & Varsdy Streets
Phyv=O Aft'vis, Cjq„ and Zap
Gurnbeirland
. ........... .
?wCA Identifivwtiov No (FIN)
5b. Latitude and loirRitudic in derhmial thegrem..
prd wPffl fieM, one Intlanq ¢3
,315.15847555 "'78.9831490'1
L,'ONSM RUC11r t 1RRF.rA1LSQFWKLlk.S RM.LNGAJ3AND1Q1,qE'Q
0,,Vi. V node yhesanw ym, co4mokew anefiwu
TA4-7
6b. ToWl wall depth: ,26
6c Borehole ditmeftr,' 0"7511 -1-111,11,11-9irl.)
6d. Water Rewel Ihehrrw eround
7f, Foir each wattwial wlected qllruwe„ Provide a Mount 1A wnfiteirials uNd,
Portland Cerrent. 7 bs
I& Pmvide o brier tleacription of the abaindoninent pmeedurei
Neat cement funneled from top,
W27123
U wn e r Dwa
RY ugning Mu fbrm, I 1wreby cerqb' drad Me was (avw) abanoMed in
aveardance with 15.4 ff&:' 02C 0100 or 2C'10V Well OwtsmetinoPandardl
and 111aff a rqj,ry 4?1'#Pb mcwrd has hwan providad ep the,
9. Rik, diagirant or au dibaiml welil detaiki;
You may use the back of thn, page to ptovRde addkinnal %r.H sne dcWL4 or %WH
w 5Aiandunwwt dasils, You may aLm aflach additional peg ifnCec-limuy
j0a. JIL I �3 _&L_MLqAj-, Subma Ibis form wthm 0 days of emnlillefion of %VCH
ahandonnifta ks whe Followinf"
D'hislon ofwager Rewurces, Infor"Ution PrOP.M..ing Unit,
1617 Nbil Service
_ftilost an Wells: In add6on w wndiiig the fimn iki iheadchn:. s 10,1
above, also whawt one coPy offlnA forn wiffim 10 dms of compawn of %vefl
sbandonment to *OhOowmg
64vap4win wvfWaler Rewarres, Undewliound hajecAun Central Program,
9mMM.40 5ewrvire Center. Italeigh, VC 27699-1636
6e. Outer Cash % le (if known): . . . . . . . .. .. .. ................. . I &,E2rMaAm-,qvw.1v..A ink., fian Wettr� In aidd 4wn to seadmS the Como to Ow
sddrew(c,,),11MVc% alwio whnW one coof flux fbmi w4lum 30 dgkvs of caam, pktwn
of "YOP 2twdarnme-f"t to the Cowy iTailth delzia.mwi of the countv vOicry
61r. In n ow- easiog/hibing feugph (if knawn). ahandOned
6ft. SareaR. leup"th (if known): . ...... —fft,)
F"O"n (5,W-30 NnwanDfWwerRmujmvi aryawd 2-22-20k,

WELL ABANDONMENT RECORD
1. Well Contractor Information.
John C. Schappell
Weil Conhactorm (.............. 11 o p� y �. . s � P... perty) .........w.
Rome arweliawner yell a6andomn weil'onhrsiher m
2332-A
-- ........ ...
For inrarnal Use ONLY
WELL ABANDONMENT DET _ —— �. ......... _.
ALLS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 OW-30 is needed. indicate TOTAL NUMBER of
wells abandoned:
NC Well Contractor CerhGoalion'Number 7b. Approximate volume, ofwater remaining inwell(s): ,,, �,,,,,„ ,�—(gal.)
M&W Drilling, LLC [FOR WATER SUPPLYWELLS ONLY � ..,
Company Name 7e-Typeeofdisinfectant used:
7. Well Construction Permit #: —I ' -- - ' .. ..._ __...
List all applicable uVil masimcli6n 0"Ift fi,k UlC Ga+nry, Slate, I'arinrtce. @In} !f%aW a91
7d. Amount of disinfectant used
3. Well use (cheek well use)p.. —
__.... .. m..................................
Water Supply Well: 7e. Sealidg materials used (check all that apply),
❑Agricultural ❑Municipal/Public P Neat Cement Grout ❑ Bentortite Chips or Pellets
❑Geothermal (Hewing/Cooling Supply) ❑Residential Water Supply (single) ❑ Sand Cement Grout ❑ Dry Clay
ClIndudrial/Commercial ❑Residential Water Supply (shared) 1 ❑ Concrete Grout ❑ Drill Cuttings
ply Welt:
❑Aquifer Recharge
BGroundwater Remediation
OAqui%r Stmap and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drairtagc
❑Experimental Technology
OSubsidenct:Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal(HcatinL>:Coaliwt Return)
001her(explain under 70
d. Date wells) abandoned: „w3/22/23
$a. Well location:
Fort Bragg
Faeilityio%wnerName Facility iEW(ilfapplioal9e)
t-'fBR-0691SWMU-69, bounded by Knox, Butner, Woodruff✓£ Varsity Streets
Physical Addms% City, and Zip
Cumberland
Goutriw Parcel idonnfwWanNo. (P"
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(irwell field. one 101tong is sufficient)
35.15851063 �-78.981317080
CONSTRUCTION DETAILS OF WELI S) REIN ABANDONED
.�faarhurrllennstrrrcfinnrecard(sJijmiailahl@. Farr7rRltipleitjeetlanarnatr•trnterzttpplyivelis
ONLY *10 the Same nxevuacrionlobaadanmrtrl, you can submit err. fam
611. Well KW, „TA4-6 ,..
6b. Total well depth: 7.4 aq
6c. Borehole diameter. 0.75„
6d. Water level below ground surface:
❑ Specialty Grout. 13 Gravel
❑' Bentonite Slurry ❑ Other (explain order 7g)
7E For each material selected above, provide amount of materials used:
Portland Cement 2 Ibs
7g. Provides briefdeserrption of the abandonment procedunz
Neat cement funneled from top,
S.CerI cation:
3127123
Siga ictrofCeitiSedWegContractor vVell�Owner Dale
By signing this -form. I hereby certify that the well(v) was (were) abandoned rn
acrordance with 15.4 NC.AC' 02(' .0100 or 2C .0200 Well Construction Standards
and Thal a aipy ofthis record has been prrNWed to the welt owner.
9. Site diagram or additional well details-
You
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.
SUBMITTAL WSTRUCFIONS
10a. Epp)( Wells: Submit this form within 30 days of ecmpletion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699.1617
lob. ForIaiection Wells: In addition to sending the roan to {lie address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mal Service Center, Raleigh, NC 2769E-1636
6e-Outer casing length (if known): ap IN. For Water Sunnly& Injection Wells: in addition to sending the ronn 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 easing/taldng length (if known):.. ills) abandoned.
6g. Screen. length (if known):.,-,....... ............ .....
Form GW-30 North Cambia Department ofEmvironmentat Quality - Division of Watcr Resourm Revised 2 32-2016

WELL ABANDONMENTRECOIRD
1. IVA ConlrReturinformat4n:
Johrq C, Schappell
I 1 4 ft"u-"c (w A-c" aw"r
2332-A
- - -AdcuH— - --------- naim crhd rnYappn Numbe�
M&W Drilling, ILIC
Permit N: W10600036
2. Well construct" Wn - ----- - - ------------ . .... .
L&V &H jPjt1kvk1P lwe N Up „" cownly, Seale, pbrlvx'v' Rar.) �fkAd' a
3. %VfA I am (chek well Rise):
M11A, ABA14`0()
79 For Gwpirobe/DPT or Ocyed-lmcp Geothermal lVelh having tbe, same
vvefl only I GW 30 Rs nteded, Indiew. TOTAL NUMBER of
vveRs;Alandoned I . . ........ - ............. -
FJ5 ONLY.
7c.Type. of if iskifeetunt usedt
X. �AMount OfdWufCcT20t ft-Wd:
- ----- . ..........
........... — . . .... -... ,
wave'r supply'Wea. 7r- Scm069 mateemls used (check all that apply)
OAKTiculhall OMunimpalffiub?ic a Neat Cem= ( Wrou& i0 Bemtoniie ChIP6 Or PLOcts
[]GWflwkWM11 (Heaw'.'Oohng Supply) OResidential Witter Supoy Ilnngk) 13 SuNd Cctneffl ORNA, 0 Dry Clay
Onrjuwilal/caninlacial OR.esidential Water SUPPIY (Shaw0d) 0 COMPew GTCUI, 0 DIA cuninf.p
Supply %Yen:
OAqwfer R=13,140
*GtaundwaWr Remadialion
OAquOu- Stoyage amt Recovery
lllifTier
[3Aqu%r,rTeA
0,%taffnvw,&W4 Lhmriage
11
[3Sh&Rdcywc Control
Oaeoth'rmw (Closed LOOP)
OTmccr
nGirmthermal f Hcair ulCoAme Rchnn)
unrlsi, 7Lz_L
4, no w wvfts) abandaned: 3/22/23
5aa« Well localO".
Fort IBragg
Facflaq lO*(d'ApPfiV.aWz)
FTRIR: 0691,15"WMIJ-69, bounded by Knox, Butnec, Wacx1nm & Varsity stree1is
­ ......... .......
Physyzat AdIrom, Coy, md Zp
CumberLand
. .......... . ..... . ...........
Pawal No (PIN)
5b. Lafitudeand pagitade in degraWiminateidstwondsor deebinal ftrees';
(1irvVel? rqdda eu
35. 15839359 _78.98313794__
('01%taga Ja -- LICTION DEj6-,T1-S'OF Wf�LL �SHMNC �ABAND�ONFD
64a WO1 rN: TA4-5
0
6b, Total weft TkPlb., 310 ---010
fk.'Oareha�edisirnewri P15
6d. ek'Idv- tovii below ground Surfacqa:
0 Speciaky fircaut i" Gravel
C.3 Benh, mite slurwy 0 (Aci (expliun urider 7g)
7C. For each waterRal selectmi above, pR,wwjde ankount oftnaterials uslol.,
Portland Cement 8 lbs
7W Pinvides Ibrpefdawriptionafthe ab ndonment prmcdarc
Neat cementfunneled from top,
By xogwpng this fivvn, I hereky lxm�� dial Ihe vedf�) wis ficre ,) abeindirwed en
arazdancz, wish 15AACAC4'pA7,0100 or 2C',0200 Well Cormowc1sex 9andayxh
andthat a cnqv nfiki rrwApyl has heenpron'dedlo 1hp. well awarr.
9. Mte dbtgrsmcr addRional wee detRlh:
You nwy use the back of thva pas Se To pmvide addlWical vmlf srte demiy or wee
I ( MAIMN.A.WL RLS"IHM.
jo& &�%v 11: Sul)mit thm faim wRihin 30 days of completion of'well
Omdonmcot to the r4owa:Y&
Division ofWater uijrces, Inform"6on Processing Unit,
p617 Map Senjee Centex.ftleigh, NC27699-1,117
lob, ELr_YC_Ldls,. �n addinn U3 snciltig thefrWbc lW ess in pia. 't one P 'inn -ipim
above. ,%ko sobou cop OF khz h � vothm 30 days of am � on of %vcH
ahandoinRucril to Ow %flovving:
Divisfan ofWater likesources, Underground 16jeckYnn Contrai Program,
1636,Nfiiii Sm-viceCcater. RiOu eigh, NC 27&0-16.36
Ilk.. lddrc......os....0Lc..M.......Y.. RabLeorAve, 1ahaolls-u&llI-inia—Loenfie
W: ]YR addnOn tosnding flyc Fonn In OarV
mipy oC Hs (mm NMhin 30 dAyr afcwinpWian
of %YOp abandownent to the couaay healith department. of 1�c counly %vhcle
6C 111oner cRaYhlRrjtobin% ten%th (if known). .................. —fk) abandoned
6g, Scream knawn).
Fom, OW 30 Noah, Cmuhna Dopmmmmi of Envharnft"W Quua q' = punsion or waseR' Rom-%Wmrn

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John G. Schappell
Well Centractor Name (or wvtl owner personally abandoning well an hisA er property)
2332-a
.....„.„--_. ...
NC Well Contractor Cer ificationNuumbmb„ .
�er
M&W Drilling: LLG
Company Name
2. Well Construction Permit#:.W10600036
pp1 AG'ntt" Ae UIC County.µ Slam, trpriance, cic-) U dmn
Gist all o icp6h well coarinrcKar rr
3. Well use (check well use):
[]Agricultural ❑Municipal/Public
❑Geothermal (Reating/Cnoling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial OResideatial Water Supply (shared)
SyPPly Well:
❑Aquifer Recharge
©Groundwater Remediation
❑Aquifer Storage and Recovery
❑SalinityBamer
OAquifer Test
OStomrwater Drainage
❑Experimental Technology
OSubsideuceConoul
❑Geothermal (Closed Loop)
13Tracer
4. Datewell(s) abandoned: 3122/23
Ss. Well location:
Fort Bragg
WMU-69, bounded h Knox, Butner, Woodruff & Varsity S
Facih !Owner Name Faeln MP (ifapplicable)
FtHR-0691S y beef
Physical Andress City, and Zip
Cumberland _
Caunry �� Paml ldeatifiudonNo. (PIM)"..
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(nfwell held, one b0lorn is suffrercrit)
35.15843416 N 78.98314599
For toreros "„ ...
8 UaaONLY-
WELL1}B�VDONhfENT DETAIIS
7a. ForGeoprobe/DPT or Closed -Loop Geothermal Wells having the same
well constnxtion/depth, only 1 GW_30 is needed. Indicate TOTAL NUMBER of
wellsabandoned -.w .... ....... . —..-...--- ._.._ _
7b. Approximate volume ofwater remaining in vreli(s):
FOR WATER SUPPLY WELLS ONLY:
lc.Type of disinfectant used: _ITm
7d. Amount of disinfectant used: ...
7e. Sealing materials used (check all that apply):
R Neat Cement Grout
O Bentomte Chips or Pellets
❑ Sand Cement Grout
O dory Clay
O Concrete Grout
❑ Drill Cuttings
O Specialty Grout
f Gmvei
❑ Benionite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
Portland Cement 9 Ibs
7g. Provide a brief description of the abandonment procedure;
Neat cement funneled from top.
& CerpBru ci ao I r
_9 3127/23
Si iumofCertifiedWcIf.
Conuadoror''ellovmer Date
Bysfgning this form, 1 hereby curly drat the well(s) ryas (were.) abandoned rn
occurdaaca with 15A NCAC 01C.0100 or 2C.0200 Well Carstmaiion Standards
and that a copy of 140 record has been provided to the Well owner
0. 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 if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONI3D
ArmchnY!lconrrnrrrtnnrerord(s)7Jarwi/oblc, Pormrdtlplein�ccrionnrvion-rvpmrsupptyN�lls
ONLY xtnh the same cottntr Clamahmxlpraaetrt,-Wu mn SI&XII rate fore
62, well ID#; TA4-4
6b. Total well depth: 34
6c. Borehole diameter: 7�.� � �,....(in.)
6d. Water level below ground surface: aft.)
SUBMT11TAL08TRUCTIONS
toe. For All wells: Submit this form within 30 days of completion of well
abandonment to the rollowing:
Division of WalerResources, information ProecMspug Unit,
1617 Hall Service Center, Raleigh, NC 2769%1617
10b. ,For 6)jection %Yetis: In addition to sending the farm to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
.abandonment to tho following:
.Division of Water Resources, Underground injection Contra] Program,
1636 Alai] Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & Iniecfion Wells: In addition to sending the form to the
6t: Outer casing length Of known}; _,..........�,, {tt) 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 casingttabing length (If known):.m. (fl.) abandoned.
6R. Screen length tit known).* w............�.�...............�. _. {tt.)
Form OW-30 North Carolina department of Environment] Quality - Division of Water Resources Revised 2-2223D16

WELL ABIANE)ON MIENT RECORD
I . NveR Contractor hifolmadow
Jotin C. ScImppell
Hb&nd*Dh1,VNr3i 00 WkVPVT-Mpen)
2332-A
NC, WoU ("Mora'dof aIfiraliofl NUMkor
M&W Dirdfingl, I C
M0600036
3, %Veil iwe (c heckvWl =0.*
Tn"vs uheruta (Ho.0fine./coolin?, SUMY
Supply,W1.411.
0AqtAfer Siomge and Rov)v M,
DAquifex'resk
ICqxTinIental
Mkofficy-gnal ((Nosed L*up)
ClowthermM gI l Icafiul;vc'xtfinq
W22123
Sim. Well locatiow
Fod Bragg
EMMMM=
— — -------- . .....
...
...... ......
TAL
7a. For Geuprobe/W)Flf ar (-Ined-Loop Geadirmal Wells 11MAng OR- mve
well constnictiondelnh, only i M-30 Cs nee0ed Indicme TOTAL NUMBFA, of
7b. A p pfoxint' atevolasit of watw rema inipg in wefl(s).
iai MOMRS6� WiUS-0—NL V-� -- ' — . ....... ........
........
7c. Type of disinfectaut used.,
7d. Amountof disinfactawt uwd- -- . .. . . . ..........
. .....................
74,- SealbIq materials used (theck all thalappty):
P M-,UAxtnentGraW 0 Benronne Mrs or Peli&s
RRenatidasataaRNVaw Stbppy (sipg1e) 0 Sand Coient G'Mul. 0 Dry My
oResidential WawrSupply (.SbavA') I i QMarde GiVIA 17 Drill cutdVIS
C1 SvtxiMtv Gmul, r.1 Gia, vel
L1 Remp0c Shan y ILI Odiex (explam umdc0g)
ftround%-mier Reriedtation
Usalinity Barnier
)StannvQtar Munap
0SdIgsidence (7ono(A
D riagm
00ther I cxvtain under
Famlity IM fifoppEablv.)
F:'TBR-(ffi9PS'%NIMU-S0,, bounded bY Knox, Sulgier, Woodruff R VamityI"StreF4P.
PhYmal Addm%& Otyi marl Zip
Gurnbefland
[AM
Paryad tdex6rafhnwxkn No (PLN)
SbLatitude sad Wagift.Rde in dagmaaafnw6uquntsslaa au adaordecimal deg, rees':
flfwaIl ficU ung 1800ra 11's suffiduqIj
35A51B44485 1 78.98317415
X IV
EMMISM''IM �1'1
A MbW, b re&xA)vd6) ifrnvirgW Or
0)"V pt§j, tfxw Tome guARY'aw. form
68. TA4-3
fib,,Total we depth- -'16,13
fie, Water hwel Wow ground surface:
7E For e2dYnatedaq w.keted ahave, pritvide a xnaunt olli'materifils used t
Pol-Harid Cement 4 Res
7g. Piuvidea briefdewripfiGn of time abandooment pnwedure-!�
lNeat cemerit. furunded from top.
H. Cv1Mjat!u i.-
3127/2-3
Z
005VIL.MavvroIli WnCfr RNma
kp, vigning dar.ijarmL 'r 0refrrrjfv dgTrgg Ipte mix (wang, abandaned W
aroirda"ve I'vith 15.4 Ma. r, 02C,0100 rj,r- A, 0200 lVoll
vread Mad as ca p, ofrbir nwerd Aray go file wif dpwrPer,
9. Ste, w1kigrom or addidonx1*011 det*411s:
You may aurae flue Tack of fliis Inge to povide, addftionM Avell qfte dinads or Ifflal
at*ndan , mealdetaik-, You imav also a sddfion,,A Ipagos arpcv"m,
SUH FAL M,
ML t.'oLAj Vffi%; Sebmit this filrnr withil 30 4FS all, rompletion of vvefl
abandopment Iu'lha R'ofloMn&
wvisWo ormter Rmoreps, linformalion Practising Unit,
1617 Mall Segvim CcnWr, Raleighl, NC 27699-1,617
Mb- nr tan �!!k!jge. In sddnion in sendmg the fbiin IIn the Rddiev; do 10a
atmve, ONO wbwnicme colpy Df Ih6 torsi ivithin .30 65% of (zrnpIledon of vvcH
,ibandaninwd io d e followmg-,
wviu�ian ipfwairx 111eeaureet, Vadergsrwimd bit!cilo" Control) Progroan.
W636'Hafl RerviceCenter, %MgbNC 27699-1636
6e. Outer caging length (if known). low, In addimon inwgtdigig The. NO= to the
id&cs%ft.q� above, Mso submin one copy MIhik finm wid-an 30 days ofcomplmOn
of weld abandon=nt w ffic couwy bcallh departawril of the counV where
6f. innerellAngilubinglempth (ifkawymp . . ..... . ........ . . —JM) abandona.]
6g, 16rerrim, length (if known)-,
Form isw-'V OwAtll Dkvwilmanl qfEnvffongnc,"R Qftdjp of"fte.r Rcm,"M 1. 22.2011t.,

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John C. Scha,ppell
well Contrador Name (or well owner personally abandoning well an hidWr propcny)
2332-A
NC Well Contractor Cen.Bcation Number
M&W Drilling, LLC
cum" Namd
2. WellConstractioa Permit 11: W I O6001a36
f is(all appttcpble nell aommichan perarrls (i,c.W VIC CaumpW Slate. Yanarrte: Or-) *blown
3. Well use (check well usej
❑Agricultural
❑Geothermal (Heatir&Cooling Supply)
❑ Industrial/Commemial
❑AquiferRecharge
❑Aquifer Storage and Recovery
OAquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
dv Date well3122/23s) abandoned:
3a. Well location:
Fort Bragg
Faet6tylOwriet Name
❑Mdaicipal/Public
CJResidential Wafer Supply (am$le)
❑Residential Water Supply (shared)
❑Recovery
MGmundwatar Remediation
❑Salinity Barrier
❑Stormwater Drainage
OSubsidence Control
❑Tracer
❑Other t otuvlain under 7i, )
Facility WN (if applicable)
FfBR-069/SWMU-69 bounded by Knox Butner, Woodruff & Varsity Streets
i lly,T.l Address. City, and Zip.
Cumberland
County
Parcel Identification No (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or deelmal degrees:
(ifwell Feld, one let/long is sufficient)
35,15847719 N-78.98319829
For lnteMal llseONLY
WELL ABA-NDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geotbermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTALNUMBIrR of
wells abandoned:_ �., .m...... ......
7b. Approximate volume of water remaining in well(s): ,wµ, (98L)
_ -._. �.....-.__.. - ._..U-1S .—NL, , .........
-.FOR WATER SUPPLY WELLS ONLY.
7a Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
R Neat Cement Grout
CI Bentordte Chips or Pellets
❑ Sand Cement Grind
O Dry Clay
O Concrete Grout
O Brill Cuttings
❑ Specialty Grout
13 Gravel
❑ Bentariite Sluny
O Other (explain under 7g)
7£ For each material selected above, provide amount of materials used:
Portland Cement 9 ibs
7g. Provide a brief description of the abandonment procedure:
Neat cement funneled from top.
S. Cemil to
t' 3/27/23
SignatuorCertified ell Conunrr %m Well t.i rer w� Hare re
By signing thdv fnnn, I hereby terrify that the well(t) was (wern) abandoned in
accordanci- with I5A NCAC 02c .0100 or 2C.0200 Well Construction Standardv
and /hal p copy n f ibis record has been pr hvidsd ro the well otvnerr
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 irnecessary.
CONS1'RUCi'IQN dETA1LS d�F WEL REiNt: ,+t11AiVDftN£D
AttacbuY•lleuratnrcRantecont(sliJmnilabta F'arnrahlpklpfectiaaorirar-warersnpplyar/h
ONLY Iwill lire sama cortvn%wdpniobaadamnenl, you cans nhadt one faro.
68. Well MN: TA4-2
6b. Total well depth: , 36 -.•••- M)
Or. Borehole diameter. 0.75
6d. Water level below ground surface :.,,,,,,,,,,,,mIT,_--M.)
5_-1) MMI -Al TINU MaWN,5
109. For All Wells Submit this tom within 30 days of completion of well
abandonment to the following;
Diwision of Water Resources, Information Processing Unit,
1617 Mail Service Center, P ldgh. NC 27699-1617
lob. For fniecdon Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this farm within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
16M -Anil Service Center, Raleigh, NC 27699-1636
length if known ltk; For Water Supply & lnlection Wells: In addition to sending the form to the
Ge Outer casing � ( )' ° -I ) address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of die county where
6£ lnnercaaingltutring length (if known): , ......................................._„„„„„, (t1t.}
abandoned
6g. Screen length (if known):
Form GW-30 Nonh Carolina Department of Environmental Quality- Division of Water Resources Revised 2-22-so16

WELL ABANDONMENT RECORD
t, %Nell Contractor mnmamrnun.atio n;
r cnotr„wAW. Name (or oarmeu rymsznemuwp6w kxsan chase , Np on lOoOXq PwPaoy)
332-
NC WeH raaarw spr (Druirfirnbun Nanker
M&W Drilling, LL
Campmry Nime
fiwnf#wAau.shiporlla.^unserna�aunpwindRis(ke UR.,O'aunp(na&54ra Vanamc r`Re•) @fftknVkYw80
3. Well case. (cllwecta'wellt aura°):
Dt:umtheromll fmrtaatcr&Cuv hng Supply) t3RrsadCnnnyIPWuILs 5uxit pky (•tare,?te)
M truatuu nunfloCannwrtu iiaU VIRmidenntal 'Watoi )awjws y (+Ilraucl)
tp Aqu6Rer Recharge,
INGroundwalm litranaadnrePion
tmPAquiffcrSt¢uradcaalld Recavery
SelinntyEwn'ee
rpxffi�Xifcr'�"k xkn
tiva w'4'pvm' ReX' XtA.nlYage
pry','',",Tp.,p ¢ 0..„, n
A...dR:::V�MM•�9irento *N�IXzhriaCOft9v
ttC-1�"y
W.IUAubsIIdCn;A'.'.'C0nIUJp
u V(`ncaattrnam al (t lug A Loop)
Ma ace—n
Mawrothermt OH, ,lwer,.'PM'oofiw^ k'te#n 110
[30ther 6.Npiain uuu r 'ti-v i
rra.• WWAII tra snto n:
Fort Bragg
Faail,tyO-ace, aMar e Eaci a w ID9 ( rpnp ha ble9
t ) l3R-064)MMU 69, bounded by Knox, o.utruwWP'ra"dzrat uutff & Varsity Streets
- "aeEule acs. a::atr. Feud a°.,rpJ.___ ,_. _.....,,,,,,m...____ _ ,.•.._�
tt bed nci
t aaarY.up Pau. IM n ufta"a n twra (PIN)
b. ffemtut do and Conapptncde in atewara. a aaureartnut PreeN.roanaNa wru-alardmaut wtagu wro
f rcr w ail Hold„ one, p¢ahumg eae,wuaw'q'Re;.nemd)
�NeQJ2tJ eau at �raxdRttaauaarvuu uvemavwxd'Aapp w,)W»ured�NcsNard;. ,� rur raswrd'RP,auk'� Bari a,^r¢aaaa aua"RI wnr ^nmaYra^roaaynrreNy'µ�daa
C,P.Fw"�Y l�r ns�P6.Nn aduw^ neadnue .�aadU�mmataaaa: pRP;�nr�'eraapazeawee ,awzar a'a'dJ mrcxPnpnuP esrmse'eans_
ruar.'WJWell IM TA�.­...........� ... .....
61).1p'¢&wl wrell dep t.h. 37
.._......_. ...�....�fft^.l
auc.'tte rcholerttaameterr. 15 —00
6d. Water latw^nt tna;towar Wonud surface-. �......_.a� .,�.p0.)
.tart,�
Tar.ForWGCOPrutnar.7tltY1rarC"Q%, d-3auopaGeothernanaalWt'ellstaaviagt'Rromr'sMTM
%eel constro vtsoWdeptt only t GVlt!'-30 as "ewaditi- Indicate l"t'3mAL NUTNlBER of
Yvells-,babM&doCNc &...,......_.___...... .......... __............. .............
7b,, Approximate volume a f waatrr remainingin
FOR. WATER &UPPLY WEL1.5 ONLY.
7c °3y1w of ifixinfcctAat used; �._�� w�.. _....�............. ....,», .m............_...
F at . Am
ount wC'uraamt"tl�aaumW ixwre. :._............................�m..—__
°ate Sealing reawata^rtata used (ckeek alit that a ppapY)»
* Neat Cemant Grout
0 ttent.o ipeCpaapas etr tas:Nuem
Sand Ceun nt. Grout
Q )..pry 0ay
01 P„°oncrete Glrrna
0 Dri..H I(.:aAtd•.ug
ltp me)ty Grout
0 Graa.vd
0 Barlontue Sharry
0 Other (explain tllrt°d' 6eIC 7g)
A. oractn anaater ta$ $dent. above, provide imouuint of mint apr asaawsd:
Yip pnrnvide as Illairalad dercmipdon of m e nabalRdantuneal p)rocr urm.
Neat cement funneled 'from top
It ff,:orrtptraw. �us,.a�
�td�tee't eta. u^uemauhs�uatl tIW�tB Corn¢uarcuas;anr y+Na:01 nJha7au,r a'�uaaz
HV,Otpaela lhnraQa`rmI hereby aa'°mg& atiw die Maxwt(°) wur (awwW) abrarnd'ararrd en
aameprelankx moth Fast h" CAC 02C WOO en, 2C,0200 Wuntt Cunraa truenown � Paaandhrd
aandeba r wu reawautff berw been,pra videed m, aAunr arretff owner.
ur,. Ste, dla raow gm anaffaffwfieanalwell affe, atrr,
You may Huse the twm,;, of this parnge raa prraavrdc a d4ituen al Wellate dLIA s or sac h
aaband miens details, Yo" may a4m alliaarb aaddifional pages ut ngw essmrv.
Rya. • „ .t. 9a: suubrnu t Ws (bripu w:wautaan 10 days unff oomp lictio n laff wwOl
a midoanmcnt to the following,
D'Misinst of hatereseurce�w, trafl'breAatooypMmIProc oleig Unit,p6171 aH Service t" enfisr, Raleigji. NC 2761-,ff637
stump Lpair_tp.Le liaata"hVel . In anddiNon Ur Sending Ilk rornrn Xa wire aau:ts&rnss unu 103
above, also sa bm� t tapt copy of fleas form wwidiiin 30 days of comp kt)on of well
atuvadonmerld k1i alle ffiullsnunrtmid
plivhOon wamtr"Water ttesrauaa•co,,, Undemgrounmaff Neetixoan Ceroutta`et Program,
1636n'Mad ere lice C,'eafer, Raleigh. K 27dw9tp4l636
dc. Gutw.r� cza,twra per� dfla (if IfuaaflWn). ........._ ,..ff ) utUm. ate atcu Fill & IaLketirm a R 3, M arla:.39atnswn to mndong ffir fbaunn to the
vddre (cs) A uavwea also Isuuonuut one cop. of tfoffaoinnn vitktuma: day.t a rzeatmeats a
oii vvefl uabandonn 1cm lac the rc•mwaty heahh derAnnwu ent of the co untY %there
6E T"ner C2%i1HWiVIhbIP ptfflsnuoernm). a@amdoncd
�W ,. Screen lPagth (d kaoann)r . ._.... _..............................affr.1,
F'oor,CIMI,,30 ta$munkaW"a¢z�svduuanm�Graw:a�.eaaxeeleunr�d` aa'wac�akaarewr:aa al' N;J!ue laa�y.. a'vrawwuasvzrt°:'n' a:.a' .a'rnaax .:..n tktteear °a.;7w,<'tr&i

WELL �p _.......
...._
L.l� ABANDONMENT 1 RECORD For Internal Use ONLY
1. Well Contractor Information: WELL ASAl1DONMENTDETATLS
John C. Scha ell -
pp 7a. For GeoprobdDPT orClosed-i.00p Geothermal Wells having the same
Wdl ally abandaning well on hismer property) we!! constmationldeptty only 1 GW30 is needed, Indicate TOTAL NUMBER of
2332-A wens abandoned: ......... __ ..--
NC Well Connector Caufication Number 7b, Approximate volerme of water remaining in well(s);,,,,,,,,,,,,,,,,,,,,.,,,,..... .(ga
MAW Drillin LLC >oRwAa >iisu ri......_...........,...._....__.m._mm_....,.,n�. �.._....... ......... -
g, LY WEI.fS orILY:
Company Name 7e. Type of disinkthint used. ,,
2. Well Construction Permit #:. _ _.... _ .....m .... __—
Lis; all pgpllaable trell mnscvrcNon pertadtr p.a_ Mr, Cotmtn Stale, Manama, etc) ij,6ratwr
7d. Amount of disinfectant used:
3. Well use (c eckwe use): -..., - ...
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
MdustriaUCommercial
Supply" Well:
OAquirer-Reabarge
❑Aquifer Storage and Recovery
❑Aquifer Test
OExMimental Tech-rology
❑Gewthermal (Closed Loop)
❑Geothermal ll ieado&Cooline
J. Date wells) abandoned: 3/22123
OMunicipal/Public
Olkesidential Water Supply (single)
OResidential Water Supply (shy)
*'Groundwater Perriediation
❑Salinity Barrier
oStormwater Drainage
❑Subsideneccontrol
OTra=
OOther tee94raita under 70
is. Well location:
Fort Bragg
Fscitity/owner Name Faedity lDK [,fapplice6le)
F7BR-069/SWMU-69, bounded by Knox, Butner, Woodruff A Varsity Streets
Physical Address, City. and Lip
Cumberland
County ParcelldenFificuianA*a (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(irwell field, one 1at11org is sufficient)
35.15714995 ,, -78.98165569
7e. Sealing materials aced (check all that apply):
N Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ ConereteGrout
❑ 15ri1) Cuttings
❑ Specialty Grout
❑ Gravel
O Bentonite Slurry
❑ Other (explain under 7S)
7L For each material selected above, provide amount of -materials used --
Portland Cement 12 Ibs
7g. Provide a brief descripfian of the ubandonment procedure:
Neat cement funneled from top.
s Ctrti roitwom: 11
;
W27/23
Sq rmwrat1 fCenifled WO Cann w � eii 4 ' Dace
BV stgnnrg thv? Jbm4 I hereby, cer16 Thar the well(k) was i(were) abandoned in
accordanix with 13AN(...A( 01C' .01110 dr 2C .0200 WOO Construction Standards
rind rhr�t u ruby arrhis record has been provided 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 M ail& You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLIS) BEING ASA_NDOM
Atttxtr uwllcrxtstruclFar rrrnrd{sJ ijomitabte. FormuAipk;��channrnm!-avatdr.i7y�pl��tvalLs
ONLYWth the some cnasrructlon+oGandamarart, }txr tan snhrad nuejaam.
6a. well m#: TA3-15
rib. Total well depth:..4........................._........_....(M)
6c. Borehole diameter: 0.75 _(in.)
6d. Water level below ground surface:,mm,
10s. Par All Weds: Submit this farm within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Ratelgh, NC 27699-1517
10b. pp-Weliv Tn addition to sending the form to the address in 10a
above, also submit one copy or this corm within 30 days of completion of well
abandonment to the following
Division of WaterRevourem Underground Injection Control Program,
I636 NUB Service Center, Nale'rgh, INC 27699-106
6e. Outer casing length (it known): 14c For Water Supply die Infection Wells: in addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completian
of well abandonment to the county health department of the county where
6£Inner casing/tubinglength (if known):, JfL) abandoned
6g, Screen length (if known): ..................... (It.)
Pam, OW-30 North Ciimlina Department ofEmnronmental Qmldy - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
L'Well Conlrarlair Inkriviation;
John C Schappefll
...... ...... .......
WrIll Conimaw New far weV owacTpgTamaUjy ubandomagweP op harwir
2332-A
NC Wail[ C"m[mao,
M&W DrElfing, I L.0
L'ongiang Name
2- Wtffl Consurarokin Perinis M. W0600036
1"Of "Al Opphtylipk well waremptKan perwrly fi e, YX Cumay, JRale Vanwwee.k.) gfhgu;w
3a Well use (clheck %0I aiir):
Rlaxdeia Supply Wev:
nAgicuttural c3muntopaYINTAic
D13a)wNw=1 iHeating/Cooling Supply) C,3ResidvnttaVW0w Supply (single)
1DRcsidialual Wait- Spupply (sharvi
'on-N%iter Supply Wdh
MAqwfvt Rohirgt-:
gGloundwater Rerawiallon
0 Aqu ffierStilizge, ital Ritcoyciy
Usali"Ity pEdnemnaer
oGeodiurivial (COsaj LnqP)
FiTracew
FIGcothermalI 0,knwCtw,hnoltrrum
130fl=i�Nrlxn ujnder7�
31122/23
I
Fort IliiiI"ragg
Farday M# (Tipphicnbla�
F7BR-DG91SWMU-69, bourelcid by Knox, Butnw, Woodruff& VQFWty Strerets
. ..... ........ . . ..... .......... . ..... . ....... — — — -----
PkTwcaV AMnus, Coy, wdZRp
Cumberland
Pa Vell fdeatdiwka NO 01N)
51). Lafilude nrid Wingilude in degirees/minutaylseconds ar dechuaO dl
R`utfl r4ld, One iWlaqq is wfflw;erA
35.15718585 N -'78,,98166776
. ............................... . . ...... . ................ . . ......... ....... . . . . .
0M, V U491A Fhvsaw aw Can msivalp aw (ann,
6a. WeR I Dff: TA3- 14
61b. Tolall well depth. 47
6e. Bomholediaimehlra 0"75 __(in,)
6cL Water leyd l grrtund wrFace. (.ft.)
For Internal Use. ONLY:
A LXf DEI�A
7x, For Geopi-abelIII T or Clall LAmp GentherwA WeRs having the same
wdl amoructiondep1h, oapy p GW-30 ir, anNA. ed, lndicjweT0'rAL NUMBER of
welk abandonmi . ....
'Th, Approximate volume or watcr remaining iA ykefl(s)a w�m(gal
41iii 11 mf I II Iu 111 I Y WELI.S ONIN:
7r. Type of iftunfeakant w2sed.,
'7d. Amount of dislaftfinint used:
"Ye. Spin g imateristis used (cheek all thainpIlAy).
* NIC41 Come Grgilat
0 Benvonft 011p; Or PtHeN
* Swid Cement Gmin
Q Dry Clay
* Concrete Gunn
13 L In H Cwl fings
* speclain, Gmut
0 Gravel!
E3 Benolinke %hwy
Q Oflicn Cexpharn under 7g)
X Foreach minterhelselectLd atirount aril".at erials U."d.
Pordand Cement. 12 Ibis
7S. 111wovide a brief descritifdon of the abandainnivat jjlwracafure�
Neat ceiment funneled from top.
3127/23
Date
RIP.Tignong aml; f"Aryn, 7 lwpwi%y iar.n-t#6 thext else we,Vit�j wax &w^ y abiwith"ed in
avAyhrdaewu wah 15ANCAC 02C.0;00 norX, 0200 Wnff
apidtPot a copy (#fivr recardhos bcoaprovidedio thewelldiwixr,
%$ftediuVrPm air• fiddRional well details-
w Vou may, Use ffic badc of d1lis pAge to pywide addifional wrl1l sitr dehift ar %yell
I AMBAULIAU N201all —r1Q—P(S
Ma. E.Q.9: Al Wd.11- Ujnvet this flonn ivivhpn 30 days of cc.m.p letion. of well
abandonment to Ole feuow) ing.
fflvliiwa of Water Rp-wuree% Istrarwation Pirocessigip Unh,
11617 Hall Service Center, Raleigh,INC 2709-1617
101w, EhLioLqVion W.J11- In addnion to sending dw fhtim to the iddiess m 10a
r
above, also %AxwO onu cilpy of" this romi within 30 days of'otwupkikm of vdll
abasidonmait io thin fal !awmg-
Mvision of Wales RefiDurm. Uhuhmground.Injew.1torw Contral Prograng,
16,M Mail Service Center, Raleigh, 19C'27699-163(�
6e. Outer taiiing leogth (if known)- I Or. Eor 11 LI tLgr 5qx2Lw1v A n tLeiian W fLp In w1dilkon to sandpqq die ftmv to the
addwwskzohoyo. 09osubnrl one iiopygWthm fann vnihin. 30&A,ysnirc0rnpl1e6<,q
or weR abiuidonmew% to the counly hwifth &VarnnLto of the wunp, ndwre
6E Inaer cagingfoubing lenpth (ir known). _(ft.) Aimdoned
rkxnw left $1 (if knawn)*......... ........ ff0
nom CAY-30 Noah CarWma Defguimem ofEnvinninmenU3 Qud" - Men= crWar r Rouairmis Ravq�cevi 2,22".0116

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John C. Schappell
Well Contractor Name (orwall owner persooally'abaudon*wcll on liisther property)
2332 A
NC Well Contractor
hactor Cemficarion Number
M&W Drilling, LLC
Company Name
2. Well Construction Permit*: w10600036 -..,.......�...............�.�.�.�.�.._...
List all applicable well consinectlon Permits Q.e. UIC, County, state, variance, etc.) rirlwowa
3. Well use (cheek well use):
Water Supply Well:
❑Agricultural
OMhmicipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑lndustrial/Commercial
❑Residential Water Supply (shared)
❑imgaiion
Non -Water Supply Well:
[]Monitoring
QRecovery ...................�
Injection We1L• �...�
❑Aquifer Recharge
CiroundwaterRemed:ation
[]Aquifer Storage and Recovery
OSalinity Barrier
[]Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
OGeotthermal(HeatingtCoaiingReturn)
❑Other(explam.under7gl
3/22123
4, Date Well($) abandoned:
5a. Well location:
Fort Bragg
_
FacilitylOwnerName y..
Facility 11M(if appheablITITITITITIT
)
FTBR-0691SWMu 69, bounded b Knox, Butner, Woodruff & VarsityStreets
w_ _.........�.......
Physical Address, City, and zip
........ ... ..
Cumberland
County
Parcelldentifiraios Na- (PIN)
Sb Latitude and longitude to degreeslminutes/secundsordedund degrees:
(if well field, one Iavlong is sufficient)
N
- . _. _.....__
F In Use OXLY�
._. ...
utrt LLA13AWM,4ENTDETA11
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells bevingthe same
well construction/depth, only 1 GW 30 is needed, Indicate TOTAL NUMBER of
wells Abandoned:_....... .............. ..................................... .._,..,,.,..a,_...__ ..__
7b. Approximate volume of water remaining in well(s):
FOR WATER SUPPLY
WELLS ONLY:
7c. Type ofdisinfectant used :. ............ .................. W_.....-----......-��...
7d. Amount of disinfectant used:
7e. Scaling materials used (check all that apply):
a Neat Cement Grout I7 Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
O Conroe Grout
❑ Drill Cuttings
O Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7L For each material selected above, provide amount of materials used:
Portland Cement 13 Ibs
7g Provide a brief description of the abandonment procedure:
Neat cement funneled from top.
3/28/23
gT!
.........
Well Contractor or Well Owner
__..
lute
by stgntrtg this form, I hereby cerrify that the ivell(s) was (were) abandoned itr
accordance with I5R NCAC 02C .0100 or ?(. _0200 Well Gonstractiort Shv dards
rwd that a copy of thir record hav been provided to the well oMwer_
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 rpay also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLM BEING ABANDONED
Attach well construction record sj rjaimilable. Farmerldple tnjecrrpn ornar-u otersupplyuwlls
ONLYulth thrsame constrncriaa,abamlontaent, you can.wbmil anefonn.
6a. Well ID#: TA3-13 __ ............... .
6b. Total well depth: 5a,,,,,,,m„,m,_ (ft}
6c. Borehole diameter: 0.75 -Can.)
6d. Water level below ground surface: Ot)
SUBMITTAL IlVSTRUCTVWS
10s. For All Wells: Submit this form within 30 days of completion of well
abandonment to the followmgi
Division of Water Resources, information Processing unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
IOb For Lriection W ls): In addition to sending the form to the address in l0a
above, also submit one copy of this form within 30 days of completion of well
abandonment to thefallowing:
Division of Water Resources, Underground Injection Coutrol Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): w _ (ft) I Oc. ForWater 5upoly & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 0 days of completion
of well abandonment to the county health department of the county where
6f. Innercasing/tubing length (ifknown): (ft) abandoned,
6g. Screen length (if
Form GW wM North Carolina Department ofEnyimnmenW Quality - DiN ision of Water Resources Revised : 22-20tn

WELL, ALM NDOPLN �ENT �RE C',qR D
1. Well C.ontractor Infortinistion:
John C, Schappell
NVOI CaffteW Name Qiu+e MxU ownev persewRy Aundmung wO an N.qherpwhie*�
23322-A
. ............ ,:D(MMIE DFTA11.2 XL ..... S
7&. For• GPA1PrVbWVrF Or Closed -loop Geotheirmal Wells Im"ne,
welt only I GVW-30 wsneedeA lndicAWFUZAL NUMBER of
welk aKnPdonqsd . ..... . . ......
N'r IVA C0Y"gna0rCVmfi=0n Nualbef 7b. Approximate volume afwm ter remaining in welj(s)Mi.)
M&W Dflifing, LLC WATER SUPILINMUS aVLV:
..........
7m Type of disiareenant usedn
2. WeU Cangtrueflo."D PIC&T'lit M.- M0600036
. ............ . . . .... . .........
4-Ar all applea4k nVII comfnecava IVrown ft V MC" Cmmt�p' slafe, tenr#Tamc e1c) ffhWHIO 7d. A mount eir disinfeaw.ft used-
1 Wdl use (cheek well uim.)a
Ma 7e� SeAn» iraaauteiiah; um—d (check sH that sup pl:rJ:
Mgncidfuwal Muficipalipublic It "host Cement Qvul w.J Bentonde Clup., iT Pelllpls
l3uppy) f....311mMenfial Wee r Sumily (sxjRr)e) 0 -and Crunmi GMLt M Dq' ("'KV
IJ Mendenfial Wafer Supply (shmW) 0 Concretz Grout U Drill Cothngs
'Ven-water Supply Weil:
Mqwfer Rechaqe
FRCJ'vxindwra" Remedumon
0Aquifer'Stmari �� aml Recover%,
rJUkuty Bonin,
CiAqnifer'rest.
Mlonnwaler Liraoxage
C.lExpurtme4ftl Teclsiology
OSubsidem-m Cowuyul
00ewhatwW (Clo3el Loop)
4. Italic wc41(a),hbaavJoned,. 312212. 3
Sea. Well 110catkya-z
Fort. Bragg
Fxnbw;0wm Nwnu rwifi�, ID# Cif.tpplicubiq)
FrBR..089191NMU-69, boupded by t�ox, Butno�, Wourfruff & Varssibj Streets
Phy%cal Addmss, C4T,,%nd Zip
-CumbeHand . ...... ..... .............................. ......
CMUdy Pam'A
51a. Lalitude oad loug[tude in de?r
ffwrM Bold, one hwhwq ceshnimuces/seconda or deefinol dr cgm-
35.15726233 --78,,98169190
CON.
6'q.WeU1D#-. TAB -12
6b,"CoWwall depth; 39
6c-HoirrholetHainvater: 0.75
&L'Wahrx Irvel befiww ground -_..--(ftj
V. Speomk'y Groat ID Gravel
Q Benfxygwo%Ufry 0 Dher (vxrAann widei 7g)
'?EForeath makerial selected above, pro vide amouat iid snatierials wised
Portland Cement 110 KIbs
7y, Providen ME4dewcrpdiwa of the a handooniLnt proeedure-
Neat cen-writ funneled frorintop,
ihisfigF.71, i Irf"re.fT cerif.,& Phae whe wellfi,p wax (wr�,qy chandonedin
with 154 WAC ` MC 0100 or 2C.0200 Irell Coiutpucrmm „*apldleardx
Gildthal 1A. CW'Y" #n'Ohis rucoptihas •beempn-wededru the wvkmvner,
9. Site d4gram or additional wffl def&Hs;'
You may use the badk of'diia pge to provkle additionalwrII site deugs or wrM
Annckmawaadetails Ya,unmyd so attach iddmoitM des ifnece.xisary
SIT MITALM'SERMN-MIALM4
102,, tLar Ali !%abmit this foun, wiffion 30 days, of emplefivin of wro
abandonment to the fbHGvviqr
Dividon ofWater RmninmN lnformot4An Proce.4sing tanjj,
16PMaR Service Center, 110eigh, NC 7769� M 7
10b. Etsn'fanettuwaa '�&''mtp z2 In addition toimiding ffic.rhmw To wIv addqe.,&s m 10a
above, 01ro Rlbrnh ofw CnP.Y Ofthisl foun %vid-tio 30 days oF (=&Iiou ofwefl
aWnduan,mm to [he fbHowmv-
Division *MWter Resources, Underground InJecdon CoOrni Program,
1636110 Sswice Center. Raleixh, NC27699,1636
6a-- 00ter casing tealth Cif known)-. loc. U.0 V��C ilk., In addRion lo sending the fi= to the,
&ddre,%sqr,0 above, o6o subind one copy aFthis rann within 30 days or cm-noletior.
of %Yefl abandonmem in die cmmN Waidw derartment PC dw counq whem
6E Ift'Wer cWaWtubing longth (if kxowa)• —_(Ft) NAomdoned
6r, Screen length (O'known)._ .............. __ ............... -,_ (11. p
rorVp(AV-:W Mwth Cwahna DnWrrmM feEmornumptal Qu'IMV . Dn'loriv ofw'atar Re as Kv 6scd Z. 22 -2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John C. Schappell _
Well ConnactorNarne (at well ownerpersanally abandoning well on hisher property)
2332-A
NC Well Contractor Ceraficanon Number
M&W Drilling, LLC
Company -Rome
2.Well. Constrac6mW10600036onPnitq: „_.... ,M.�......�_.._ti..� ....w..U........�.....................
List all opp11ca6te avS rarntnictioa permlta f.a Efic Comity, Slate, Variance, etc)+#'kaoMin
3. Well use (check well use):
OAgricultural ❑Nlunicipal/pttblic
❑Geothermal (HeadnglCooling Supply) 17Residential Water Supply (single)
❑lndustrial/Commettial ❑Residential Water Supply (shared)
❑Recovery
❑Aquifer Recharge
ISGrouQdwater Remediation
❑Aquirer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stommwater Drainage
❑6xperimentalTwImology
❑SubsidenceControl
❑Geothermal (Closed Loop)
❑Tracer
❑Leothernal(Iieatim-CoolineReturn)
❑Otherte.,,Mainunder 70
4. Date well(&) abandoned: 3/22/23
SR. Well location. -
Fort Bragg
FitylOwner Name ITFacility IDk (ifa licable
FrBR 6 SWMU-69. bounded byKnox, Butner, Woodtffnis Varsity Streets
Flysidal Address City, and Y.ip
Cumberland
County Parcel Identification No. (PM
Sb. Latitude and loagitude in degrees/minutes/secoods or decimal degrees:
cif wetl Field, one lat/lorg is sullicient)
35.15729797 N-78.98170391 W
CONSTRUCTIObI, DIET OF WELLt l VEINGABANDtjNEtl�
Ariaohwellcoasti7mlierl record(s)ifaroilable. For amuipteinjecrionarnan-i atersrrpplywells
INLYidift the mnro caulrndlon/abmrdonment, Iwo can sirbant cnefarm.
60. Well rDff- TA3-11
6b. Total well depth: 47
6c. Borehole diameter: 0.'..75�.mm,(ir•)
6d. Water level below ground surface:
w Fa Ir tonal Use ONLY mm
LVEtL ABANDO MNIFIEE
NT DETAiL3
7a. For GeoprobdDPT or Closed -Loop Geothermal Wells having the same
well constmotion/depch, only I GW 30 is needed. indicate TOTAL NUMBER of
wr114 nhnnd/ined
7b. Approximate volume of water remaining in welf(s):
FOR WATER SUPPLY WEId 5 ONLY:
7aType ofdisinfectantused :........
..
7d. Amount of disinfectant used: _.------ ...e,...... ..........W�.....................................� � ..
7e, Sealing materials used (check all that apply):
Ri Neat Cement Grout
❑ Bantonite Chips or Pellets
❑ Sand Cement Grout
D Dry Clay
❑ Concrete Grout.
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected ahove, provideamount of materials used:
Portland Cement 12 Ibs
7g Provideabriefdescriptionoftheabandonmentprocedure:
Feat cement funneled from top.
B. Certifieatior
-,3,27123
gi_ _ ........
grmnsnffenucaf&" rrmn&uedWell Conhactere \cllOv�m�ea Date
{
By signing this fm7n, 1 hereby evil ify that the we11(.er) was (tyre) abondaaed in
accordance with iJA NCAC 02C_0100 or 2C,0200 Well (.anstraction Standards
and that a copy ofthis record has been provided w the well owner.
9. Site diagram 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 if necessary.
10a. Egr All Wells: Submit this farm within 30 days of completion of .vell
abandonment to the following;
Division of Water Resources, Information Procesviag Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. ERE ln'eetion Wells: to addition to sending the form to the address in 10a
above, also submit one copy or this form within 30 days of completion or well
abandonment to the following;
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): fft.) i(tc- For Water Six l'a & Ini"tlnn Wells: 1naddition to sendng the forth to the
address(es) above, also submit one copy afthis form within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casinghtibing length (if known): IR) abandoned.
6g. Screen length (irknown)t............................................................._ ... ,.. (&)
form MV-30 North Caroliaa DepanflML of> mtironMMial Quality - Division ofWeter Resources Rerised 2-2-1.2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
J'Dhri Q Schappell
Wen (Of weU Ommer parmmily abandumns %1,011 on wslw propely)
2332-A
NIC WeR CaiRrmlor Cedig himuon Nudwr
M&W Drifling, LLC
C'OrnpanyNalme
2 Well ConAlract4a Permit $: W10600036
T" .11 qPPOCONO, Hell P1111, c UA-� Coway, Sarv. Kinw,:P,
1 Well wic (ch"1swell mat)-.
Water Supply Weffi
rjAgriculturW
01CA.vOwmal (PlesfingCoofing Supply)
UYnduOTWiConkmerin-d
Non -Water Supply
[JAquifer RechMe
E]Aqader Stcage axd Rtravery
Of-'x1mriRnental Technalogy
Fcw Twerwil Lme ONLY
MUAPAMNNIE�Lr DfiLARAS
7s. Fair Gmpmbeffirl'ar Oosml-Laop Geahermal We"s having thessma
wt.A cxxsft-ucbw/dqpsi % wky I rjW.30 0srwaila.l IndicateTUTA L WIMBER-of
1------....---
7b. Approxiwat voluaw of water remainling in wefl(s);
7d. Amo ant of disip Fec#A at umdi
. . . . . ......... - . . . ........... . ............... . . ...... ................ . ... . . . . .......................................
-- -- ... ..... . ..... — 7e. &Wing materlIah ".W1 jebeek, all thal applo!
Elm] vnkupsllhbfic 04: Ned Cam-NO11aut 0 Denwile Chipi or peflets
e) 0 sand Cement Groul 0 Dry
OR.wdf..,MW Wale, Svpl�
c' Mertdnival WsTL7 SuppIly (ffiucd) C.) Conerwe out 01 thill Cuvufnws
0, w1unwor Barney
Ostormwater Lksinage
CISubsidenux Coniml
OTravAea
Refi.xvin) 00ther
4,, Date vredk&) atmndened. 3122123
sm. Wefl Wadow
Fort Br,agg
r,�uihtv ;nii
— - - --------- — — --%ruatnYa- - - - - d"dR�add MU.6boundvodby Knox, Butner, Wbodruffa Varsity Streets
VWstud Aftw. City Zip ., and
Curnbedand
Ca"my
Pum,014k,alkwono No UTO
Si#., ufifudp. gad toudamn de 0n dep,revshninutands or deelmal degrees;ieilsec
35,15733470 -78.9817'1704,
OX V widlk phr sdmv twaTtruMon
6s. VIVeD HD9, 'TA3-1 0
r."
i6
6b. Tana ad well depth. %r-
0.75 (111")
ILI spec'JOI14. GROUT Gtavd
10 Bantanfle r0un�'w C.1 Odwi (cgpWn under 7g)
X For wich makwitIl selected above, pmvide awaunt of imaterials up.,417.
Portland Cernerit 15 lbs
7g. Provide a brier dMeription of the abandanwest procedure:
Neat ceimeint funneled from top,
]c
1�v,wgwmpdu.v,fbrrn, I here -by vernly rhal she Toedl(V was ewriv) ofoandiowd ffA
arewdonev "41h f.14 N(,'A(' U2C.11100 nr 2C,0200 Well SSandia
andrAne a c.opw?f6up the w1l mwwr-
9. Site.dinpraim oraddiflonal wvH detaft
Yna, may we ote imrk.. or twr page to prowdo M&6nal %0 Ale deWls ot wefl
ahwAmment doask You mRy alm attacb addffionspap m iiffntu mwy.
SUBM1111I rRUr7fQ101,
I On. rgr We ft. Submit this form, vvitWn 30 dayIs of wrnpklion of
sbandonflumt tv dw Hlowng°
Division or Water Rmarces, Infamstion Procem-ing I WIL
1617 Kill Service Center, Rs1r1gh,,N(.:'276"-J617
lob Far lnn.-C&m WelLs. In addifion to wndinV ibe Whin'n to thc sddfess nii d I
aba%v- also subma oue cnpv nr this fonn wiffiin 30 days of cormpleflon, ofwelll
abandamnent to flw following7
Diviiinn of Wwwr Rcsmwf,,.v� U ndergrawid tojection Cimimvi Program,
106 Mail Seirviiev Cit.Wer, Raleigh, NC 276"..•106
I FfAr 14VA& SIR & era"
NVellit In addibon to rwnding the farm Taflv
fir, Ouirr Casing fength (if known): L.Rj __j_
.mkkcssks�above, akoisubmit onecoTNoftlirs fk= Mthru 30 dayl ofcoMPILIRM
of vveh alrandonment to qic county heolth dtf.kartmenw of ehe wonty where
U. III C.8%inghulwing hwg1h (K kywWD)a ... --j rt.) abmidoned
6g. Semen Nngth ffknown)r..... . ............ . . . . . . . . ------ J ft.)
Femn CTAI- 39 Nunn Cwahnar Drpm 1110 RnvwoinmwvvA QuafitV - Di OrRou4 Wwor Rmmmv* RevagA2­22 -LO C

WELL ABANDONMENT RECORD
I. Well Contractor Information:
John C. Schappeil
WellCantracratVame _m ..n_ ,,,,��� � - � ._............
(a well owner personally abandoning weft an tdsRwr property)
2332-A
C.. _ _........_
Forinte......
rn4lusetnai v WELL ABANDONMENT DETAILS
7a. For GeoprobeMPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUhMER, or
wells altandmted'
NC Well Contractor Certification Number
1b. Approximate volume of water remaining in welt(s); ..,.. ...)gal•)
Drilling, LLC
FOB wATErE SUPY YWELS LY! ___ ...........ee _......
LLONM&W
CompavyNatn�
7e.Type ofdisinfectantused:
2. Well Consi ruction Permit# W10600036
%ist all appliinbtn nail rottsfrxelion purvntts C,a VEC, f"armty, 5rara G'prtanca, etc) ijkrroun
7d. Amount of disinfectant used:
3. Well use (check well use}:
....m............_._....... ...........
WaierSuPP(Y._......__............ �� ,�._�.�._�.�.....�._._ _ �..........�w
WcD:
7e, Sealing materials used (cheek all that apply):
❑Agricultomal OMunieipa]/Publio
@& Neat Cement Grout 0 Bentonite Chips or Pellets
Meothermal (Heating/Cooling Supply) OResidential Water Supply (single)
LI Sand Cement Grout ❑ Dry Clay
11IndustriaUCommercial OResideatial Water Supply (shared)
.0 Concrete Grout 17 Drill Cuttings
QMonitoting
0Aquifer Recharge
❑Aquifer Storage and Recovery
DAquiferTesi
DExperimetual Technology
OGeDthermal (Closed Loop)
4. Date well(,.) abandoned:
3 22/23
eGroundwaterRemediation
13Salinity Barrier
t3Sto13nvtater Drainages
❑Subsidence Contra]
OTracer
00ther l:,rrlain under 70
go. Well location:
Fort Bragg
FacilitylOwnerNarneW ww Facility IDll (ifapplicabte)
FTBR D691SWMU-69, bounded by Knox, Butner, Woodruff & Varsity Streets
Physical Address City, and Zip
Cumberland _
County .......... ,, ,.,..... a Parcel Identification No.
..t..............
Pull
5b. Latitude sad longitude in degrees/minuteslseeands or decimal degrees:
(if well fidd, one tatilont; is sufficient)
35.15753727 N-78.98147967
❑ Specialty Grout 0 Gravel
13 Bentonite Slurry- 0 Other (explain under 7g)
7L For each material selected above, provide amount of materials used:
Portland Cement 8 Ibs
7g. Provide a brief description of the abandonment procedure:
Neat cement funneled from top.
& Certi :m n.
(r�1 3127123
y
Signature of Ccmfed Well C . nu for ar WiGI Uvmcr Date
By string this firm. 1 hereby certify that the will(.,.) ryas (were) ahondaned in
ocanrdonce with 13A NCAC 02C.01ltll toe 2C.0200 Well C'.r wimction Standords
and thara copy of this r ec+ord hos been provided is the well owner.
9. Site diagram or ad ditional well details.
W You may use the bac< of this page to provide additional well site details or well
abandonment details. You may also attach additional pages iFnecessary.
CONSTRUCTION DETAILS OF WELUM REM ABANDONED
Attach FvetfcrxarfarcfwnrFaerc!(,:JlfonritrMle, ForMullrpleii�ieu0rn6n-usptrrsuppfyic�flr
ONLY urth thesome gtmvpwainiVahandannreet, you con subaill aria foram.
6s, Well Il#. TA3-9
6b. Total well depth 30.5 _,(ft )
6c. Borehole diameter: 0.75 (ice)
lid. Water level below ground surface:
SUBMITTAL INSTMICTIMS
10a. For All Wells: Submit this form within 30 days of completion cl' well
abandonment to the following:
Division of Water Resources, Information Processiagllnit.
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to die address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following_
Division of Wafer Resources, Underground injection Control Program,
1636 Mail Service Center. Raleigh, NC 276994636
6c. Outer ensing length (if known): (,r) tile. For Water Sup& s: infection Wells: In addition to sending the form to the
address(es)above, also subtnitone copy ofthis form within ail days ofcompletion
of well abandonment to the county health department of the county when:
6L Innereasing/robing length (ifkno,.n) (B,) abandoned.
6g. Screen length (if known): _wITITmm ,__w _........,.,.y_.. (ii.)
Form (1W-30 North Carolina Department of Envitom»enial Quality . Division of Water Resources- Revised 2.222016

WELL ABANDONMENT RECORD
1. Wept Cmitratfor Infairmation:
Johin C Schiappell
."aclorName for wall CwUp.,up'.1smally ab'anduning wOl on WaIcrpioparty)
2332 A,
NC Well CQnuactor Cerfification Nuujber
M&W Driffling. LLC
CompnUN Nmnfd
Z Well Covitrurdols flermig IP,006000'6
...........
Lur *0 applicable 4'&4IArWlirs 70 e, VIC C"Ountµ', "Siare, Marlaver, lor) mfknmwa
I Well use (theck well use$.
OGe.OV--&rM8t (HenfingComtIng Supply) CiRcmdenthd Waker Supply (�singlc)
0 ndustnaKbmrnercia!l E:,lZrsidrvfigl Wairr Suppty (shared)
Nuu-Wat#rSnpplj WeM
F-tAqu&r Recharge AGpoundwal.cr RLmediation
l-]Aquifitr Starage and RLcovery Bairrwr
[JAquifer"T'Lst OStormwwmer Dratmge
f.]Swhsidence Contrxg
CIGCOOII-nnal (Clovxt Loop) OTracy.T
I 70eathennal rt VRj.-Iurn) 0 Odier wmAairk p.mda:- 7 a I
223
4,. Date well(s) abandoned-
3//2
S& Well locaftow
F---ort IBmgg
. . .... .... . ............ ......
Rwility/Ow ow.T Naar, Facility ID4
FT 8R4j-h9iSWMU-69, hoUrdpil by Kriox, StArkeril Woodruff &Va. rs fty streeLs
Phn. wall Aftv--k„ C"Ify, ikod Lip
,Cumberland . .....
County Pumll Idenafilranea Ne.. kPTN)
lib. 1,011ide And 16099Mde, to or decinmi degy-resz
ju"Vell ficld'orvc 1"luxis Ya SiOEIGaLmr)
N
E D
Avach weg
OAKY W"#h Ow saaw
(in, Well IDN: TA3 8
rota."Total wtil depft --
30 A.)
, — .......... C
6c, Rerelsole ifiameter- CL
6d, Water leyd Illretew ground surface: ___(ft)
. . . . . . ............
3LFI,,�-LIIL—%,tlqip()�.N,%IFI.N,r IMAM
7a. For GempnAefiftr or Closed-14op Geothermal 'Weftba"rlphe same
w6l consli-ttetion/depth. only I OW-30 is nmmkled, hidicateTOTAL NUMBER, of
wrth abmad oned:, . . .........................
7b..AppireximitO voluffir 011"Water reffinining ill[k
FC)R WATERSUPPLV WELIJI-,'� ONLYz
7e. Type ofilkinfectaug issed;
7d. Amount of dhdorectant used.
7e. Seafing mkerialR used (chiackiiIIII that applly)�
9 Neat Cement (hvital
113 Bentontte Chips w, Pellets
0 Sand Cement Grout
U Dry Clay
D Concrete Grout
ID Drill cuniqp
I. specasiny Grout
L3 Graw9
0 Omwnac Sluny
OdiLr (explain under 71;)
X For each walker,W selected above, 1pprovimte amount of waterillaWr usod.
Portland Cernent IIbs
7g. Provide a bviefd(i4eiription of ore ubandeement prmedarr;
Neat cement funneled froirn top.
Cer"
. .. ... ...... l WeD Con"Roor or WCH Owner Datc
By Og"ing thkifiorm. I hereby rflrdfy May. ehe well(s) was abandoned in
acrordance rrith 15A IVCAC 02C. 0 of) e.y, irC' 0200 W4,11 C°2tamn'trur'td®n Sildrpm.Iard-g
and thw a copy ofthisrecord has bepn prorided to the weld owner,
4). Site diogirma or a&fifioual weH detailm:
Ynu may use the back of tMs page to 1prm,idc adrkionalwe.11 site details or well
W Avandon V01.11 mayalso akoch add ificoal par , rmcm,2iary
er,, iT
5'LMVHTTkL
.11-4 IMIKO _3 (INUIS
Ill& JRE��p Saiilma thlis lban within 30 dlkis -,Yf camplehan at "YCH
atyindomnenuta the foHoMng
Divisiain of Water Remmirces, Inform2flon Proceming Unit,
161,7 MaH Service (J'Cater. Italelgh, NC 27699-1617
Ift For [gjtgj2t.�. In fid.difion (o swdfil the f6rm to Vic, addres.'s in lai
abiwe, also %4bink one copy of this rorm within 30 doyi of of welfl
aNwndonment to the foKlawin g:
Division of Water Remmirces, Underground fnJerfian Control Pro gram,
106 Mail Service Cenwr, 11kaleigh,141C27699-1636
tie, Outer cm-i rag length (if kawwn)t I (k-,�.pqgLLV&leg In additum to .ondxT theAmini ll* the
addi—n(leA) above. alm subnmone copy of Ons form within 30 days ofirmviplehmi
of ivelf abundnnment ttl the COWly heallth depadment of die county where
OC l4nmr easing/tubing lergth ffknown)., abandonecl
6p, Screen length CH'known):
Farm G%-30

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John G. Schappell
WtI1 CanlractarName ......._............._.........._.......�...... w ww�..... ®®......._
(ur welt awnet pasanally abandaniug»ell as bistro properny)
2332-A
NC Wel l Contractor Certification Number
M&W Drilling, LLC
Camps ry Nome
W10600036
2.Well ConstrucdonPermit #--,-,_..„ .
J.kz (IR applttaNe, trait conc;mmilmr per mlta (i.e. UIC cormry. State, Yurvavice, ere) ifkpntra
3. Well use (ebeckwell use):
Water Supply Well:
❑Agricultural
❑Geothermal (HeatirlglCooling Supply)
❑IndustriaKommemial
Non -Water Supply Well:
❑Aquifer Recharge
WAquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
❑Geothermal (Closed Loop)
4. Date well(s) abandoned: _3/22/23
For .....
WELL ABANDONMENT DETAILS
7s.1+or GeoprobeMPT or Closed -Loop Geothermal Wells having the some
well constructiouldepth, only I GW-30 is needed. Indicate IMAL NUMBER of
wel(C shandnned
7b. Approidmate volume ofwater remaining in wel(s): --.._ ..............................,.....,(tat.)
,FOR WATER SUPPLY WELTS ONLY: �-
7e. Type of disinfectant used:.. _..,....................IT.�.
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
DMunicipal ttblic
R Neat Cement Grout ❑ Bentonite Chips or Pel]W
❑Residential Water Supply (single)
❑ Sand Cement Grout ❑ Dry Clay
❑Residential Water Supply (shared)
❑ Concrete Grout ❑ Doll Cuttings
❑ Specialty Grout ❑ Gravel
❑ Bentanite Slurry ❑ Other (explain under 7g)
ElGroundweter Remedistion
E]Salinity Barrier
❑Stormwater Drainage
❑SubsidenceControl
❑Tracer
❑Other (excilain under 7t: y
so. Well location:
Fort Bragg
__..... ......... AAA_....
Facility/(honer Name Facility 1D4 (if applicable)
FTBR-069/SWMU-69, bounded by Knox, Butner. Woodruff & Varsity Streets
Ff"cal Address. City, and Zip
Cumberland
Court. ...... rarcelId oati........No...............
i.
y emifigtion tin. (PIhO
5b. Latitude and longitude in degreestminutesiscconds or decimal degrees:
(ifwsli 1ie14 onelatflongissufficient)
35.15755180 N-78.98151755
7f For each material selected nhovcs provide amount of materials used:
Portland Cement 8 Ibs
7g. Provide a brief description of the abandonment procedure:
Neat cement funneled from top.
r�
B.CertiF :ltron:
� 4 e 27/23
r ..�llOw � �e r Well btvneK .., � ... �� .... e,.. .. ____...._
St nadu eof4erghodR'el[Caofmstora'
By signing thisfom l hereby certo• that the welf(s) was (cram) abandoned in
accordance with 15A NCftC 02C.0100 or 2C., .0200 Well Camortrction Slandards
anlihat a copy ofthia recont hear beon peovidetlio the welt 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 if necessary.
CONSTRUCTION ETAILS OF WM"SI BEING ABANDONED
Atlachf.+elicarrrGxtetewrreroid(slifaratMhle. FormrJtlptrlojectlonorrmro-iVolersrr�tyweits
ONLY stvth the sans eaeun xv an/alwndo,+mBh+. you On suNWI rare fad-
6a. Well ID#1 TA3-7
6b. Total well depth: 32 00
6e. Borehole diameter: 0.75 __,,,,, ___-—(in.)
6d. Water level below ground surface:
SUBMITTAL INSTRi1ClYONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Divisieu of Water Resources, Iuformation Processing llnit,
1617 Mail Service Center, Raleigh, NC 276"-1617
10b. Fur Infection Wells; to 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 following:
Division of Water -Resources, underground Nectiutn Conirol Program.
1636 Mail Service Center, Raleigh, NC.27699-1636
6e.Outer casing length (if known): _(R)( above, also submit one coW In addition to sending the form In the
py o, this form within 30 days ofcompl,ction
of well abandonmcrnt to the county health department of the county where
6E Inner casing/mbing length (if known)! (ft.) abandoned
6g. Screen length (IF known): „ _..._-.................
,
Form OW-30 North Carolina Department of Environmental Quality - Division of Waler Resources Revised 2,22-2016

WE 11,ABANDONMIENT RECORD
ORD
Contractor Informitfim.
Jot -in C. SchappeH
2332-A
NrWO
M&W Drifling,, II......
................
Cam'Pany N114M.
&I I I rl nPl4f." a h I? -Wr mr1m, 4 a f2po I 'Ai (P.a I) I rL, Cbeenn Sam, Kniao a: yjkrfflnm
3. Well use (;btxk well mm)'
DApp'cullwal UMumdpWTubhc
100oothermd Olegir.WCoohng Suppily) E.Mesiidamfial Wateg Siiippkv (singlets)
Mesidcrrual Watim Supplly (siarcd)
im
DAqu&r Reotuafp'
P.Gmundwater Remethabon
C Aqu aRi Storage and 9 ey: owiy
CISabaity RaTrax
DAtilWier rcsa
Mormwaxr Drampe
13E,tpairrmtal 7mhn4blully,
USubsidenix Conival
Lxwp)
iiizmfim('o'wfin' Rrwum
M�her focMam under 7 L,
4. Date well(s)albalmdomid: 3/22/23
I
jm,AWVP t 11yeation;
Fort Bragg
; T, 5. io�q
rT8R-069?,FPWMU,69, 11i by Knox, Bumer, Wbodruff & Wwsfly Stirpets
.... . ........ . .. . .......
Pli Addmms, Cay, mW&p
Cumbeii
Pwriq NO (PINJ
5b.Lafitudeand
(W%Veli 1ICK 01W, 6,001mg
35.15758853 __7&'98160003__.'_____._
j'0N$ L! AND
UNLY 106 glee sunre "jn "ry". Irr"'"'
fix. Well 11M, TAM
&b. Total well depth: 33.5 -.0t')
td IrdnameUaanua diameter., 0 . 75
. ............ —_(in.)
6d. Water level below rMund surfam
as au um«n1R,V ONLY
"L
79- Fbiir 1113Yingthiasimm
well constTuctim'depth, only''I GXNI..30 is mode, Indicate TrUrfid. MMLBER i
waInsabandoned:
R�'��Al ER SUITLY WELUS'ONLVu
OfL&Iji ifi.%Cj
% Ty pe . . ........ .
7d. Amount of dii . ........ .
. . . . . ..................................... . . . . .... . . . ........ ..... . ...................... . . .
7P_ Neafing materiak asyed (check sin that appiy,)'r
* New Cement Orr W
a Bentomto Chips of li
* Sand Cancm Cmixr.
0 Dly Cla?
[3 (NmCme Girm
0 NO it"Uning's
0 Specially Great
fj Gravel
C
"'i Benkonne Slum
r Ogler (CLXPIMLn under 7g)
76: For rack mateTia$ Selected above, Proviiii RUM50 VfW9ftrW9 au'd-
Portland Cement 9 lbs
7p, Pnsvwc a, ieffie.ion of the abindonment promfure,
Neat cement fum Ieledfrom top,
P1.
,// . . . . .. .. 31 27P23
gymilniagg dro ftrm, if hereb cpx!*, thae xhc wellfs) was (wem,) ertiandemed la
amyrdir"ce unlh )J�A IWAC 02C, 0100 or.2(' AP2"M I'Mell
mid that a ley fj?e Welt
% Sitc diiagram or 2ddiflantlill well1l detmiW
You rnq ire the hadr. of 11his paile to proMe addhionitl utill wr dewAls or vveH
W almixionvirtent det&&, You m", al m altach a&fifionid PR -gym if ndcessar"
RML11 Ili A L I N 9 r R U (:rl 4 W
AD Nit &]Sahmft &is fonin mNvy 30 days dap" CCMPPCUVHL Of 1will
Rhandonment to time f0flowing
DMsiou nfWnter Rem urces. Infomation Preemsing Unit,
1617 Tstimil Service Center, II[ Lahigh, YUL"' 276994617
Iflh r je,r In �mfa # �Wefhx; N t0din: on io mndeng the 6ml to %e addrrel loo
atum, ollso i �)M� Ct)rf: of this fom wahm 30 days ofcomplefien of well
Amdomlient 16 the follom6wig
Division of Water R murcm Whider-ground In,ity.tion CbmtrW Program,
16311 Service 4L eniter, RsWgb_Nii" 27699-16M
be. Outer emyting Ilaaamgth ff kamwn):: t ii ±QLyVAtLT Slim & &b1iteflaLy N ells Ilan addimn t6,,wmMimg N., form 10 dm
,addrr,.ssf t451 Am,., aWi scibm.ft one ri.,ipy of thLe forro wilh ii in 1) days ofemplet lm
of YmN abnadmiNnem m ahie c.cunq, health &Mnment of Me countV whele
6E linam-miaWtubing length Cafknown): abandon e.4
6g, Scram ]i flCkri . . . . .......
Fornm ('3'Bl' 30 Nm%h C'm'Wa V�P;Mrmcrtof Qd"diN - Mumon of'" Rew—Wou PW"sed2722 PP.',

WELL ABANDONMENT AECURD
1. Well Contractor Information:
John C. 5chappell _
Well ConuactorName (or weRawswr pfflxwlly abandoning well onhialler
2332-A
NCWellCantractorCaiufiCll Number._
M&W Drilling, L.l_C
company Name
2. Well Comstruetion permit WI4600036
3- -
L&I an applicable well C[HLfUlMrton perarF4t {r.e, UIC. Counq sratr frarOwc ela) lybrbilw
3. Well ase. (check well use):
❑Agricultural ❑Municipld/public
❑Geothermal (Heatirx%Coolmg Supply) 131esidential Water Supply (single)
❑htdustrial/Commercial ❑Residential Water Supply (shared)
Well:
❑Aquifer Recharge
®Groundwater Remediation
❑Aquifer Storage and Recovery
Malinity Barrier
❑Aquifer Test
❑StormwaterDmicage
0 Experimental Teclimlogy
❑SubsidenceCoulrol
❑Geothermal (Closed Loop)
❑Tracer
r-li,—rheas,otCnnhneReturnI
❑Orheriex'idainunder 7m:l
d: Date well(s) abandoned-. :
Forrnte<nmi Use ONLY
WELL ABANDONMENT DETARS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells haVtng the same
well construction/dep*. only J OW-30 is needed Indicate TOTAL NUMBER. of
weilsahandoned:­ _ ..
7b.Approximatevolumeofwaterremainiugiowell(s): _...- _.(gal.)
TOR WATE� q..__.....� .._��..,.��.. _—. _.,.,, _....w............. _ . �.....
R SUYFLY WELLS ONLY:
7c. Type of disinfectant usedr _...._� .. _ ... .
7d. Amount of disinfectant used: _ _..m .......m�..................._
7e. Sealing materials used (check all that apply):
R Neat Cernerl Grout
❑ Bentorute Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
El Drill Cuttings
❑ Specialty Grout
Cl Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
,7f. For each material selected above, provide amount of materials ased:
Portland Cement 8 lbs
7g Provide a briefdeseription of the abandonment pvocedtrre:
Neat cement funneled from top.
sal. Well location:
Fort Bragg w.._ — __... _.. _ .... ��....
t
FapBR-069/SWme y (ifAVaf ilY _ 8 Cerirftcatr o
y t. , , r � 3127123
FTBR-0691SWMU-69 bounded h Knox, Butner, VaFsity Sireets )
Phyemcel Addtrss C - ' a_
,ry,andlip SmgnaturenfCartmfedWcllContrsamrorWellt3rmer 1Y�fe
Cumberland aru l ldem.......... (Pu0 '8y signing thin jonn, I hereby ccertify that the well(s) was (were) abandoned in
P ,,.
Counry on No aatirf/dnce wish iSA NC'AC 02C'.0I00 or 3C.0290 Well ConsrrucJlan StttnrlarrLr
am/dtat a copy otf this redo it has been provided to the well owner,
Sb. Latitude and longitude in degrees/minutia/seconds or decimal degrees:
(if Walt field, one latitaag is suffic,em) 9. Site diagram or additional well details:
W You may use the hack of this page to provide additional well site details or well
575581 Q N -78 98144178 _. abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLISI BEING ABANDONED
.taachu�sllcanrrnrcRasrecorrl(s) Jatriiiabk. Fnrnnr7tiplei»Jettinnwran•uwfersapptykctk
ONL 1'rsieh dre,#a�nrc canstnretton!abandomneut, yviu'rua sabmrr one j6Ml.
6s. Well Isla: TA3 5
6b. Total well depth: .,....•,•.... ., (ft )
Q.75
6c.Boreholediameter:(in.)
6d. Water level below ground surfacer„
SUBMITTAL IIVSTRUCTIOM
10s. For All Wells: Submit this form within 30 days of corimpletion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh. NC 27659-1617
10h. For inieetton 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 following:
Division of Water Resources, Underground Injection Control Program,
1636 Nail Service Center. Raleigh. NC 27699-1636
I or- For Water Supply & Injection Wells: in addition to sending the form to the
6e. Outer casing length (if known): 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 loner easing/tubing length (if known): ^ n,a �. (tt•} abandoned.
6g. Screen length (If known):._u.._......_......... ._.........................mm --Aft-)
Faun GW-30 Nonh Carotins D:pwiment of Envuonmeniat Quality - Division otWaler Resoareea Revised 2 22.2010

WELL ABANDONMENT RECORD
1. Well Camrst-Ior Infarninflonz
Johin C, Schappell
WOIConftdox Nagim turvvefllovapersonnflyab.-wrid-mmg well vip NalfreropraO
23,32-A
M."Weill CammOnr CaMqWan Mambo
I&W EMIling: II...:I C
Cwtipany Name
W10600036
Lrytali arphayide wO cx'Av&WnOC6OeI P?a MRS, ft a ir."vkud)t 3190#4?, Honaavq , 'ae) Yfkagan"
3. %vell use (chech, well ure)':
[J AgrMulb.2,11 OMurnim*/PuNit,
OCkothannal (I4wAingICi[x)ha& Supply) Msmiidenuai Watar Suppky (single)
OndustriallCommemmi 1DReOdaglia9WamrSu;q)I-
y (shired)
IMMMM
DA.cji Iii
A Groundwer Renycdistsan
DA(luffier Storugc Mod RVzove(V
Insalliniq Bar=
I:.']Aqugfcr'rcsI
cjslorrnwamr Ifturi'6V
arm"ranenul Tethnology
C.T.Submdtmce Contu@
[11CAectl1wrnal ('Clostd LTMP)
OTtacer
GQmth,amal d lcagu �, CkAuw Mum)
Mher t expb �Tk OMIer 7p
4. Dgae weli(s) Rh2advined- 3/22/2.3
52. Well locadourn:
Fort Bragg
FACRity Irylig ffflippilcahk)
- - - ------ . . . .... . . ....... -,
kfludacJtunremirwearer
FTBR4.)6R191fiIMU,rw% bounded by Mox, &Mer, Woodruff &'Varvty.SOPet's
Fh'vvczd AiMmisu, Cq, and 74
Cumbedand
I Sib. Lefitude and longitude in ft-ree0minute0secoinds air detimal diegmesr
sf%up 5011d, One WInorg L' ruffim(mg)
35A 5757564 -78,9814-7531
(is., Well IDO" TA3-4,
6b, ToWA we.0 drpf,b. 30.5
tea.:Bonhnle diiangeter- 0�75'
6d, Water levid beta w ground surrice..
For IfWprnal Use C)NILY
WELL, AO&N-ROM
7a. IPa r GeopvghdDPTgDr Clo&e.d.-I"p Geothermal IVeRs having the swint
weH consicueffoiVdapth, only I GW-30 is nmW, Indicate TOTAL NUMBER. nf
--
7L Approvlimate N'Clarion Ofrwaler reiinhilai"'g in wellft . . .....
I ttt a, 7c-"type of dNinAbelant %L%d:
7dIL Aimenint of disialceinnit imsed............................................�
.. . ...... ..... . .. .......... . .
7e, Scaling i avwd (check all that apply):
9A Nest Cement Croul
n ftntonite Ch.gips cr PeOcts
E.I Sand. CLaw-M, Groul
0- I)Vy C)ay
D Concrete OrKMI
0 DrOl Cutbqgs
0 Specia by Grout
C"I Gra)vl
03 Bentanftc,Slwry
0 Offier (explaiin mWer 7g)
'7f. 'ore eb i w.locted jbovprovide Amount of gun ledshi used
Portland Cement Iles
, -
7g, Provide a buldrdt
" ripbon of the abandonment 11i
Neat cemer-A funneled from top.
Oyxiqyang Ibi's fiynn' I lsmwby twrrify ffiat Me well(!,e (wvreja aha#Tdoned ej 0
nruy)rd4vA-x,, wkh 1.5A NCAir.." ON"', 0100 ibr K" 0200 Well ConvhMewo" '71canordr,
'Old M01 es OAPY 0jrrha me and bars been p rowded to the
9Ske dlAgram or addiflonal well dplails:
W You may usc the hack of this page v) jjxumle wildhionall well r tc &AB11 B.% or %wfl
u,diandanfoerllr details. You may ako armch addidonal pages ofnr-..xwsary
Q JIMEAMUIALIN, ho-kc—IM
No JAL,&l %V 'cubmH rin m this ibqhir 30 days of,rompkon, T.4 M%rfl
ft
abandonment to the
Division o(WaterReswirom Information Pror"Aag Unit,
1617 Mail Service C'enteir, RaMah, NC 27699-151 T'
I all"fly Taisitkn Mwft� Ins d""Iffion to sending thc� firm to thu-ain ddxess tft
-
aiivvc, also gubmil &* cupo ah'this rorm an ilhim 30 davys or i of weH
to dw fpHawin&
ffivionion nf'Waaer Revourems. Vnder?raund Inj44-fiiin Control Vrngram,
1636MaH Service Center, Raidgh, Nir 2769�9 1636
61-- Outer emeing Nagib (if Ima"n - hi widihon ugsundinp Me ronn Ran the
addTemg(us) above, abe suhrm one coFq ofthii fnnri Mthki 30 qbLys Dfcornppeflan
of Ivell abandcmM.Irr'l, to than Coaampy heAilfh of &C county vVilen"
6g. Screen length Of knownI . .............. .... --ift.)
FW11" iii 'qunh CaMiTna Depa"Onew OfFmaronmentA DiOlion r1rW'xM Raxw== Rpm."M 2-22 .20 ^

WELL ABANDONMENT RECORD
[.Well Contractor Information:
John C._Schappell _
WdI ContrauorName (ar eveR owear�sonal ehandnnin well on hidlrer prapgrty
2332-A
xc wan crsttttaclar certe6gat;na Nam6er
M&W Drilling, LLC
CompanyNatne
Z.WeUCnnstruehonee.rat#:W10600036�......_w_.�._...m.�.-..m.......n.,,,,...�.....�.M..�..�_.
itr a!l applicable urll rnnstntcltnn parmils (xe. UiC County, &M. Parlance, rlc) (fArra+vr
3. Well use (check well use):
nr dnterrrar vseoNLx
WBY L ABANDONMENT DETAILS
7a. For GeoprobelDFT or Closed -Loop Geothermal Wells having the same
well txmstructiorildepti, only I GW-30 is needed, Indicate TOTAL NUMBER of
wells abandoned. _.IT __mITm
7b. Approximate volume of Water remaining in well(s): ---,,,,_—(gaL)
Ta ............................. _......�...
FOR WAER SUPPLY WELLS ONLY:
7c.Type ofdisinfectant used;
, ._.. .._..._ _. r
7d. Amount of disinfectant used: w ._..... ..
Water Supply Weli — ��� 7e. Sealing materials used (check all that apply):
❑Agricultural ❑MunicipaUpublic R Neat Cement Grunt ❑ Bentonite Chips or Pellets
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single) ❑ Sand Cement Grou! ❑ Dry Clay
Oladustrial/Commereial ❑Residential Water Supply (shored) ❑ Concrete Grout ❑ Drill Cuttings
❑Itri ;ate � ._. w�...._� ..,.,,,, ❑ Specialty Grant ❑ Gravel
Non -Water Supply Welt: ❑ Benlonite Slurry ❑ Other (explain under 7g)
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technokrgy
❑Geothermal (Closed Loop)
❑Geothermal Coolftirr,
4. Date well(s) abandoned-.' P 23
}&Groundwater Remediation
LISalinity Barrier
ClStormwaterDrainage
OSubsidence Control
❑Tracer
❑OtheriexAain under 7+a)
SR. Well location:
Fort Bragg
.... ............ ,.
facilityAjWI r Name Facility 10A (ifapplieable)
Frak-0691SWMU-69, bounded by Knox, Butner, Woodruff & Varsity Streets
Physical Address, C4, and Zip
Cumberland
(^aunty � � Parcel IdentificationNa (M)
$b. Latitude and longitude in degrees(minutesfseconds or decimal degrees:
(ifwel] field, one IsUlorR issufficient)
35-15759264 ,, -78.98151185
7£ For each material selected above, provide amount of materials used:
Portland Cement 8 Ibs
7g. Provide a briefdeseription of the abandonment procedure:
Neat cement funneled from top.
S. Certifi bfion:
) �r
... _i. r. 3127123
Sigtwtt, . ofCeraf11 Welt Cant uror Well u'., her Mir
By sig Ing this farm. it hereby Certify thal I;ze well(&) was (were) obmtdoned in
oceirdance with 13A KUC 02C A100 or 2C .0200 Wei( (An irrwstton S51ondurdv
and that a copy of thin record has been provided 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 if necessary.
CONSTRUCTION DETA OF WELLIS) BEING ABANDONED
AltgthtvaJfrnnsiarerta+recolri(sJifmoilable Fermrr(liptain)ecoanornan-watersfolylardts
ONZY rth Irre some comttwdiori/abmrdonotrrr; µxi can submit bmfi a7.
6a.We11M#:.TA3-3 _....._._ ...w_.._ ,.
6b, Total well depth: ......_.. �,.O
6c. Borehole disinder: 0.75 ...........
Cud. Water level below ground surface:
SUBMTI AL rNSTR rCTIONs
109. For AU Weil: Submit this farm within 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
10b. For 3niectiy ells: 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 following:
Division of Water Resources, Underground Injection Control Program,
1636 Mai) Service Center, Raleigh, NC 27699-1636
6e Outer casing length (iftnown): ._Ifs_) 10c. For Water Supply & Iniectiom Welts: In addition to send:trg the Form to the
address(es) above, also submit one copy of this form within 30 days of completion
of welt abandonment to the county health department of the county where
6f. rnaer casingltubing length (if known):.... .., _ fft) abandoned
6g. Screen length (ir known):........ ...... ............. (fL)
Fgrrn GW 30 North Carolina Dquir- ment ofEnyironmental Qualitv - Division cf WaterResou=s Revi3ed2.22-2016

WELL ABANDONMENT RECORD
.......... .
1. wr3l contractor liaro"aMfivnz
,John C. Schappell
umily abandowns well on Nqh0'PR-0PeH-1T)
�r woR awaor pu."
2332-A
1—..... . . . ........ . . - . . ......... .
Nr W01 ronimior 0.-oh firatim, Numbew
M&W Ddling, 1-1 C
2. Wev ronstruction Perwalto-, "WI0600.0.36 - ------ . . . ... . ........
. . ... . ...... .-
1"Al all apphrmble, well e 01", ('010gly �svxf.', vartwxx, eg"') #.j,kMxwfl
3. Well Use (elbeck well as ):
DASacuftuW
a(aeothenovas w (fleminp /Coo4n,q SUPOY)
ElfndusIriaVCommennal
Non-witter supply'"1011..
,,.Mquipbr swiageand Rexovery
0AqWrer Test
OExpermaAW rechnok.)&v
QGoothermM (OosvAi Loop)
N-K,kxkhermW Reuim.
4. Date wefl(s) abandened a _3422-12�
52. weli 06cation,
Fcwt B�r
i8 i�iagg
-c- "; o- .....
Tw .
0Muni6palftb6z
OR,esidexatW WaTer Supplyksin0e)
'.lRewdendal Wiltor Suppty, ('shared)
mz=
1-1intoner -femAuinunder 70
racui�y Oft (Wapphcablf-I
FrrRR-0691SWM1J-,69, bounded by Knox, Butner, WbodniffVdarality Shtmts
. ...........
ZUp�
CLAmbedand
rounly
Pari,xi 1draii3ficarion No. (PIN)
5b. Latitude anted knigibsitieki degr"muminatesisecondN or dex-imal degrecl
for lnsenml thw 01,41LY,
MN If-
:1
'79. For Geaprolbe/DIPT or Closed -Loup Geothermal Welb hawng thu sume
W0 consftuctioWdepth, only I GIYV-30 is needed Indicate TTYEAT.., NUMBER of
!'NeAssbandonir.& - -- ---- . . ..... ... . ...... . . ............ . . . . . . . . ....................
'7b. Approximate volume of water regnaining bix well(s),
i-17.115P—PL Y WIF ON —U'V:--
r7c. TM of disinfectant used.
7d. A nwoung of fflsfiriferta wit used:
7e. Sealing materials, used (clixq* all that apply);
* Neor. Cement Grout
U BtnitonftCh�p% or POWs
* Swid (:'�'Vnent. Grout
n Dry Clay
("Uncrate Grout
0 13H claturip",
F:7 .5pe6altv Grout
Benlorwitef Slam
0 Oihm- (pxplain under7g)
7E for each inaterivi Selected above, prVrideawneunt of anaterials used-.
f3ortland Cement 8 bs
'?P, Provide a bmief derwrispfion of the andepoment Procefluire:
Neat cement funnelorntop.
W28123
WO conwmtor of Wi Wner Date
1.3y'sigming, Iftsfoem., I here6Y cerqp rha# the iveLll(.,.�) was (svepv) ahandoned in
arq-,,ardanire wish L'5A PJCAC 02C 0100,P.ir.2C,,0200
am? that as copy ofthis recardhas bee" ptvwded go the well owner,
ff Won fidd, ium latAong ws $Jfivcat) 9, Site diagram air oddifionall well detalls'.
W You may %= the back of tWs page to provide addcnal well sne derads or kvrH
sbnndnnmLn16ft-0S 'You may also attach fghfivanal pWm
UNI.Y*vuh jus V.— All X%IpllvSubmit wNs fbnn wfljjar, 30 days of complefion Of w6l
TA3-2
6b.Total wired d30 epft -1-- —VL)
75
6c� Borehole divinelter: 0
6&'Waterlevel below
abandoawient to 0-, fbHoi&ing�
Division of Water Researecs, Infowmintion PIMMSW�- V'116t,
1617 Mail Service Ceiwr, Raleigha NC 27699-1611
10b.Fe 1°° Inip -L tLujW lk ells-. In addition togcyjdjnjg &hc! funn go ffieaddmis in 10a
-- —
above, also subnaft,one copy of d6 fooftii wffhm 31) dayi of com&bon of WOH
uhandantnent to flie fb1hwii%
Division of W.1hlir Rr,,,govyces, Underground Injection Control Prtqerailu,
1636 Mail Seryke, garroter', Raleigh, NC27699-1636
& �T[n-ec ion �-effs.: qn addifian to sending dw form to die
fig; Outer casing length (if Wim"i 1): . ..... .. 0L) addrvss(r.,,�) above,olso submfl. tmc copy ofthis fonm widun 30 days Ofeolwlctwn
of vxH ubandlonment to the county Ilepartment of the caunty wheTe
6E Inner casinghabin, length (if k-nown); ahxwdorfed
6g, screwn length ffkflimvn)�
Foffn Um? -10 Ncmh Caraj?na oEmrommemml Qmhty - Dwim n at' U, T R W, M a 'A I C. urel kinmed Z-1 5

WELL ABANDONMENT RECORD
1. Well Contractor information:
_John C. S_ch_appell
Wdi ContractorNeme (err well owner persmntlly abandoning weft on hisfier property)
2332-A
NC Well Contractor Certification Number
M&W Drilling, LLC
Company Name
2.Well ConstruelionPermit* W1060003.
List ail applicable melfcnnstNetian permirr (Ke UIC Canntyt ,Flare, Yadrracn, ex)�ijknouvi
3. Well use (check well use):
17Agrirulturdl
❑Geothermal (Heating/Cooling Supply)
DlndustriaUCommencial
❑Aquifer Recharge
❑Aquifer Storage and Recovery
DAquffer Test
ElExperimental Technology
❑Geothermal (Closed Loop)
OGeolhermal tHeatiR' Cooling
4. Date wells) abaadoued: 3f22123
Ferinternal Use ONLY;
�i•L ���t�i�� D
7a. For Geo probeMPT or Close&l Aap Geothermal Wells having the same
well constructionldeptb, odly .I OW-30 is needed indicate TOTAL NUMBER. of
walls abandoned:
7b. Approximate volume oIwater remaining inwell(s):,�
FOR WATER SUPPLY WRNS ONLY:
7c.Typeofdisinfectantused:_..._.........._..................................... ...-........___..,
7d. Amnunt of disinfectant used:
7e. Sealing materials used (check all that apply):
OMunicipaUPublic
U Neat Cement Grout D Sealonite Chips or Pellets
❑Residential Water Supply (single)
M Sand Cement Grout D Dry Clay
aResidential Water Supply (shared)
❑ Concrete Grout Cl Drill Cuttings
Q Specialty. Grout Cl Gravel
U Bentonite Slurry ❑ Other (explain under 1e)
IlGiotindwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
OSubsidence Control
❑Tracer
❑Other (explain under, 731
Sit. Well location:
Fort Bragg
FeethtylOwnar Name Facility IDA (Sappheable)
FiBR-069/SWMU-69 bounded by Knox, Butner, Woodruff & Varsity Streets
Physical Addres. City, and Zip
Cumberland _
County. W. Parcel Identification No, (Pn
5b. Latitude and longitude in degreeslminatrslsecoods or decimal degrees:
(dwell field, one latilorg is seltictent)
35.15763787 N-78.98159735
CONSTRUCTION DETAns tiF WLLL,S ING ABANDUNE-P
Aeaoh+++alfcons(rnc4rarrrxani(sJeJuvailahle Pormtdliplanlerlranortm+-M6lerapply5oells
ONLYwith the some mmovdiockbandonmGu, Jbn Can knbmil onefarnr•
6a. Well YIN. TA3-1
66, Total well depth: ,32„
6e.Borehole diameter:0.75 (tn.)
6d. Water level below ground surface: (k)
Cw- Outer easing length (rf known):
0E Yodercasing/tubing length (if known): (ft.)
6g. Screen length (if known): _fft.)
711 For each material selected above, provide a mount of materials used:
Portland Cement 8 lbs
7g Provide a brief description or the abandonment procedure:
Neat cement funneled from top.
S. Certif tmfl
3�2712
Si$oazNar'iiinFCertifiedW�IlGnntmtxtrcnrWell ,caner........._ Daec
By signing thisform, l I:ereby certify that the well(k) was (were) abandoned in
accardance with ISA MCAC 42C.OIOU or 2C. _0260 Well Clan%ruction Standards
and Nrat a copy ofrhia record hers been provided to the well owner
9. Site diagram or additional well details:
You may use the hack of -this page to provide additional well site details or well
abandonment details. You may also attach additional pages if neoessam
SUBMITTAL fuss aticrums
I0a.ForAl1Wdb Submit this farm within 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
10b. For IniMliop Wells: in addition to sending the form to the address in 10a
above, also submit one copy of this forth within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
t0a For Water Supply & Io)ection Wells: in addition to sending the fort to the
address(es) above, also submit one copy of this form within 30 days of completion
or well abandonment. to the county health department of the county where
abandoned
Form GW-30 North Carolina Department eflinvironmcntal Quality Division of Water Resources RoNtsed 2-22-2016

WELL ABANDONMENT RECORD
1.'%V01 Contractor mual'ormatlauwa°
6'Wto r"w RrrYa *1r���awrae leer VK11I aamwer �piafsaawwly rmlaawrrcluaranw & %vell asas.� .p -y )
......�,..: tafl°t�n' P�&.6 rDrIXvppk'way'p
2-
VC %Yell nnirrrctor Ccra5carior. Numlaea
M&W p fiClimma , i••.L
c umpar,.reo; ;uaaxs
frS&aaek' pnyakaa°ae@.^a� aaa aa ;eranr�rsmcrararraa s �rur.ml'x. iddC, waa) lJAMXITww
3. Wefl use fu: eck awaril aasey.
DA.drua,ullauW i»ld imia;lppal aniailur
W (' rAvt4rerraad (l l ttlasu R "wur laaap au p ly) F Resi�dereurt�a�i Water �� ipply (sftle)
0.1ndminat/CaaumRamuerceil ORe„idenspanllWaco auapnpgly(sham ;
N.00• 'a ter Supply Well:
CV. uproAi� ld.a h� r eF.Vlioundwitev Rema lidion
i...tnupnwlr lSRmryadnaal a.away" C'wallaaly wrier
ClAquife 'Nsi l lStawuomawwatlerc lDrrwimaya»
i1iMa umarorolal"R"r.lawaaahaa, y Mauhasaalwwnw•acCaaanuroI
r'K! "anilasrMw (qansand LOOP) 01"mace n..
paintm p"uChlue&`Vtxrda�niunna'rderW:t
4. Dole m4lps) abandoned.- , i W b
Sar..' elllamswlaun
Fort Bragg
t aae. My.Ma,Dnwr;w Name l arthty tiaai gifa aaalaa.wlulle)
rBR-ti69i V'WMU xa9u bounded by IKruaaa Butner, Wfaaod auif S Vwrslty IM.sts
t. pna,snea•l rarlaturw;w R; ay. nlnd ;'ripe
Cumberland
Cau laity Parcel pulrca9aaia uruivaN a PINY
Sim Latitude warld lanugf uda. in or decimal dogr¢a u
(dw edi fdct d,, one kmuraN% au tufficua:mu'.l
35.156104690 � -7&98355603
r$uMam,% aamrd'M�crarvrtamorr•+P7maaa aa°rRswnd'd�d r�"wwwroMPau@edad..1'a"naa•araaerPaap9mr, urth@rrcu�Paa� r%rame+ba•nr°axa�r!rwap�rNl�waaxXFa
d"AMVU� rnaranbk eMw:,uaaaonea.re�zuA�aataaarra,2rFinaaavdauwaxerrrnd. pwaam raae.wurkr„„reR arsaa.rrsaro^n•
6Qa Wen IDN., TA2-1
6b. ToW wwell depth. ....2...
. areholediaameter: 0"7H K 5--fim")
Sd"Wa ter (level lrrlrwv ground surfnce:a 41P."y
p F'ur 1[rrkap'utl4nt ar r CN.LY... �_...,�........»„�.�...,.,..,.,.w,w.,.,�,,.�...W�__ _._._.m,....
N..... --- .- ............. .....�� ��—
&MCtMa —TAB
Its. For p'reopareabefff'k"aarClused-p opa em ermal'Well n ving the sazoc
waall eaareslamu�cimaama`depntla, �u#ftly f t;l-.�tD lisuapeederl. lasmlglaw "l`fY"i"pM If�B,]4Wlipir":F: aafi
wwvips altwaardaumd, --
n,Apprcraaalaaxahewo-alrasuaeofwater remaaahai ;lawell(w).,. ...... —.R'galmi
FOR %V'Vu%"p"E.R SUPPLY WE1111-1i ONLY:
7a. Type ofdUinfeebannaauled:_............................_.�................... �� ._..
7d. Amount unwc aut' d"n.swnnf"a,ar,:snaual wasenla ._..... �..
fie.., l"mrap; maaawserWs used (%tech all that allaply)'u
1' NUt CrrMeaal p:laa llk i:::.l 1periplaaaite Chips aai, laallm ,
y:•1 Sand l reanaeanr rarrc uk 0 Dry 0a:y.
* Crauwrr'aale llrumur r.t Dxilt C'catharpp
* Spe0aaftya Grout L Gamnwel
i.] Beten:aamiwe Slurry C';n 01hen (a.^apalaina under 70
7C l or easeb wauaate lal a lented above, as al.
Portland Cement 11 i s
7 . 1pra)wi& a larlfl deseripurnavar aah"lbe sbaando nmenl pp«aeu dur::
Neat cernent funnelled from top.
,. w23
ay�
Ma,soaiflrumn r&;r�sbfic"dOINCOw''arrua�aaa,�R of
w awa'a°tU o.Sa„mmr ?fAysura.
lieu map mxag Ads ,irrva°n, f heprfay awrlyy Ilia/ the iw"ruMl s„i anwar (nwov) a bawwtaiaune'd in
acconAmirm mrith IJA aW't`AC" 02C, 0109 pr X:" ,0200 8V61 is onxtrwra^uaon Va n de -&
and alanffe au vvrj? 'tp(' ehrw a^maa~aaN hans been parrmdodto the, swell nwrpnrr,.
% Mtedlogram,rir addlaivul welidelydist
"%"'ease araaay nuswn the back orthm page to provide additional vmtl asilw: dtwib rrmr Welt
abacead efa d airs„ You m sy Aso alaarlr additional pagcu u f naer asryM.
S..K#BNKt",.ld: STR S
10s. fgE"jL_VXfjW. Submil fts fhrm aro ith a ill days s of eanurupaAwsua'.wua of welt
uaNarndawraauua.*amt io the follaaws ng-
Division of Water Reanrces. puarer-anamtio n larauerasmuwpp wants.
Ml? Mail Service C ^arter" ualeig?ph, ».NC 27699-161"7
80b.. In adrditu o n w sewn+ nig dre foam to the adainros ten 1109
minmw r, also saml:uaaast. tine rsapy of %tail+ t"uuanwn vwdtlnsur 30 day.,; of ecaaraprielion of well
abauaulaawun=1 to the follau'Min.r
iy'iwhzulaara aw�P%'�aala^w-'ll:rcaarra:rs. pp'nR.rrlercq„rannuuual Ilhuq(en^luasua W:„°maur#mw,ri �u,rnpuursaa�„
11636 NlaallService Center, allei h,'NC'` 276,a06
fti Outer raraceamly lemtplln (if un$dra �rlrin.awr apw awsakaa ar arom%pe„ftlnls lmsrraIn lrtsaua tans send and tlu fannmu to tbo-e.
copy %itlnnun 0faylsmfeauampte. ion
wnf uawall ahaandonuneaat 'dau 'tlma ctyu ty laeahh dat.Iparbrw nr caf lbe s'a w-Ity where
6f. llmmer ,wing/tabmattp kngffi (if kmuowwa)t ......._.w _...... Ift.l abarada:unod
„ Seru.eiru length (if k no waa):...........� __........., _. .4 � �
i✓onn9„aW.10a m^aWrntlt Catawalama t•.aiC,prnRIIna"ntgar EnvirCkImenud Quebty•MA"BP.ha9 nrwaalex 1(r.A.$Xktln%9'.'Y.'.`Ae lna"V' N,-,nl arm a.°,::^tarsi

WELLABANDONMENT RECORD
1. Well Contractor Information:
John C. Schappe_II
Well ContraetorName (orwell ownerpersonally aendoningwell on hislherpreperty)
2332-A
NC Well ConbadorCedrGraboo Number
M&W Drilling, LLC
Company Name
7. Well Construction Permit# W10600036
f-ist a/t oppliaahte well emysinrcrlon parAuts C.e. 64 Cnrrnry, Stare, Neriorrca, rrcJ l/'finorrn
J. Weft use (cheek well use):
Water Supply Well:
OAgricultural
❑Geothermal (Heatiur)Cooling Supply)
❑lndustriaUCommerc ial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Teehnology
OGeothermnl (Closed Loop)
4. Date welks) abandoned:.,,/�2/'�3
5o. Well location:
Fort Bragg
Facility/thvnerNamo ...........
_......
_._.._._
QN(unicipal/Public
Fan ntten,a......_ ___....................... ...
I Use ONLY.
WELL ABANDONMIENT DETA"
7a. For Geoprobe/DPT or Closed -soap Geothermal Wells having thr Same
well consttuctionldeptb, only 1 OW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b.Approximatevolume ofwaterremaining in�veU(a}: ............ _(gal.)
FOR WATER SUPPLY WELLS ONLY. ��� -� _. ......_... _ .. �....................
lc. Type of disinfectant used.-_... . . . ..... . ....................
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
a Neat Cement Grout ❑ Bantomte Ciups or Pellets
OResidential Wate- Supply (single) ❑ Sand Cement Grout ❑ Dry Clay
OResidential Wntl:-Sapply (shared) ❑ Concrete Grout ❑ Drill Cuttings
INGroundwater,Remedi ation
RSahnity Ranier
❑StormwatwDraittage
❑Subsidence Control
oTmcer
Facility IDA Wapplicable)
FTBR-069/SWMU39. bounded by Knox, Butner. Woodruff R Varsity Streets
................. .............. ... _ _ .........
physical Address, City, and "Gip
Cumberland
County
Farcel Identihcelion No. (PIN)
5b, Latitude and longitude in del reedminutes/seconds or decimal degrees:
(rrwell field, one w1ung a sufficient)
35-15603265 N-78.98359459 W
CONSTRUCTION DgrAfLS OF WELL(S) BEING ABANDONED
Atfx/e u l! renslnrclMn rctad(.$) ifwndahle Far' multiple rajectlonernoh-itW Zrsrrpply reelLr
ONLYulth dw some coulnicriomabardonmenR lea can submil aw form.
6a.WelllDt., TA2-15
6b. Total well depth:.„42 ()
6c. Borehole diameter: 0,.75
m,,,,,,,,,,... (in.)
6d. Water level below ground surface: (fL)
❑ Specialty Grout ❑ Gravel
❑ BentoniteSluny ❑ Other (explain under7g)
7G For eaeb material selected above, provide amount ofmate rials used:
Portland Cement 11 Ibs
7g Providea brief description of the abandonment procedure -
Neat cement funneled from top.
& certi�a a:
3127123
- .t.�... ,.._ � .. .........--..._.
sipwurerofCertifiedWalIConrwaca or Well Owner Data
13v signtag thus form, / hereby aerro that the we l(V was (were} ahairdoned in
accordance with 15A NC -.AC 02C _0100 ar 2C _0200 Well r'.onstr uclion Standards
and that a capv of this record has been provided to the well owner.
9. Site diagram or additional welt details:
You may use the back ofthis page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
10a. For All Wells: Submit this form within 30 days of completion of Nvell
abandonmentto the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service. Center, Raleigh, NC 27699-1617
106. Car Infection Welts: 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 following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): {ft) ltk. For \Pater Suppiv_&_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 wefi abandonment to the county health department of the county when:
6E Inner casing/tubing. length (irknown): .., (ft.) abandoned
6g. Screen length (if known):..n..._,..._, ....... ...�...,........ _ lft•)
Form OW90 Ttorih Carvhnn Department ofEnvrroum-InUtl Quality-DWraiell of Water Resources Revised 2 22-2016

WELL ABANDONMENT RECORD
1. WaIl Contructor InfDrmstiow:
Johin C, Schappell
WeH ConftwitorNawna (ar vm.-fl own" pormwdly abaynkifunawr.g an WAer lrxop*"y)
2332-A
NC Weil Canu-2dar C.'amficataon Number
M&W Drilling, LI C
COMPROY NaM
I. we" Construeflon PermlioV W10600036
Uo a IIqj,)pJuvjbkn w 8k r. amceprm Rd nsa d, maradmr tex UK,', cbravy. S'wr� Abraoxv, Vic.) rcrAnvtqp
3 Well ut Irlebeck well w5e)-
For Intunal thm ONLY
M1,11 ND NM '�WT..REJAM
7a. For GeoprobelDpror (3ased lAolp Geothermal %Mbg hruring The &Ufle
wcicommm-bitntick-Imb, only I GW-30 is needed. Indw-Ate WTAL NUMBFR of
%weffl,i ahanduae&
7b. Appmixuate vuhimme of writer remaluing in weff(i): (gat.)
. .. .. .................... ...
rok,%wrrm suppax wFiL% omm-
7c. Type of dWn&LIani uwd-
7d. Amount of disialectaut useth
Waiter Sipply welp
7ee. Sealing swerish u.%L4 (clivich, all that app(y).:
O.A.pricultural
MMunimpWINAblic
a Druat CL rm-nt Grout 0 Bentonge Chips nor Peflets
Moothemid (lieWftlCwflng Supply)
E]Re5idented w9w 101.1p;ily (single)
0 Sand (:ace ertt Groin ED Diry 08Y
0 indi"oYCoini")emcial
Ull.wdenhal Water Supl-Ay (shaxW,)
M ConcreM Urmit. E] D16H Ciminero
L.] Fruillion
U SImiatty, Cmd n Gmwd
he. --- - -------
0 Etentonife 1.1urD n Other (expGwn ander 7lx
LlMonitonng
. ..... ...................... ...
'W"
ORmomy
. ................ .
YA�Q—aop e"HE
'71r For evcIlm miiitcrW sclectedaboviv, pTovtde amourit ofutaterials sud:
MquiferR,whaTUe
90roundwaier Regneftion
Portland Cerwient 11 Ubs
TIA,qotrer Slome and Rwoway
osafinky Barriex
. ............ . .... . ........
0AqxAfer7'cw
[:!iWrmIVaw Drinnase
rUxwimmul'rixhnoloj.�or
I]SubsWcawA7mtUW
7p, Provides briiii.,filmeriptian oftbeaMudonimient procedure.-
00rxabnuml (0mcd Lcppl
OTTacrw
Neat cement funneled fromtop.
r5i3mbermal 0 Retum a
00ther wwWn urAllet 7uip
4. Date vrdl(g),jb9ndvued-. 3122123
sn" RIf.TH torm h'D u.-
FortBragg ---- ........ . .............. . . ..........................................
R�wdkyiOwrw Kam. FiaciMy IDN (if applwlbie'p 8, Cernfi 6
FTBR 06918WIIAU-69, Ifuu»k rded by K nranm IButner, ftodn& & Vai-9dy Streets x",
Rkymeal mtp oNflufldWah C offirado;r Wefl $teo27/
no, Oynind 7 2.3
Cumberland MP.V#Xqvqg AhIsfiarm, I hr-.-reb)p my-fil), dral the wefl(iy Aus (we,,#4 abandmad to
CMMAY iwwrdeinew widh 1.5A AA(70A " .0100 or 2C 0200 Mill. Owisdmc Unn Stividurdiv
5b. LuTiWde and lomgifiude in drpmeshninule0umands or decimall degrees-. eppy <V
(grs,cri fidd, anc Won,4 buquffimcnt) 9. Site d(xpiram, or iWAkmanaFRell detsjib.,:
3515601730 78,,98363113 w You knay use iffir, bae., offifis pap to pum& oddktona� wrlhw te detaft OrL Wej�
abanckmment details, Ycsia my a1w. woch adfflfiond pga if nei=wy
ONLI'aith die some rowididlop vbandvmyvrmrou mnsuftfs ffmefidm
6m Well I.... "'rA2-1 4
W Total well deptIn 42
6e. BorohMe ffimnemeir: 0. 75
6d. WiRer level bele", ground sdrface.,
10& Mlj!: Subaik Oie; rwai Mihiiru 30 days of twipleNsawun of weft
ab2ndanm,,".mI'.o thcfvllowjnr�
Division off lVaker Resourem Information PrattsMug Loft,
1617 Alsil Service CenW, RaI6gh,,NC 276%MMI
I Qb. n.c.hissfigm Inaddibon to iandinp flie form to ihe Adniss m IN
abM% also SUbMiT One wOPY OfffiiS F09M WARI 30 d4j$ UF COMPIletion (if wen
abandonment to lhu frA[mvirig.
DiviOwn ofWaler, Mmiurm, Utulerground Injection ContirW Program,
9636 blail Servire Center, Raldglh, NC 27699-4636
I Ot. JGjrr' _te F1 Eta V �jj' Wkfiim C
_ j _ mpg 6e. Ou leir cusing lleug!4�b (it kagawn). w =ftig 0 orm to Oic
Addrem(eii) above, ab�:�siahmi� unc imigy uflMs form wii.16n 30 t*ys ofcompWion
of well 41b"W&W-tracnit qo the County JiMM dqvirlpnent of the cooniv where
6E brier mingibubfinleagib (ifLawn): ahmdoined.
6g. Senvirk length (if knirrim 1. (ft, N
FM'VII%GW-30 Nadh cwaiwa IIATntun"m 011"Wan 01ilvater Rmwmrmz� RownW "! -.7-2M q

WELL ABANDONMENT RECORD
J.'Well Coaftexhir lairomatiou;
John G. Schappell
. .................
�Vrlycoffl;om. r Name (ar wefl"MeTporwrisHy abmdowungwan on know prol[w.dy)
23132-A
,NC WOCaninatof rexufimuiuu jgumwir
M&W DrUflng, I J C
C.N.MPA" NAMP.
1 warl consh-acdon remit,#. W10600036
3,, Woft we (chack well use),!
r...'JAgnenhuml
Mrblfhwwp� (14f-wOngCoofing Supply)
rMiduz r1avolmr4wim
ClAquffix4r R.ecbwge
D,Aw-aifer Stomp A arKI Rempery
I E. 6 A f. n ui rer"I " i mt.
10cleod-w7rud
rMakileTmal Rleaflnot coofin"",
t Qp�tu Well(s) abandoned,: . 3/22/2 3
I MunkilmliPublic
Dftiidenfial'Wr-iter Supply (Mingle)
UR634,OW Water Supply V&amd)
8(iroundvnter Remedidlion
DSR.Ifig(y HaTriler
Croformmar Draivage
r"Mubsidcnoe Control
D"fraw
I 10theuk,,xrdsin uvder'7�- I
6a" Rlf.49 InM001h
FoTt t-agg
Fr,Tfi WO w-n-0 rwOrrr IDN CXuppficable)
F1'BR,-0M/SWMU-69, Sounded by Knox, Butner, Woodruff 14 Vaoty 9kreats
Phywca� Addnm, Gly, anid ZIp
Cumberland
H MLJ
7a, For Gee prebelfflor aoqM-Laojs Geothermal WeUz having the mme
well cw4Uudw/dq.Ah. only I M30 is needed, lndicale'RYTAL, NUMBFM of
va,41% abondone&
'Tb,. sveR(s): _ ___(gaL)
iqw...... . . . .
71L Type of d%infeclant used:
'Id Amount Di'dislaire.r.ftat owd.,
.-.1 1 - — - ------- --1.--.--...--.------ . ......
% W.hig Materigh used (chrek SH that opply)-
9 Neat Cemeiof (.Irout
R qBenf.oftife rh P,
13 Sand cm"tryTout,
rj Dgy ]Clay
M Concrue Grout
0 DO Culunpp
U SIXcialry Grout
0 cifflVal
0 Rentonileshiny
map Other (explain under 7g..)
7E For esich Ma'agerialselLcted above, 11prowhiesmount ofmalerihls bsed.-
Poilland Cernef-ft 11 ft
7jr]Vrw4de A brief description oftAealkawJunment pramduirea-
Neat cofnent funnelled froM top•
8. (.at, "fi,
3f2'7123
P4
SigaMINX, ofCcoRInd Weli R. cast -w 4�1�. IN*
PAy si�"'Fww 114"Tform, I &"J-Lbj� Irflify Jjja� (he 1#4�jj(N) 'Owx (wrrvq qk1luk"ad go
acwniwe with IYA -NCA(.'02C X1100 Or X.0,700 Well
andthaf a Copy ofthis rwtwnihea�v brewpe-miuledto Mm wallowpep,
Sit. Latitude and tbsrikude liva ale goinl(MiTAULS/Secoallin Or deefinal degirees:
(irwoll Wd, one kvAorp, in vifflokint) 9, Site 3d4ram Or Addiflonal we,1111 detafts:
78.98358& 156()6863 788 �'au, MEky (1jr h&Ck of lhu pap to psoyi& Addit.loxiM %yelft mtz, defoik or wdl
w abottdownent&-leans. YAna sway al po atoch addi tjajviaj I -Mgm if'xi, .
LIN Sam M
He. EqjLA_lT %Vdit. Siabmll this rkqTxw Within 30 days of cafftf,4Cdotil Of wan
dramWei! 1M., T.42-1 3 abodomnexi.f. to th a k DrAYiqF
,41
ir%Tbtal Well depth. —._ (R-)
0.75 -._Jun.)
Cid, Water iewl Ibelow go-voind surface.
DMODin of Water Rimourecs, linformflan PrGc mkV Uqjj,
1617 MUServicy? ("QattgjrwRaleigh, NC276".4617
10b. In w1dition to sanding the irann lo Ow.; aftess rn lOn
above, WS0 submit cane copy of this fourn wid-6m 30 da.r, of coniplMion of''well
*wdonniew. Io The fellawinr,.
DMsten of Wavur 111tesources, Underground Injection, coni"Ol Program,
11636 Mod Service Center, RMcllgb, NC 276!99-16.36
fie,, Miter essing Meng& Cffkao",a): M& Fair Water We!l�- In addition wseindbW., the roh-rn to 1hr.
*15PUS(es) 2110ve, alqo submiil One copy 4:1,fiM fbM wflhin 30 days ofcomplatIDD
of wefl nbandwmen° go the cotutty heafth dapuimtni of the e(junty vhere
6f Inner casiawtubing length (iftnowill); alyandone4.
69.,
14flnu Gve-30 Nodh Comfina Depanwt of FnymnnwimW Qun6ty - Dive kon of"Water Piro SoUmrAw Rcv�s=A2-22-2'0i6

WELL ABANDONMENT RECORD
1. Well reatnmenr Informskjon.
Johii i C. Schappell
IWITi—c-ontr ear, YMAI oww, prgwmUs Abalwopung wolf on blehm proptay)
2332-A
row LAZITW Uxv. MNLY
---- - --------- - ---------- . . ......... .....
... ....... —.- ---']
3L'VELL-AjAjND0 PW TAM NN_tL
Taw(,Josed-.Laop lVdIs fiKvInT,, the ,.,,wne
wd wn.mruc horgileirlb, only, I GI*W30 is nei%lod, Indic2it"KITAL, NUMBER of
a%vftabandixml
N�C` A`ch Cyntmaw CA-Iffica"m NuWxy 7L Approximate voume ofo-ater remaining ha ! 1)
M&W Drfllirg, IJ-C
7c. "Irype of dishd'ecract aw.A-,
W10600036
•— ------ -----------
List aft qjpbrablc wmvff 0 e. far, roump, Slwc, llaffamx. cfc,) �ftmpuv Id. Awauut of dkwinfitr�'.bm owd.
I Well imse (a:hecu i well use). . ....... . . ..... - — - — ------ -
Water Supply NVOL
7e Seahng mstcrlslw awd (check alt Mai 2pply
rJASnnhhawall
D'MuwcipMrTubhc
is Nee Coment Grokit
("I Beragrule Chips IT poilm
EIGernhamM Suppiy)
0Rc4',rdLnfiW WaterSupi* (siRq -
,k)
0 S
'MA C'Mant Caw,
0 D ry C hiy
DRcbdvIrw4 wakes r Supply frjuvod.)
0 Crrilmele Gma
M VnH Cutilupp
E; SIV611ty Groul
!El Gruvel
ro Bentcae Slurgy
If::1 Other (=,plain ander 7
DAquifer Recheigu
Mquifcf Slonige and Rwovery,
Z)Aquffer T&-t
E)HYpeNracoal Technnk%T
orimthenvisi (CIM-ed tx)r4p)
r ElGeaflxnvnrd dHe'lifivvycmifinL�
4,. Date well(8) abandonedz 3/2.2/2 3
";AIvell 104M.flow
Fort Bragg
FMORwfGWnM Nufflo
P-Groundwater Remediauain
OSRVarty Banky
UsIonnwarzi yycaa maim
OSubsOcnee Ca"M
0TrKAZ
Mffier ii,:nHain ooder
r8obty 1106 pad 1pphoubM
FTRR-0691 WMU-69, hounded hy Knox, Butner, woodrtff & Vir,,.Aty Strieet.9
Cay, and Z..�p
Curnberhnd
ICKM49y,
Parcxe Idept&cv.ma" No (13M)
Sb, La.fitude and Ilongitude in degre.. iminuteilsewnds or Jedivial dim.plm:
Of I.m.11 R'Wd, area: WWug mdrimenu
�35.15605732 �,a 78.98362879
1, JU�3i" r ,jPffi, A ffZn ij, r ot&n - qiesw, .ivn
ONZ. V mlih lhexwne rvwmrwvwN stehode jure,rerm
(in WeR I IIDN:," rA2.-12
6b. Toto.J,weU deptic 415
6c, Tler0krile diumder: 75
6q$. Water keel below grDand iurface-
"If for LTch Material velat: WI above, pimidde ammArit ofmaterifth used.
Portland Clement 11 Jbs
7g. Provide a brief &i.crlpfion of thetthandonment proculumn
Neat cernent fimy,Wed from top.
k Cerli
A., 3127/2.3,
K, "ray MAVk,-r? TUC
orm, .1 heyehy c'ernfi, dial the wed(w) Iva s Aven,) abamcdopled m
accardimer, wilh 15.4 w2c,0200 IfIelf C'nizvD.UrNkrin Stondurds
wefluwnLm
9,, Site diapana oraddihonall wdl detMho,
Vmu in,,;ky. t1so die Inck OF this pxwr to provide WthumW %rit she deigiN or welil
W RbamlDamaildctaflE You IMAY ahAiattichadddionol pages Ffirrcessary
I ft EqLAJ� W—.,Fjh. STA'n-nh this Form Nvithm 30 days, of rompIction of ivcfl
RNHKIQnff)ffMt W &C ibliMffl nr,':
DivisioR ofWater Rpwwurces. Informanuip hvcessVmg Unit.
1617 USH Sefffice Center, !I9IN9h,NC27699..Lj(,1,7
10K in aftain" to -'ending Hie 11brin to the in 10a
above *Vsti inbuk ore copy afthiq fban witMn 30 days of cwnpWron af%voH
abaidonnimit lo the
Divigift of Water Iftescurces, Vndw%round Wulecillon Couliml Frogn4m,
1636 MMI Service Center, Raleip ,h, NC 2769A�- 1636
lip- Onfer tasing length c[c)
also submit onccopy ofaKl fonn within 30 gJaP of complen-AR
of vvcH ahandanincrit ts, the counN, auhh dportmena of the Count%, whtra
6E Inner CIM"'P'NuIbilly, ICERV1% ff twawn)«' abandonc&
. ...... ......
FMn GIAI-30 Nonh Carohna Deputment QUAWY .. rDvvqpIvn ofWafm Rcwmun, Roviped 2 - 22 270 16

WELL A.BA,,N]II30NIM.I.�i,'IVr.REC"0, RID
I. MPA CantrackrInformation-
John C. Sch,appell
t�Va fa c (40 MU ownei Persually AbmAcminp pt PP. y)
,wManhiw1wr , in
2332-A
119C. Well Nwibcs,
IAI DrMing, Ili.... C
— - — — ----------------------
iT..psny N . . . . ..........
L Welt, Conshveflon Permit 9"''W10600036
Uve OR a -1-1-- � .......... .. .. ...... ...... . . ...... ....
PplidexhIr f?'•„e.UX Cmffl% Mam Pariber", em) ttknUIRIA
uge (Pheck Will uxL),
MocuiluTal DMITfidpal/Public
-- - --------
- — - ....
- - -
MM.LA
78. For GmProbalpirr fit, 00,uM'Loop Gember"21'WeIM4 having; th". Mare
Well MufflictioWdepth, only I (M-30 ils nceded, Indicate TGUA.L, NLIM.RFR of
weAlsibmWone& . . . ..........................
Ib. Approximple volume of"ter rewashfingin Weliffl.; — — ----- - '--- (PL)
. . ... . ... ...................
7c.Type of f.Wnfeclant usrd-
Id, ATROU1111. ordbibili'munt ufWd.
.. . ........ . ............
U Sealing Funterlah UWA (c.hftk A that, Hppiy):
M Nmt airem Gmut n GI ClUallim CWTM or pciftc.ts
CIGeodwanal Oleafing/Cooling lkq�ply) nRiesidatfial Www SiApply (Single) 0 and Cement Gana 113 Dry ,0qy
ORNniftnind Wahr,&qnAy (shamd) � [3 Qincre..*, Chaut 0 -DrM cutfinpp
EMS=
OAcIneer Realnuge
nAquifer Storage, and Ret4mveq r1salinily Darflet
IlAquifor Twa Moral walex DrAinag ,,e
DrArothermal (Clo.w:d Loop)
0]GmUvxmaJ V fizfin�� CoOin!etuml 00flxricx,r�Aaln uadff7,�!
4,, to well(ii) ahandeined:..'
q% WrIlAuplion:
Fort Bragg
F=NWyI0%mcr Name facility 11W (MIPPilrAW)
RIBR-0694-MMU-69, b,Diundpd by Kinox, Butner, Woodruff & Virshy IS.Atfeets
cilty, WndZip ;hy=- —Add�,&�­"""""""
Cumimiland
P&M011 WenrifickmAnNo
5 h. Lift0tode and lopgRude in der Arconds ar declm:W deglem., recs/minute
(4 wg9 fi@dd, ano favlwwn is suffic-mont)
35,15604471 N -78.98366332 W ... . .........
6a- Well FD9- TA2-1 I
2
61n.'rowl well dewtht 4
fic. 0.75
6d, Wafter Wyel below gymand sufface.
0 Syxxialty Gmut LI GMVW
IIZdonheShiny (3 Otheir(explam undcr7g)
7E For cach material selected aboye, piruvidearaount afniaterixig Wed.
Portland Cernent 11 lbs,
7g, Provide a briefAncripfficAin ofthe abandonment procellaire.
Po t cement funneled from top,.
A
312.712.3
84T kwa,mii, Pfc.'ardflud Well I u., C.,
fly sipmrig diisfiartiA, I hemby a,,ri(fi, Mat ffie weg(xj was (iverip� ahand6nod-in
,im uq dVCACWC IPPOD fir 2C' MOO Well Condri4ofidn Sesunfardi,
ardelial o capy,and eba reicaql a daaeaa ins ryo aak an rra Af, ivell mmer.
9. 1,90P, dhigram or adidWanal well detaMc
You. may we the Tack cofilds puff., to ix-ovide addkio#W well site clands Gir well
sbandopmenideWSL Ybumay at ra, Attach additional pages ffnee.essary,
NHIMID:jM-IN-8Tgxjc.. �IONIS ". -1
—.— .. . . . ...................
MR. TELLAAA —Wdls: Subngf this rofm mithirk 30 days oflarmpletion a f %wA
"idomnent to the f4humpillW.
IDIvi%Wn of Water Resources, 7arbrom0onkrocakaing tjxm,
1617 Mail SeiLwice Center, Raleigh, XC 7
101h. E.j: In addiflan to ssnding ffie F6m to the addms.s in 10a
ab*M also sulanift Diric COPY or this fom wilhin 30 days of cm.npled'on,of well
Abmidcounwit ID the ffflavAirig:
DiVision of Water Resources,vadergmund linjecdon r.ontrol Frograjnu,
1.636,9a il SerVier C'macr, RsWgh, NC 27699-1.636
fie. Outer caging Ileamr'di (if known): . .......... . .. ... ... .. . ..... . .... l[naddigiont.osodinga.Ikcfuw.Fnwf.he
addrc&%(as)abn,Ae; also q0mnit one co" cifUiis roan within 31D i;" -don hys of' COMIAL
of well abandonniev to ft counW health depy1mant of fim cauOry %Vttcrc
6f, InjuRr casiDgIbibiap allmndoacd.
llenp ,,th
Pona QW-30 Nallh (,swfinaDqmvTruW QuIlKy - Dcwudan offtcy IRCIMarugs iterntid 2-212,21D 16

WELL ABANDONMENT RECORD
1. WHII Cuntraclar Infornmdon:
J61hn C. Schappell
WA ('awii loww& telivegy)
2332-A
. .... .. .......
UK, O"N1,Y
LVF— A"'i MR, I ", a'- N-M-1—H—EAT —MAX-A JIA-
7z. ForGeollwabe/W air Closef-Uap Geatherxnal'Wemg havinp eswna �, th ,
well canippith, amly 11 GW-30 is neo&A Indicate TDTAL NUMBER of
wiveft abi —.. -- - . . . . ..............
NC"W�11 CiDWYAMer ('eoifivflian Numbef
7b, ApproMinsfe vatume of water remalli in WC11(s).
M&W Driffing, LLC
iomon., Nmm
W10600036
7c. Type ol'disinfectaiiia used: � . ......
Ija ail aANWA, 9refi oinvenwrion pyrougs ke UK', C'Ounn"'.54pec" Rlao*va'ed1a) dOwnco
[7d. Amount of dishl1i used-
3. Weril use (elmekA ell ui
---, - - — - — -------- - . ......
Wiie—r —Supply
7e. Staling mateflails w*d (check all that apply):
4 Ne,00.wrm.mtGroW
0 Bent "mite Chip& or Prilers
E.Irkath"mW (Hewn1riC(mling, SigprAy) 1:11 midenfiall Wate, Supply (swj..,,4e)
i 0 'Sand (ennent Gout
[I Dq Day
['Hndudn0Cnmai=ia1 ORingdemial Watc.- Suppy (AsTed)
[3 Cancmite Gnlw
Cultinp.
llfiaiu.,4mon
El ialYl^Gmum
0 Oravel
Non-Waler Supply WeIN
0 Btalonhe 131wry
El OthcT (explain ui 7g)
Injeedvion Walk
OAquaf�z Re6arge
OAqWfer Storage and RacoveTy
C.Xlcakhei marl (Closed Lcq.T)
D Gmthelmal Mcgtn n °_'e.'Ool ine
& Vakm well�s)abandownd.,.3/22123
L#,Gro%indwvuT Mnadieeian
Osahnky Berner
0SH)rMwairl DTainase
Mubsid&-:ace, Contid
[11'raccr
sa. Well locadon;
Fbrt Bragg
Xmile, --- — ---------
F"IFIBIROBWSWMU 69, bounded by KnOk, WnEtfl WOOdii & Va M. RY Sheets
Rkysfwai Addpima, ('hy and Zp
Cumbellaind
pArcel ldvoific. =-ORNO
Sib. Latitude and longitude in or d", hual degreim
(iiNe" ngkL Mr.%, suffia.ml
35.16627470
X -78.98353'122
7E For each riii selaeW Atiove, lawn Vide amouut ofmatem.' 6 u.sedi,
Portland Cement 10 lbs
7g. Providea biriefdem,,ription ofthe ntrindearnent pmmAuxe.
Neat cement funneled from top,
VqN J27/23
sw"atum OfCa"V60 M 0a WcH Ch, n Date.
OV 'rygnnig fhor fin7n, I hervhY evrldjj, lIffed 116a wpflA) mas (m-eiq) rjbandhn.&,1 #a
aawrdanve Milo 1.54,&1CA(' 02CA100 ffm° 2C WOO Well (.anox7naim; Vajidkgrdk,
w7delpal 11 c'qFvc';/"rftT reafiftj hay been jimVidt4to ffle wen, Oapja&'
9. Site dibligiram olir ughlitional well delgils:z
You may tme Ow back of this page to pwovide addit"vial well sir details or %VCH
W aboodonmen! duwde Ycxi may ahn snach adddion-al pAgges
CONSTR('Ll(j ".L " 11
!.�U
4dfadp wellmnse"wrAga r4waffix) �fwwm fable plywrib
thexame nrvrxe O, Pit poofora,
6a. WeWl 104: 'TA,2-1 0
6111 wen depth-, 38
6c. Borehole dianiaer., 015
—00
ad. Water levLA below groundupdhee . . . . . . . . . ................. m(ftj
Wi Ov, rri Nis rhmn vatfun :lip di of cvmpkbon of wall
abandonment W the fiAllowingt
DiV4,114D of'Mrsler Resources, Tufarmadon Pirocmnhig Uttir,
1617 MaR %Ixviee CenterRAWggb, M"'276OM-161 7
1 W Ko [ ion WO.I.k... In addiitioin to sencfing flie form to the giddmss m 10a
IgigtL .....
above, allo submit one copy of thg- i whh� n :10 days of ecrnplaoin of mmil
aWridonment to ilia raflnwing.
biviiion af%ter Resources.- Underground Injection Conwal Program,
1636 itall Service CentLir, Rs1ei1gh,N('117699M636
6a. Outor casing, Itaggh ffkinownt: I Ge. fl—)rWaIL In sddWon lie sending die Form In the
a30 day bvvL, HkIn %uhiifil one copy DOM$ fann Ihin v"is ofcompidivin
of v41 AkNrndcnnwento Pic county heafth qkpartmcni of the c(iwmK,, where
6E Inner cabingjObitag lanigth if known). .... . . ..... . abarxkmed
6g. Sereem IcifNtrl
Oh (ir lWown): . ...... . ...........
Farff'u M-30 Minh Cxvhna Dq=1atx of Env,mm woul Q,Naliq, - Div kmn of Wate, R.inar�".$ R cwwo 2-21,20 b

WELL ABANDONMENT RECORD
1. Welt Contmebor Tuformatiow
John C. Schappell
Well ConoactorName (crwell owner petsnnally abandoning Well on his W property)
2332-A
NC Wail t`.antraceor Cem6txuon Number
M&w Drilling, LLC
Company Name
Z. WellCunstructioo Permit #:-...._�-......w...-_-w1o600036...__._ _...._......_— -­.•�....................�. .��....--
I W all applicable traitntrrrluction pemda fie UIC cdrrnry, Slate. V4dance, ctcJ ijiAn,tn
3. Well use (check welt use):
Water Supply Well:
❑Agricultural
❑Geothennal (Heatirg/Cooling Supply)
❑IndustrialfCommerc-ual
Non -Water
❑Aquifer flecbarge
❑/tquifer Storage and Recovery
❑Aquifer Test
❑Pxparimcnlal Technology
❑Geothermal (Closed Loop)
4. Date well(s) abandoned: 3I22123
For Internal Ilse ONLY-
_ ....w........ .. .. A _
W)EI.L ABANDON1t�NT DETAILS
79. For Geoprobe/DFT or Closed -Loop Geothermal Wells having the same
well twnstruetionfdepth, only 1 GW-30 is needed, Indicate TOTAL NUMBER of
umll s sbandhnerl
7b. Approximate volume ofwater remaining is Well($): _... --------. . ,(gal.)
....... w ...•. .. w. � . .. •, ��.
FOR WATER SUPPLY WELDS ONLY:
le. Type ofdisinfecautused: .......�„ ��,.
7d.Amount9fdisi6mtsntused; _�•„,�„
7e. Sealing materials used (check all that apply):
❑Municipaimublio
19 Neat Cement Grout O Bentonite Chips or Pellets
❑Residential Water Supply (single)
❑ Sand Cement Grout ❑ Dry Clay
❑Residential Water Supply (shared)
❑ Concrete Grout ❑ Drib Cuttings
❑ Specialty Grout ❑ Gravel
❑ Bentonite Slurry ❑ Other (explain under 79)
RCroundwater Remediaion
❑S linty Barrier
❑Stormwalcr Drainage
❑Subsidence Control
❑Tracer
5a. Well location:
Fort Bragg
..
Faotlitylowner Npme Facdtty ID (if appbcabic)
FTBR-0691SWMU-09, bounded by Knox Butner, Woodruff & Varsity Streets
Phystcai Address, City, and Zip
Cumberland
Caunly Parcel ldeatibcationNo (W
5b. Latitude and longitude in degreesfmtnutes/seconds or dedmat degrees:
(ifwell nerd, une Wars is m0cient)
35.15627004 ,,, -78.98357280
76 For each material selected above, provide amount cimaterials used:
Portland Cement 10 Ibs
7g. Provide brierdewripfion of the abandonment procedure:
Neat cement funneled from top.
,
3/27/23
_w...
1 t;tirte ............ ._
SigtiaiureofCe[tifcedWdlCorr.�ractornt'�dlOwner
By vigning this form, l hereby cerlijp that the welfft) was, (were) abonrlaned in
uccordan& with 15A,0:4C 02C A160 or 2(' _a200 Well C:ontrracimn Slandardi
and that a copy Af tht. recarri har been provided to the welt 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 way also attach additional pagesifneeessary.
CONSTRUCTION DETAILS OF WELL(Sl BEING ABANDONED
Anachuwilcominrcnonravotd(sjifamilahfa For mrdnpletojeciiaAormm-ivalersupply welh
OW isms thLo Onte canslnrcllanlahandnnmenf, you we srebarll one form.
60_ Well IDlk TA2-9 w ......
6b. Total well depth: 38.5
6c. Borehole diameter: 0.75 „_•• (in.)
6d. Water level betaw ground surface:, � _w_,•,•••_...—.0t.)
SUBMITTAL INSTRUCTIONS
109. )qr All Wells: Submit this form within 30 days of completion of well
abandonment to the following,
Division of Water Resources, -Information Processing Unit,
1617 Mail Service Center,litaleigh, NC 27699-1617
10b, For Inieetian Wells: In addition to sending the form to the address in Ida
above, also submit one copy of this fomt within 30 days of completion of well
abandotlmcnttp the fq!)owing:
Division of Water Resources, Underground Injection Contra] Program,
1636 Mail Service Center, Raleigh, NC 276994636
6e 0utr r casing length (if known): (ft.)roc o 1 gr. i j13 & 1n ,cfdnn 1VetlS: In addition to seruLng the form m the
address(cs) above, aico submit one copy of this form within 30 days of completion
of xvcll abandonment to the county health department of the county where
gf g 13
6f. Inner casmrobin length (if known): n,,,,,,,,,ww. J ft.) abandoned.www_,
6g. Screen length (if known): __...._ -(IL)
Form QW-30 North Carolina DepartrnentofEnvironmenal Quality-➢ivesion of Wato Resources Revised 3-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor blortandow
John C. Schappell
WO CoWmdor Nmm, char` lwlt omw� pommMy abwdonmj,,., weU on ho.01vT Propirsly)
2332-A
Nr wd fl C n n a rw" or Cei irrogon N 4 ffbej
M&W DdHing., LIC
2. Well Construchon Fe""it N.. M06130036
- -1111111111111111--.- . . . .................. ....... . .
Do all qq2tinAfe uvell ii rmpnuo 1,11(Z t'Offlu), Asse vvdlm�ur vn.,j vjknoum
I AMMI use (chack well ume):
SUPIRIV WeM' . .... . ...
0AUrAcultmW
DQ*fficnnal (I I avbzVVCoohng Supl.fly)
r .]Aqimfrltechwitc
0Aqwfin- rotas as araRocovcq
m.')AqnOur'Test
f...lExixfaxi Technolo".`
DGrAstberynM (C.' , taaM Uop)
-k 021te Meandisined: 3/2-2/23
rw Ii lexuW time ONLY
............... -- ------- ------ .............
79. Fox, GeopmbelDPT or Closed-toop baying .r the wre
weli siuwactlsaaeoddelFGla, only t etaY-30 h, nooded, Indicate TCYrA].'NTUMBh,.K' of
%vells abandumd . ...... . . ............ . ..... . . . .......... ... . .. — -', - ---- ........... -",
7b. AILpra):mate %gDlii3meof"atet'• remainhag)n WCH(5):,
wiii-i�5.4-wx ... ........
M, Amount of dWO.w1unt i
- , --- , .................. . ..... . . .. .. . . . . . - - - - - - -
feu Sealinv materriab used (check gH that app[y)-
MamciPAIPU113hr,
8 Nwa CeiiTicnit (3nivi 0 Bonointla Chipa Pr PcHmi
DREsderrfial Waler Supply (Mn&,)
U Sand Cement Grort M Dry Clay
UtRwsiidcnoar Waits SuTqrly (%ftarudl
IM OncRew Gmut M DdH C'utdap p
Girayd
n Benvionste Slurry 40 Chhcr (cxpWn vadum 7g,)
okacavary
.......... . . ............
.
7E For each material seleenad abovf-,, provide maM
MiGroutdwawr Ronediouan
Fpcx-Vand Cement 10 H'.)s
01.5ahrim, Banm.
. .........
C.Alkifinwater Drunsgp.,
. . .............
05ubqidenrr. Control
7g.. ProvkIr 2 brief description of the shandonment procAura.-
O'Dacer
Neat ceiment funindedfrom top,
So. Well fvcltbar,m
F:brt Bragg
........ . .
FarmfiTyMwner Name. T`=Ogly MM jd'%ppbQi
F MR-0691SWKJ-69, bouhtfed by Kj'mx,, Buiiner, Woo druff& Varrity streams
Physut',d AdJroii City, wNd Zip
Cumberland
feu wa fdCabficafian No I M
5L LaduAde and kor-glitude in or decrivinal degrftN:;
�d *01r Add, 01M U00.1
35.1562669-0 -78,98360416,5
312"7123
-VAnr or Wig
j
WrA ConT,
h)i'V4gjIwg ffirsfirm, I hereb), cernly Merl the weIIO) H.-as ii`t+vrqd uhayalanint in
aevor-dani w9ft IIA AICAC 02itD.i9 OO eo• 2C,#VeN9 ft"ell
arydih4a a Copy oflypa reconilki 6avrl providedia The UT/I fjwni.r.
0. Ste d6girsm or additi wefl details:
' You may use. the Ibad,of Ws Y Me o prmide adidnional vvefl deWN �OF MrO t ahandonmeni details, You Tuay als'u atutch adf.h6aim6 frage.s &aenasssryi.
CONSTRUCTION DETAILS OFArr &A " NI BEiNG ABAIND -Q,bjw
More 4fa4AWah1h Fornpuleipleetleawan ap 4rdt5
MI. V as Me yame eym DMf i VdAraft Mcf,11M
63. Wall FDR: TA2-8
38.5
6c. BorAole diameteri: 0.15
6d. Water ImA below gi surface;
IU Submu t IhTs fonm within 30 #yr, of rxunPtCIhMI Of WCH
MvWaa of Water Resourcefl, finformation Praivessivg Unit,
161"T
14ft to addi6on 0 gending the form to the adcUrz in Wa
above. abo rubmil orria copy of this Ron willun 30 days of annplefinin of we"
aban,jonmeM to Ibir fcflovAng,
IlMvisian nfWatew Rfi Undiilrgrtuad Ini Controf Program,
t636 MaH Service Center. ICMeflxh, NiC 276954636
61% IMer casing livagith (if known): Wyo-sr tun 2&hulhn w=011-18 fl-Re IPatavaa W ow
diddirrWes) abavcnnt, rapy orthis. fbsnivinthin 311) d2ys afr=pMon
kif well abandon.mmi. W 1he cauWy bcAh depaRtment of Whic cc,wty wherc,
U Fniarr casivF Jsubing length (if fatownf.,
6g. Screen long4,b (if knern). . ... ... .... . . . ...... . ..... _(k)
Fe'In GtV an Nkrd' C ' aroh*VCParuxlent of Environminw Qa Rty - A.hivisiun ir'f'G'ti"atcsRewmCcs Raosed2.22-2016

WELL ABANDONMENT RECORD
1. Well Contractor information:
John C. Schappe_II
Well Contractor Name (ar wall ownerperwnally abanP-D
mmmdoningwetl on ldsihcr P^openy)
2332-A
KC Well Contractor Cdfificatrun Number
M&IN Drilling, LLC
Company Name
2. Well Construction Permte#l: Wi060.
6 _
Litt all awls'cable reR aepslrueNonl —its r.e. uli" r-mty, &ate Yadance, etc) Fjknaim
3.mWell use (check well use).
Water Supply Well:
OAgdcultllral
❑Geothermal (Heating/Cooling Supply)
❑industrial/Commercial
Well:
❑Aquifer Recharge
❑Aquif& Stomp and Recovery
❑'Agwfer'ibst
OExperimautal Tecbnology
❑Geothermal (Closed Loop).
4. Date wetl(s) abandoned: 3/22123
OMunicipal/Public
OResidential Water Supply (single)
❑Residential Water Supply (shared)
CCrtoundwater Remediation
❑saiitnity Bantier
C Stormwatar Drainaga
❑Subsidettct Control
❑Tracer
Sa. Well location:
Fort BraggFa6li_
FrBR- 69 SWMU 69, bounded b Kn a lica.le ..._...
ty �Facility il)fl (ifeppliwble)
y ox, Butner. Woodruff 3 Varsity Streets
Physical Address, Cily, and Zip
Cumberland
County Parcel ldenhficationNo. (YIN)
51i,.Latitode and longitude in degrecOminutaf4econds or decimal degrees:
(ifwellfield.onet lemissuf6cienq
35.15626647 _ N -7898366366
CONCTAUCTION DETAILS OF WELUSi BEING *BANDOYEd
AuachurelFcwadrucFlanreearl(s)Fjamtlable tiormrrAFjtlelhJacllPpariroa-�ratarsrr�ilyueFLr
ONLY xith the ramc rnnsMMlon?olwirdanmeerl, )ore cot snbmil arefomi.
6a. We"It rDll: TA2-7
6b. Total well.depth: 38.5.._.„.,,
tic. Borehole diameter: D.75 (I.)
6d. Water level below ground surface: (ft.)
For Intemal'Llso ONLY,
WELL ABANDONMENT TA
7a. Nor Geoprobef FT or Closed -Loop Geothermal.Wellsbaving the same
well construction/depth, only I OW-30 is needed, indicate TOTAL NUMBER of
wells abandoned _.
7b. Approximate volume orwater remaining in welt(s): (gift.)
FOR WATER SUPPLY WELLS ONLY
7c. Type of disinfectant used: .
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply).
R Neat Cmtcnt Grout
❑ Bentordte Chips or Pcilcts
❑ Sand Cement Grout
❑ pry Clay
❑ Concrete G.tout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bonlonite Slurry
❑ Other (explain under 7g)
7r For each material selected above, provide amount of materials used:
Portland Cement 10 Ibs
7k provide a brierdescription of the abandonment procedure:
Neat cement funneled from top.
._........
B.Certi
_ 3/27/23
Si m of Cendied Well Conlract �1 i
Aoatu or rJtr yell Qwnal'�m W W .. is —
gy signing Nita form, f hereby cerl6 that lire tivII(T) was (were abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Cnnstrucaon StandardT
and ihat a copy ojthir rocard hox been provided ro the well owner-
9, Site diagram or additional well details -
You 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.
10a. For Ali Webs: Submit this form Within 30 days of completion of well
abandonment to the following:
Division of Water Resourcm, Inrormation Processing Unit
1617114ail Service Center, Raleigh, NC 27699-1617
tOb. For Injection Welts: 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 following
Division ofWater.Resources, Underground Injection Control Program,
1636 Allail Service Center, Raleigh, NC 27699-1636
be outer easing length �iEkmowo): ($) 10G For Water Suttfily &ITlr'ection ells,: In addition to sending the form tothe
addmss(ea) above, also submit one copy ofthis form within 30 days of completion
of well abandonment to the county health department of Ibe county where
6E Inner casingRnhtng length (if known) _.. mm(R.) abandoned
6g. Screen length (if known): „................................ -...rN
Form OW-30 NorthCnmlmaDepartment ofEavuonmentalQuahly-DfvismaofWaterR=urres Revised 22.2016

WELL ABANDONMENT RECORD
L 1J C H co nrrador IPanfira'run tiauun.
John C. Schappell
Well tt"o anwwrma s (air vwwi'i. i lan!sii abandoning well uur Vn4�^grorrnWnaah"'�nb"D ..IT, ,",W..
2-
—_i
hiw" vH�ptt � uveuamraanhaua d;:uxnufi�c.�uakea. „guuum0xs
tt"c:aaapewai;q v$'raane------
—... .�..� .....�..� ...
0036
" y ll Cons'ttrara m y �r rrnmtar � �
ba all aaprsPra°xhi ¢aweVl ase aua^aa xa r aua aHr A a UX'" M1 uwapatt lfas , 9 rcxmrrr cac) k�`"Kweauuan�
1'WeHI nave (check well use).
H II y ��ia�lU R
1"?a�u tufittzllksm�aH
w.7Cuitthrelmal (Hestini Supapa y)
offiHuasluaaBsCorr rruru naal
10jecrianrra' iwH•l.
AqlJ ReOwnG
C..;AapuunHu r Storage acrid R,,,,*vcrN
C'iAapuXen "Td.1,11
U" Eyp e n mrnasuwttunl "rechnuribr
d lGeottheuronW p lanxnlll.•.cx TD
Ott. tts wall m,� isaun na 12212
U.Mu icipaalAlublic
....
For ttunta"uwwttE ¢ar>raiwaa N
'71. Rr enpuu"rattarollkwHcum° ClurwA-Leopr Geott1 ermial Wells Hflsvuear wlae saine
well r�r ttann kauzra aHegntUw, manly H. (M-30 Hs n cif HuJ "H"O°H"Att.'HaIU M BF-9 of
7h. Appy'oVduUtewruul Me WY(WiffbEr Jim
mai�wn6inin a�r9l�sy: .... . (,f
7c" Type aafd1iwriira;aeal. . .
7d. AmountO''aisnnf ttan'ICuuwi... _........ � ,
7e. Seal[i ag makerinis used (check all that zppl�l);.
Not i C aurrna Graaaul C, BennRrcnnhe Chips or'Pe lc s
EIR side nQi�tul WaterSupply Q'SnwnyyHrp 0 ad cement CImrMl61P 0 'Dry Clay
1:.ftsidcriW Water Supply GAad) Un Concride G aran4 M Drill Cuttings
!Hnrpamadwwisfew HH,ermw dildion
E.1.9slinky 'Barrier
tHl&A,uttrwwraslef &a a w nagy
IC ISwubsidimccCcri
y 17racer
Sim Well locadean.
Fort Bragg
filidlitygownia
B 0 9P WMU a "U�ounrdixil by Knox, Su leer pVJ7uuattuaHmN
T& VaNtty Streets
Hnhymel Addur, awe^ Om ennui Zup
1&11ribella l d
^suaaauw'No (PRO
HO1",imtitnaule and longittude rru dflEmeiiramili 7uates saec¢uaaHs air utterknawll dagmes.,
or,:acll@ pia,K one kaualaaeg wrnaHwupaawcl
A5 -78,98371194
:"kaJ'wdanw elcriegaamcparer,murdi giefaawu laahlc.TuarAariaR pou��waaavvaapr &derr:nagr6�°awa-9Ca
ON,V t wh ri sa me prul re°a mkirar carae Arm
6b. "tt°oisl well depu . 38
6d.' +tlaattapr lewd luaa:Hravw grouind suar$urri..
Spexlafty Grout i:H rha e.1
* H e nlonad SITurry i"'H GdaRHne( (cw pttllrruun vnutala2m 7g)
7f For a cln m ntteiri al selectedRelected abort Ipawi irnunoarrr. of MaTeeml5 unnwed
7 a. Provide a brief �da ,ipnttion n'i the uattaanunr enin ent parsr rarcee:
3!27/2
a, W rcka( a^.8H . sari � —
S tt,Gutao.^u'aar kiR wan �1Ng14F q.rca
BY signing rdkia fi[arr). i henrb.n° ii dual aiur nvdlev) was (were) arkrdoaoed s"
:arawda nap *A IJA Pam"'A(1 02C,0100 or 2C r0+200 6"aaii w°awwaataaM.:ada R ""iHprRdi4ralw.
andthist as a;rjry a y"ttprir yn:rae w`1 ieauq heen provaaia din 113ar mil a w"ar;
9•, 'Site diagram our aadlillinwnattuaH wveUlUnl iuraHr.
YOU MaY wua"a. IJ bmck nf'i'imk pas n to provida wadaDaaianu U well site deksaHs OR wns Ulf
auUrnundonn ie w dettails. aana mmany saU.raw rtt srHa sreH HuH6�un riU psn att' nrrrao saaw •
II[1�HIVtt "bi° A IfNK Ulkrp `l"yQjj? e
BMw En 1' YS II. a Sunb mqk this lawum veitthin 30 days a B romrupl'ettaaon of well
syaua;Ourk"rent in 0M fawllovwaaai
I)M%ianin nwf Waler aFV"rees, lnforrnursiiou'proveml nw; Utah,
4iH'H7 twttrnHl SeiuMweCenter, Rualw.irggln, 4C �"!"Cw1Hil•Hi17
I UL '^ n" cf w> 6.r: 6n addition 10 •qem in Are learuaa to OIL, uddre&s in 103
above. also unubunna'1 cram oopy aa'd' ile¢s form wduhinu 30 #ys of a.znrrnlnlmbn aad' %VCHH
abaaradoniiincuwtt w Vic following.
mWilvHmHannuroff' "autt + aowrr�c Underground Injecdoll, calaulProgurnal,
l rnslulddres i aninttays.Eqry ter raA wa su naxnnan copy uk"iBaus H� imhi atti .tta��aa�u iH0.r: p�waxa�rnm.Hs�
fie „ nir�ttewr wp'p Hb1. known)._..�� ����_W� 1tt.,4 7r
wwdttfiaaro 30 w"s of usomprttaattuon
of w Va sbaandaannnerni to the colonpy healih &pnrimirnt of a:Hae an omv wherr
W
s&wsrxr�nn
U. IHnnsemr�rrreq',aM'pangnwuag lgu Qu�iS:awswRawp). e..� "®�.�......_.............�.
6, , screrm length (If l urown)w
Fffw m 4Mv`P7M -bC a Gumuatta 'naxa9 u� Gm pumra rau w n1` uaro r¢ paximmugsx N p aeov. ttlli w on an6 aew r&µ wa apraw s Rcti r,sc tt

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Jahn C. Schappell
Well Contractor Name (crwell owner personally abandoning well on hisllxr property)
2332-A _
NC WaU Contractor Certification Number
M&W Drilling, LLC
ComparryName
z. Well Coastrartloo Permits W10600036
grl all applicable urlt aHarnucfiun pernrits (le U1C: C:mmrtl Stale: Partmice, etc) t, jknonn �.
3. Well use (check well use),
❑Agricultural
❑Geothermal (HealticglCooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well;
❑Aquifer Recharge
❑Aquifer Storage and Recovery
OAquifet Test
OExperimental Technology
❑Geothermal (Closed Loop)
e. Date well(s) abandoned: 3/22/23
Ia. Well location:
Fart Bragg
� ..............
For fnterrml Use ONLY^
WELL ABANDOEDf ENT DETAIIS
7a. For Gcopro"PT or Closed -Loup Geothermal Wells having the same
well cobstttictionldepth, only 1 OW-30 isneeded, indicate TOTALNU1v ER of
wdisahandoned' ,_. .... ® ..... ......,
7b. Approximate volume of water remaining in well(s): ,,•„•,,,,,cow_,,,,,,,,,,,,,,_
'FOR WATER SUPk'LY W1IIdS ONLY:
7c Type of dWafectwat used:
7d. Amount of disinfectant used: ww� _ .,......-.---.IT•IT,,,m,
% Sealing materials used (check all that apply):
❑MtmicipdTublit:
a Neat Cement Grout ❑ Bcntorlite Chips orYellels
❑Residential Water Supply (single)
a Saud Cement Grout- ❑ Dry Clay
❑Residential Water Supply (shared)
❑ Concrete Grout ❑ Drill Cuttings
❑ $pecialty Grout d Gravel
❑ Bentonite Slurry ❑ Other (explain under 7g)
SGroundwster Remediation
OSalinity Barrier
❑StormwaterDrainage
❑SubsidenceControl
❑rrs=
I.10th m 4i'Y,P imyot LmWer 7k,!
R-0 1S Y Krim Butner, n C& trsets
Fatality/Owner Name Facility D ca e
FYBR-tlti91S4VMU-79, bounded b Knox, ButnEr,lNoodrufF 8 VarsityS
Physical Address, City. and Zip
Cumberland
w................_-- _ .._.a......
Catuuy Parcel Tdernifimicsti on'Ko. (FIN)
5h. Latitude and longitude in degreeslminuteshieconds or decimal degrees:
(ifwell field, one iavlore is s0ment)
35,15629717 N-78.98354732 W
CONSTRUCI710N DETAILS OF WELLIS) BEING ABANDONED
4rrpchaveticaosrrrrcrinn,,;rnrrf(sjiJ�atlablr~ lbrnrrrlttpkGjeclionarnan•irwtersup/ilyrvrtls
ONLY wllh the same cpurruUtonraboadonmrarl, you can submit one form,
6a. Well IM: TA2-5
6b. 'rotal well depth: �38
6e,l3oreholediameter: 0.75 (in.)
6d. Water level below ground surface:
7i: For each material selected above, provide amount of materials used:
Portland Cement 10 lbs
7g. Provide a brier descriptian of the abandonment procedure:
Neat cement funneled from top.
g Cer I:ieet%on:
3127123
Sigriaiiae ofCeniffet Well Contractor or W41Owner Date
By signing Ihir form. I hereby cerllfy shot the well(s) was (were) abandoned in
accrnrlance with 15A NCAC. 02C.0100 or 2C .0200 Well C.omtruction Standarcle
cord that o copy of this record hat been provided t p the well owner.
9. Site diagram or additional wall detalb-
You may use the back of this page toprovide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL fNMUC7IONS
10s. For All Welly, Submit this form Within 30 days of completion of well
abandonment to the followinr,
Division of Water Resources, Information Processing Ilnit;
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For inies ion Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this fornt within 30 days of completion of well
abandonment to thefallnwing;.
Division of WaterResoarces, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): m,m„_ ift,) 10a For Dater Supply & Iniection Wells: to addition to sending the form to the
address(es) above, also submit one copy of this fort within 30 days of completion
of well abandonment to the county health department of the county where
6C innercasing/tubing length (if known): __ITITmmm,m(fL) abandoned
Gg. Sin length (if known):.......9._ ............ .—Jft.)
FarmGW-)o North CarolinaDepanmeniofEnvironmentalQuality- DryisionofWarer.Rescureas Ketised 22-201b

WELL ASANDOM ENT RECORD
lm Weill Contru cter Inforwaatliaa.
Wra"Clp iOnva aas ,"L'r C for wwmll vewwm r Van msuaawramV,yr A aandmsmumgg nii mnu%'m" Prsa»wurovl
3 — .
C Weill Q amntm tamr C'vnakaararaavaaa °tiauumbmm
LLC
1aaruvgnrsrau;'�arnnur........................................._...wwwawwww_wwe. �..............._. ....
«»allaounatrnurrt'muararardu�}gym 136
_ ......... ,
Irse all applicable evrCW vanwnw�me^rur:�d.mua�u�marroac r�.a. R raawamdt Swede, P�adma ar r ar') V.mm✓aroa�as
& Well use lelueekwell Dune):
rear Supply Woo
(JAgHmilturM MMU66paVpublic
d"aasath vuaaal l'Ihla 'r ng7 G.a ulitm ISuuprrel,yg ORarh&areitW WauR:a„T ninrVro,VaV7 (aawak le) 0 sand Cement taaxao
E.11 d u"i,l4exual g.:JIRL- iciceaietl Water Suappaw d nlharvr '' 1 10 (.aancuec C'yxnin.ua,
--.,__......_
laartnmaaaanaatlmetia*tIL^� .� ,w�n... ...�..r.. me.�...�.�.n...�
U For GeoprebrAMIT pair Cloy -�l. op Gmthennal a ,la having tlae ramrie
ww4i eorstruue'daar id tale, only S Gam 30 is ne-edmtd lruaiueaatie l' l'�r'l l il,p W l riff
wu0sal nmdauaed—
°711n. Approximgtevduimeof vm, ter reominingin well(?a�«.
_. -. 9_ ... _.... ..
I Sr�111�..."� l �.A� lwl,$Jl'�1��" �,, dy7ai7.n'�'a
7ul o-asaavuaurtaaffallslmafftaiasmmsea9x
Dskgnrola.r Red han r'r
Graun idw a= RealediaRa tan
IC.:lAq uirer Storage yard Reawery
V"lSalinkya R arrsmer
L Uquuiffer Tmi,
Maaurnra hwtuler llra.dnn'ag' ,.
d...b�':iAP�pAi �6'8b'waM�M1'�b� "�!"gttBnaP�&�pyd
�pi7.��ad�C'afl�*a �I..&"ARNN.�ak�
CJGoolherua'a8 (00se3d 1La qa)
'7uraaer
MeGR'R.tnerrnalM4ifirEa.%CdYkAm.L$Remo)
O(Wher1 exrlwn under 7,
4l.Date welliabandoned: .. 12m.da ,.
a" Well lasatlew
Fort Bragg
_..... ..._. m�.�„ �. .. d fi1'appgollaasttRaV.i.°)
FTB -0,69 ',"M dV 1,45%. brsauvarlrad Idy Khox, Butner, >I89daa+vce7ruff & Variety Streets
R°IDµg"=Al Addrem, Cll , gnd gips
'an. Latitude and tongttnmdepm ordi dragdnu rs :
ldlCro7 dl field, one tfAAa yhg its wu#6ru matt
7e, Simbog materials used (Check all their apply�'z
NOW C"eaument Grout. C. t Bemxiuror to Chips ar 1"n^ikv:
0 ""wpurtxaduufty Grout u7 tnuxarae:
El IRvsntaawnft Shir'ry° i r Other q"ul nindur 7L,
77 Far eseb materIvil selected above, provide aaaaaumonW of raaWrWs arsd -
°7,,.Pruum de.abriefd smerlpataanaaand"the, alaamnaNeumuaaamat.pnrmauedure,
Neat cernent funneled frarn top.
d +feu°&mkt nnaua
3127123
uvar„uamrm ffta,*.al WW°oa9t �' aadeNz,wc9m tlrr 6ndudn tl,y�,�_..._._ Me
_.._
i"N napeaap.- rdaa"v ,lamrm, / 1i urm'vifiu dlaaa site aweiil(V nasa:-� Aviere) a sa?uraeartaaraa"al aaa
rac r."wWraRr e 'uwdfh 1.1,4 ,MC'AC W,2C.0a"00 arr 2C ,0200 tl&" rcr a auuaada ama:^Asaar . as a aeds
�traal v7 ors ercsN rt� 16nus arteraw rX luar ffrauera gua'asrr`admnrY A"mm H7aa�. nme�ld asuremrmamr
% She diagram a air''addlititnstlk wed] deWft
Vauu avmtay; use t he liack aftlals page ee porgvxle aaldltd`aannal %weft wume denaft Or well
MV Owdowil detaffi, You may, aNsewat.laaeld.tddstiaama(lpawdu ,affunrleaa«,>sah,v.
rra:Nrt�keamr.N.awae,�aaa�wa•d'uarrsarmaaaHrmddCYa,P��wvza�prrAa�Pr dadnrwxrewNaapnMa^prr�rruJxmro�rm^aan�aa-arev'aata°aira,�O�mrr,rillr
rd l"ha 0h ehr a�ee wo a�w xraarmdeasam rco Pi„bvu e.wn wmrlwanel aaenr �"mtan-
i6s. Aak l'" [Do- Ta
2-4
li Total weR .".5.""".w � �Nt„p
..,
7
�r�m V�ueaun'Su�alnb dla¢aamgarv^a ..� ..,llunml
lad, 'Water lrmael below ground suarra'reru'a--_.m.. (FU
Slplllt'l1T.T'ALjv r°mr%vk
lqa:. „�Q �° Saabaink R&nus Bann i0thda 30 days of a, anu)M'pVationu <.ar well
alhnaanrlarovnhe ent to the .rul.lauwwrlvn :;
Dill OfWater Ra.saaamrreq, In formafien Frocic;ssdnug. Unit,
ldg P Mail etiiva"Mee l:'eunlera Raleigh, NC 7699-1617
ltp'lp®,�,, tarroim ells: Iin air. dilian'ot rtrru %'enduagd ft! ldirm le the 2ddaas:s in Mi
aluaawa,a, ablo sub m iice one capy iDf this d"omt %vil Vim D days of raimplatiora of well
aBmuasdata Enev'to dine l7ltVraw6rgp..
@ssa6alara of WaWrReapureeg, NVnde rdaramnd l.nnJer aor Carauau'ial lM'r,ng,trasa.
16M ?Fall Ser0ce +d emteurµ RaMph, la`s. 27669 9-1636
6v Outer aemslutg length of known). .:.:__ . (lj.l fOr- ll"aur Wamaer »pudgy . in addition taro serdard the ftn mn to the
addre im) above, sWi susb e:9 one earopy offtlums ff'Wsrsam wuriili ua'a 30 &qN wuff'raaarnlnlaRlaur
of well 'ahaa'oalatirvwuerH to the oriaamuty health department of 0.e earowurty wwbefi
6ul jMMr°easla tum lw.agleump0'u7'dfflanavra'u➢'a � .�l it zbl endstnod
6tl Screen length llftawwim@a w. �_...........:.:.:....................................... (fr'.
Form OW -rat w'Cmrcttta 7.". g6raaYsm�w L9u�rsu:uaaar¢ n¢' IC:mnr�4rans�awanpnal �!"magnfl'w` - �uw�swaaa+a su9`g7d^:mnx^x �:�e�.nuarr�n�c RewiaweaE 7,22 l'n: 6

WIR'LL ABANDONMENTRECORD
1AAlelif Con.trao.-Iny [Afruwadorn
Johill IC. ScIlapPefl,
We4ll Couu2dw Name (wiwtt ownew pLrwwMUIy atwAnung WOW du MAMr ptojjmlvl,
23312-A
IMM Drilling, U C
compavrywamr
W10600036
. ..... ....
rr,c, UIC, County, Sude, tIOda#=. eda) #byMW
A Well ukelcheckwall use):
Water Su pply MAI.
OAfg-icuittual InMimicipaltPublic
Weothprmg old egow /CoulwX SuppIly) DResidential WatexSUPTAY Crfitgk)
Water Sujqti)y
0 &I [ui rcr T? vc k a rg c
Rctw%fioinn
OAquifer Stony m wd Reciowry
0,98uphy Berrien
OAqxfiFbr Tug
Oftff"Vatp TLE)Millage
OSubsidence ConhMI
COGeothermal (�,Norml Loop)
cy'Tracex
IDGeOthOMW (HC.'DfinWCODHD9 ROOM)
11.30ther (cvrAMn under 7j,,)
4. Dutewllfs) AbaAfinuml.- 3/22/23
SA. We'll pOcsfiou:
[,:::btt 1:3ragg
BwMtV WO (Vapptimble)
FIBR-069MMU-69, bolunded byKnox, ElUlrwir. WOOMM & Vgr;%r Streets-."
NvticW Addm%, Cdit,40d Zit
Curneirfand
hure� tdoKification No (POO
511b.1adivdtand
ffwA fWd, ona, Wfa% is sufficicink)
35.15629800
MEr—RUCITORMH .01
ffavuMakle. For sardfi#0 it�Aryiwp or, larrRIPP&Ivells
ONLY unk Ikewal"t 'pate wo xabmu M#rfiwM;
d)2. Welt ry)#: '"I..
"I A2-3
-- ...........................
6b.'retalureflideptk: 3&5 .—(M)
0,75 --..--0DJ
fid,. Water lavel bdow groaud"Wil rracc . .... . .... . ............... ............ kftj
For Internal U%eONLY
WEMLARAWMN —MENIMPETAU --I;
7%. tauten GeoprobefflPT or Clased-I.Aup Gewhermat 'eDs huv�alg flit suRM
wdl vmruucftorVdepth, cwly I GW..� O is incedNI. Tana icaticIrfrAL NIMBER of
wafl.- alpAndoved: , ..., --------- ---- - ---
7N Apprv%imzfA.vOIvTxmQFIvMtcF reIinainIngEwa wr.-ff(.-.t), .. . ........
. .... --- ---------
FORWATE R SUFFILVIMIS ONLY'
7c. Type of dish-dectout usul-
7d. Amount of WAnfertant wmspd:
'le., Seafing mAterbris used (check A that apply)r
0 Nest Cerneal, Grout
Cl Benutafte ch4v are PrAlcu
r) f"Wid Coment Ofew
11 Dry MY
0 Conciew Gaud,
E2 Dwill Cumings
C] s][r.6ally rhoul
0 Gravej
0
[3 Other �,cxpkain under '7g)
Portland Cement 10 bs
7g. PmvrIdzs briefdemeripflon oftheshandowent, proxmdurQ-z
Neat cement funnieled firom top.
jP
Av 31,27123
e Ile d
Ryxq,noyg' heraby mrit,(y dw rhe ivcfit); was (wgrq) abandoned era
ceacordenrue wah /14 W.A(,* OW-311irM or 7C 4200 OW1 Cow."Iewan SeemdaMV
andibw &,j cvpyqfWr reronthaw been ps-evidexho the swil awirre.
9. ffitedlialram or addificimal MWl detailirl
You may pse tjNe badcW Ofis page W: Fiirovkle addifional %veR Me del -ads or weH
Awdon mcnidetafl,,,, You may also affach addftioasl pipes if"noemmmy-
sumurrm, M5 , EIRJ� MOSS
1 On. Subvkft thfis fitmt within 30 days of campletion of weH
absndownent to wbe W lOVO ng�
DivisOn DfWaferRueurces, Information Prom Wng Unis,
[617 WIMI SeMce Center, Raleigh, lb27699-1617
JQJJ:r, Eor Ift'tLLiou NVeffic 1haddifion to Sending Am roTm to :he at dress in 10&
abpve, also whowh one copy, of this farm kvUlmun 30 days of cornpletion or well
Bbandonment to the foJhw4qv,,
Divima" UfWftjCW.r R,,lources, Undergraumd Iqlecdoil C*60irtO lProgram,
1636 NIgIO' Servke Center, Ralleigh, NC 2'769%.1436
6& Oiater uslinp Wenrth (if kamvn): ukir10c. Abiqt—
=(es) above, a6m submit one copy offidf s orm WiMin Spy days of complrdun
of wLU abandontnent to Ow caunlY healfli dqw-ftnent nf the counky 10cre
6E Inner ca%ftNgftWag, tenpth (H IIMGWn)'BCt.)Aturdoned,
fieen [ength (9 known).
Rann Ca'IN?qodh CIMhna Deparoment af8nvu*nMvnW QuAty - OwWwl Of"ArstaRe"MurwN Rovised 2,22-2.W

WELL ABANDONIVIENr RECORD
1. WPH contrartor InfinMatilow
John 0. SchappieU
wen caYirwtor NNwmt (crftn ower pemwririAy abandaronswed c'm hwiNirmpeay}
2332-A
For Internal Use ONLY
W
7a- For Geoprotm.4M eir Claral-Loop Geotbermal Wells having the same
weilll ron-linclionedepth, iWy I GW-30 1� nsed(N-1, Indo.we T(TrA.LNUMBER or
weH&,jbandoiruq
. ............... . . . .....
remsifliar !in well(s)�
INC Wall cuarw-tor Ca kfiGattan RUM�,Wx
M&W DrMing, LIC
.............
Ill OR WAITR SU PPLY WEL111 S ONXLV�
- - -------
Campwwy Name
W10600036
L %UM Conflruction i N., __­­ ­ . . . ...... . .........
LMI all (4a (A", ("Ithloary, Sicw,, vanevice, era,� �J'Avof'qy
7d. Amount of disinWant used.
. .......................
I Well 'age ftheck welli nse)-
ateir Supply Welt:
daS'"Ung w9ferifiN an (Chmh OR 1hat appbl:
73Ap F]MumcipaMblhc
M Neat C'ement Gmul
0 Renkoeure Chips or Priff(rb
at TAIA ing .
,Heagxv,WCrA]ing RutTly) OftsidentW W er Su y (8 le,�]�
0 Sand Cement Ovam
") T0TY (nay
Olndm.gnallrarvsnarciali ClReiridtffmaN Miaver SuppW (shared)
E, (.1100cre, w Gnat
0 Drill rut6no,
[Trwalmn
U Specialty Ginmt
0 U.,mvel
Kon,Wster Supply Well:
0 3Gmtomfe 5k)rry
0 Other (txiiAaw ander 7g)
oAqu&r Suvap! Land Rm)vLry
rJAquiterTrrst
nFjrpwgmenbJTc,chn61oSy
3GffAhearr al (Ciimwd Lxiop)
4. We wcH(s)abaniloned- 312.2,12.3,
MGmundvitatra lternediatwn
E39ahruty Rw�er
1:.1St0TMW1rr Dmimige
0sahsidence COMA
ElTracer
00ther r,!xvhun ander 7s. a
sa, Well lomflon:
Fort f3ragg
Faw�vW IDA ffapphmble)
FTBR-089AMMU -69, boirmided lby Niox, 111itner, WoodMff & V'MitW S"'RUMI
Phy%W Adducss, City, and Zip
Cumbedaind
PwrA Hpwificarwv No RIM
W Lpfigudo and Wfligitude in degretilwhititar/seconds or decimal dquVes:
now
35,156296,35 N 7&98370154.
. . . . . ........ _­
LS_01, %V __L1 , LBEIM ARX�DCLNEB
69. well FEW: TA2-2
5
6b. ToW well dep4h.- 38,— . ..........
(k. 1kireboile diameter:
Ad. %$later Irvel below ground surfitce; _ ___ (ft-)
7E For mch material Wecfed 2bovp, provitle amnotint of materhals avul,
Portland Cernent '10 lbs
7g,. Pn)vide a bdd &-sewiption air the pirocedumn
Neat cement funnelpd korn tnp,.
8. Cc
3/1
2723
1,6%4 ".fc�! vd�wd &RbWAM! 0NA'eHChv= DVA
Ilysignuip , j1ps ftirm, I heir.hy a:,erijo dire the, wedft� wem (wce) a6andpoxed fa
drxyrrdana,,iwh 1Sd1.M('A(' 02C 0100 or 2C 02, 00 Welf C'vm
and that a ropy Rt firb rcrevif IM41 bovo rredvidedla 014, "W1 owyktr_
9, Site diagram or addRinoral vv(41 deTSM:
YOU may rise the 11i ninhis page to pmuie, addificnal %VaH sim deWLs or %vetll
abntidonmentdcraft, You mayahoaftachgddWarW pages ifuccentsitry.
log. ,tea LA�LW_WpAlp SubMit this fonn witbw 30 days of m4npkfion. of wdf
abandonawnt to dw follovOng
Divisism rif)Vstzr RessirrvesJulisroaaflon Proonsing Unit,
1617MA Servico! Ceawr. RAIleigh, NC 27699-1617
110b. fLrj1gLPq ' jvn RIP 19
In adtfifiron m ienchn die fhrm 1v fhe -'iddrms m H)a
Mxvve, Aso submit tine copy of Ifts fixiin within 30 days of comple6ion o0vell
almndonmem 0 die fhHoonng:
iffiAmuni of Wme,, Resources, Underground Injection 0)1atrnl ProVi trat,
NMI NOR sellice 2769,94 636
X& InLert-an We W addnftnu to jcM,nA*iv Cbnn to the
... .......
6e. Outer ening Wngth Oftnow4, addtc,,,­.,(es) 4Wvv, Mimw1smh one copy of this fonnnwithni 30 4,%vs ofromplebmi
of %v,;I, ahmidonownt w ohc county heaiish de enema of The cotuli)' w1here
6E Toner caMnpjtabing tength (if knowmi)a I ft.) abrandon-A
ui Rereen Jength (if known). . . ....... .
FMM GW 30 Ire eviswI2-2M-!,Nnft

WELL ABANDONMENT RECORD
I.Well Contractor7nftirmation:
John C. Schappell
Wd1ContractorName crwellowner ne abandoning property)
( petgo� lly abandoning well an hrslirer property)
2332-A
NCVVeIImm ..............-,,,,-
Contractor Certaflreoon Number
M&W Drilling, LLC
Company Name
7- Well Construction Permit #: ,W[0600036
l.Mt all applicable Ivell comrtvenonpermttr (ee. Urc. Carnrty, Stole, Variance, etc.) fkawtrn
3. Well use (check welt use):
..... ........
Fen Use ONLY
_. ...._
WELLABANDDNMLNT DETAILS
Ia. For Geoprobe/DFT or Closed -Loop Geothermal Wells having the same
well canstruction/depth: only I GW-30 is needed. Indicate: TOTAL NUMBER of
wells abandoned
7b. Approximate volume of water remainingiiwell(s): , (gal.)
FDR WATER SUPPLY WELLS ONLY-
c T, a of disinrectant used:
7d. Amount of disinreetaat used:
w i.. .......................
Water Supply WeI[:
7e. Seating msterials.etsed (check all that apply):
OAgricultural
0MunicipallPublic
s Neat Cement Grout
❑ Bentonite Chips or Pellets
OGcothrxmal (Ileating/Cooling Supply)
OResidential Water Supply (single)
❑ Sand Cement Grout
O MY Clay
❑Industrial/Commercial
OResideatial Water Supply (shared)
❑ Concrete Grout
❑ Drill Gaming$
OTrriai ^ation
❑ Specialty Grout
❑ Gravel
Non -Water Supply Well:
❑ Bentonite Slurry
O Other (explain under 7g)
❑lvlonitoring
MIR-very
❑Aquifer Recharge
®GroundwaterRemediation
OAquifer Storage and Recovery
CISalinity Barrier
❑Aquifer Test
OStotmwater DndrAge
OExpedmentalTeehnolggy
OSubsidenceControl
OGeothermal (Closed Loop)
©Tracer
❑Geothermsl
rtder'7u;I
4. Date well(s) abandoned: 3122/23
53. Well location:
Fort Bragg
Fecifi 10Wner Name Facilitrf ty ._. ty 100 ( applicable)
FT8R-069/SWMU-59, bounded by Knox, Butner, Wocdrulf & Varsity Streets
Physical Address, City, and Zip
Cumberland
County ...__.._._.... �. �. ..�..........._.............�, � �.
Pa=lldentificationNo (PIN)
$b. Latitude and longitude in degrees/minutes/secaods or decimal degrees:
(ifwcll field, one lattlong is sufrcient)
35.15629580 ,,,-78.98373708
M Far 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.
8 certifimmm no �� "�
3127/23
Signalgnan'rtc cfcertifred Well Contractor or lr�
�.w.. all 0.� ---•Datm
-..- By.pfgnirig that form, I hereby certify that the welf(s) was (wer4 abandoned in
accordance with 15A NCr1C 02C _0100 ar 2C .0200 We11 Consrrrrcrran Standards
and that a copy ofthi.• record lros been provided to the well oivner
9. Site diagram or additional well details:
W You may use the bads or this page to provide additional well site details or wel I
abandonment details. You may also attach additional pages if necessary.
CONTRUCTION1RK1 JS OF WELU$1M9A tiP Nj,DL
AtnebWall cominfclonmmd()tfan ahra FarinrdtFpleInjecttonornan-itaterrupptywelk
01QY14th Ore same c"inwtoWobandanment ymi ron submit rmefw
6a. Well iDN: TA2-1
6b. Total well depth: 38.5 (ft.)
6r- Borehole din meter, 0.75 (io.}
6d. Water level below ground surface:
SCTBMIii AL IN T1CTrUNS
10a. For All Wells: Submit this forth within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing [snit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. 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 following.
Division of WaterRrsourem Underground Injection Control Program,.
1636 man Service Center, Raleigh, NC 27609-1636
6e. Outer casing length (if known): _ITITIT IT, (ft.} I lie. f•or Water Suooly At Tniection Wells: In addition to sending The form to the
address(es) above also submit (me copy of this form within 30 days of completion
or welt abandonment to the county health departmetd of the county where
6f. Inner easing/tahing length orknown): _m _m .. (fw) abandoned,
6g. Screen length (if known): y _-- _ -. � M)
Fomt Gw-30 North Carolina Department ofEnnronmenlal Quality- Division of Water Resouters RcYhed 2-22 2a16

WELLABANDONMENT RE, CORD
1. NVeH Commetar Infismatiam,
_col-m C, Schappell — --------- Trft'A;h�imm (Cr WrU a abandompSurfi un h6vki pmptny)
2332-A
'N'r WeR Cornaam CatificiumNombm
M&W Drilling, LLC
— — ------ -----
2AVeH Construk-Aen Perink #., WH)600036
LoRl &I appikabro mwdl cansfrucivolmimi
3. %V00 use (checkwell msej:
N$rmer SUPT#y Well:
E.".MunicipWPubhc
I -leatin C!oo 'n a a
I , ling Siipp�y) nResi& ki � W ta SuplAy itsir
1V
OR csidemeW Westv Supply fshareA)
2:12-11ni n_
Nes , ..Water Supply
Clfi.quiLn HC aas fwuep e Groundwer Renwdiauop
OAquifer Stmige and RMOVCF� CiSalinit, HaitiLr
V
ClAquiferTest 10slow"mater maimse
0Ex'PmhmCnu1'1TedmMo&y MSubsidrxs=CanfraD
01'racer
Rztum4 i"iOdier feqkur urdar7p,i
3122/2-3
I SA. weh H01"Sfilsm
Fort Bragg
F'WAAY ITU ffapphcmblle
FTBR4894WhAU-69, bounded by Knox, Butne'r, woodn.1% & vargly stmmft
ph'p�iml A.Aditso, City- AM Z;P
Cumberland
Pivoel WnufivOmmNo MIN)
Sb. LaCkade and lmagimde in nDa f eesfasefuaualta fxeaaucaaHs or dexAmM deg. mg'
q if w.,O A . W,,me latAmq; is mdriam"'I'l
3615481446 78,98276512
.. ...... . N
g,-Q Uk-IL 'N g HEW AmmP Q.T.11.2
jk __ AM
'19forb wil r.muln'Coor rex'anl(k) 1.1o" makdPre 110droO OP #Pjn NWAW Tire O'W
ONLY'lorh
6x.'WelllD#. TAI-10
50
6b,Toml,%441 deplh..11,11111.11, ____ RL)
6c. Boreho k diamt.4er. 0.7,51 —00
6d. Water Irvel below ground mirface-
g
Rr tnfanmiA Chic ONLY
Y-MUL"D Imm—HEN�rDETIVA-1
7a. Fog, (,,'Ieoprobe/UFT ar Close.4-Loop Geolberami'Wells baymg the SUATIf..
w6l eanqnxfianidepP_�, oq�y. I CmW 30 rri, nmded'r fndicate'TMAL N UMBER of
vyeUs ahagwdrmm�d, - -1 I'll, "1 ­11111111111111-1-­­
Ti.kApprounsate Vale Noe of WATer rem ildmilaz hmell(s): .......
%Type of dL- infeclant useM . ......
7d. Amoll 01 of Asinfew ant uried . ...... . ........ ....... ..
7e. Seating mptayiels ased (ebech all thutsppdwr)-'
R Nea (14mcm Gaow
C.1 Hrwvaruw� Chip.m Fdhas
E.] Sand Cement Gmut
C' D' Claq
1"I Concrelc Ckatik
0 Drill Cial6npp
J srulcialq Grouv
0 Gravel
U BentamteSlurq
D other uexplain imder7g)
it Farmh materiel selmwbd albove, provide mo one of materials imse M
Porfland Cement 13 lbs
'T* Provides bdefdrseripfion uftW Abandonment Procedurm
Neat cement funreW from top.
CICS11111 $0
3fo 7/23
WIWI Cmeaeupror Vell Owwr Date
qv sU� -e.p, thol 1)ye jjqzlj�f) was (%%no abano"Poled'sn
gning Ads ffinyl, I himd.y c,�q
ver.ordapicc Web JJA N(A" 02C..0100 or A", Q00 HVpff CrmumUmnSlandaraix
P'6ieprd harr 1JILNm provjdofl In dw Weil v wner.
or addifional wrl� dekafls-,
You Trial, use the back of thm page M Provide aWMMIM Viull Ske, kwh" 07 well
abarodmi ment details, You may Aso ailach a4dfOanM Papm- irnw=45WY,
1 oa. SIA,bmg this fimm willhin 30 ckys of Camplenon of well
abandonmem %o the., hHomans,
Divi�iqir* ofWater ftmurees, Information Proc Unit.
1617 MaH Sea ice Center. Hakigh. NC 27699-4 617
101)« fjr lnjecag —Wells, In additm to seading The Fbim to the addms,,s in 10a
4W N4 dtin.30 days ofgxmplem k3FWCl ,Abmrc, also suhmit cone uiM Fam w n
almdoment to dic tehllnyhn9:
Division orwaerInjectionConty-0 Progrom,
1636 Mail Service Cinder, Raleigh, NC276994 06
joe.EpLW ln zddNbon ka seading e room w the
6e. Outer casing leagib Or kmown)a __Jft) !
aWrmsies) above, ahs ;uhmft one copy, of��h�s J.'bnn wil.Mn 30 dalm O'compkAhon
of weH abandonment To nhe coiuMi health dem-nment of the cx'sUmy Mmrc
6E lameressinr abancbmed
ftub-Nor
6g. Scregm lenir �tb0ftnown):. . ........
FWTH Gw'W Nmth ("amhua bmman Qfwale. R=011AIrms Revmd Z. 2Z 2016

WELL ABANDONMENT RECORD
I. Well Conlraetorlyd'ormation:
Jahn C. Schappell
WellConuacror-m-w-(of wellowner personally ahandotw:awell anhislbcrprogeny)
2332--A
i�4 Wdt Conuaetar Ccrti€tcWiaa Nurat,
...••.
ar
M&W Drilling, LLC
QompncyNe,rtt
IWellConstructionPermit# VIIIQG00036
List all appficabta well awnw0bli penwft (r C. MC, OWAV• &ate, variance. am) llItz "M
3, Well use (check well use):
CAgricultural umunicipallPublic
❑Geothennal (Reating)Cooling supply) ❑Residential Water Supply (single)
❑lndostrial/Commercial ❑Residential Water Supply (shared)
❑Aquifer Recharge sGroundwaterRemedistion
Mqujfer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geethemlal (Closed Loop) QTracer
4. Date wells) abaadoped: 3/22/23
ForLaernal Use ONLY:
7s. For GeoprobefiPT or Closed -Loop Geothermal Wells having the some
well constntctionldepih, only t OW-30 is needed, lndicateTOTt -NUMB$R of
µills abandoned:— ....1
7b. Approximate volume of water remaining in well(s)g
I
FOR WATER SUPPLY WELLS ONLY:
7r.Typeofdisinfectaatused:�-, ._ --_.-
7d. Amount of disinfectant used:
7e. Seating materials used (check all that apply):
Neat Cemenl Grout
D Bentonite Chips o: Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
13 Drill Cuttings
❑ Specialty Grout
❑ Grovel
❑ Bentonite Slurry
❑ Other {explain udder 7g)
7E For each material selected above, provide amount of materials used:
Portland Cement
13 Ibs
7& Provides, brief description of the abandonment procedure:
Neat cement funneled from tap.
sa. Well location:
Fort Bragg facility
_.�....... � inn: I
a� S. �mfir� 3127123
FTBR--069fMMU-69, pounded by Knox, Buingr, Woodrufff & Varsly Streets � ,m.
a
t
Physical Addm3.%Cky.and Zip .........�.. Si nFCenified4VnitCnouaetoror�"w•h"ellOumer slate
Cumberland By signing Mts form, I hereby mr10 that ilia wel1(s) war (iwm) abandoned in
Cau„ty raraal identiacahon Na (pl;`1) accordance wilh 73A JVr-4C> 02C .0100 or 2C.0200 Well Construction Standards
and chat a cape r+f thir record has beer: provided to /he well owner.
Sh. Latitude and longitudain degrmlminutes/seconds or decimal degrees:
(iftvoll Field, ape Wong is sufficient) 9. Site diagram or additional well details:
35.15484078 N-78.98279831 W You may use the back of this page to provide additional well site details or well
_._. abandonment details_ You may also attach additional pages ifaocessary
At! h oclliDeecaT� OT VYELi ($,) BEING ABrU!jlN,1rcN 1,
wwllohl�, I'ariurdlipleinjecalr,rrarrrx+-warersupplyu''fig
O(Y7.1` rwth !!rc some caftslrurtianlntxmrWnnrear, Sinn eansuhmL one jean.
6a. Welt lri#: TA11-9
...
6b.Total well depth: 50
bBoreholediameter: '7
n
6d. Water level below ground surface:
M ALINSTRUCTIONS
10a. For All Wells; Submit this form within 30 days of completion of well
abandonment to the following:
I:);vision of Water Resources, Information Processing Unit,
1617 Arad Servim Center, Raleigh, -NC 27699-1617
t0L Egr Inlection Welts: in addition to sending the form to the address in IOa
above, also submit am aopy of this form within 30 days of completion of well
abandonment to the fallowing:
bivision of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, :VC 27609-1636
6a Outer casing length (if known): ._, iOc.For Water Supply & injection Wells: in addition to sending the form to the
(R') addresses) above, also submit one copy orthis form within 30 days ofcompletion
of well abandonment to the county health department of -the county mvl=e
6E inner casingftubing length (if known): �„� � ,,, � ..............(R.)
abandoned
4 Screen length (f known)= 9...._. W................ . m. m., w...-.-,.....................
(fr.)
From GW-10 Nanh Carolina Department of EnnronP=. 1a1 Quality - Division of Water Resources Revised Z-3=-'616

WELL ABANDONMENT RECORD
L Well[ Costractor Informstion:
John C. Schappefl
T1.1 "C-L'I I C,t—or
23:32-A
NYC %Vou Cmarmlor Cursfiewinn Nuadwr
MMV Drffling, LLC
W10600036
. . . ........... . ...
L&I aft appIscoNe, uleft w4unw"dion Permits eix, UIC Calmly, Xffdope,, Vorwh.w, ek.) 0,krim,
3. well use (cheek well use).
McolhermW ('d`dealir%iroohng SUPOY) GB esidernial Wattr Supply (Tiinglr)
'..11miustriavcOmmemial oRtNidenfitJ )TYatex-SuppOy (sharedi
Noa-wkler Supply WCU.,
0Aq.W& Rmbargp
M- Cro Rind %ra te r Re medi xi a R4
ClAquifer Siorage ard R=gvcry
Osafirky aanils
C Aqw fil 'Test
[281onn%vava Dramage
, awns netrtatTeri notgy
rISUkxSKkflW C'rtntrol
C3GKAhmnv.fl 'Closedl.aopj
0,PF8CLT
u-Irlmffllermal I l� aallXvofirw, Ralut r
00thert(r, pknp uader 7g)
s. Tbae abandeacd, 312)2123
so. Well 110c"fiouR
Fort Bragg
M For WemW Uw LY
79. Foir Geopm1beINT or Clwwd LOOP C-folherM21 Welbs h3VH%lhv!WnC
NveH rxigual ruction*P1111- only 1 Gkv.30 ts needed InRficate'r(MALL NUMBER Of
,WUs ahanAnned — 11 . . ....
7h. Aq PVDOHSTC VOWIMC 0 ( WSW rem Alaing in Nwellfs
- -- ---- --- -----
11 RWU'ERLSVPPLYWELES0N]'V-
7C.'rypeof diAtIfectant user ,—
Id. A•moqwyt of disink4ftaint use*—.
. ....... . .
7m Staling inAtiriAs qstd (ch0k all 111hal SIIPPdY)u
14 Neat Cement Grotd.
� 13Rnji(aMt Chip, or P01W
D %and C'men, Grout
0 Dry MY
o Conemm Graw
00 DdIl Cuttines
E."I sp=iah), Gfola
0 Gra% d
1.3 HentaMe Slum
M Oftf G "Plain under• La)
7E For exch goalerial sekxte4P Above, 110MVidealgle"MI Of gnskeriats, u&ed,
Poirdaind Cement 13 IbS
7F g. providp, a bwiefilesewiption al'the abandooment Procedulyn
Neat cement funnel q 'frolrrc top.
.......... ..... --
ranAmf 00 M q*4TV4W,:)
F-II'MR-001SWIM-09, bounded by Knox, Butner, Woodrulf & VaM4 Stmm, 3 3127/23
. . . ......... ---- . . .. . .....
Mk"kA I Add=a, City, and l��tp ii'd
CurnbeHaind 43d sirgaIng, 1111.1 f0n", f keeth ex"raft, Mud guarWC111(s) Wax (Wre)
PmA Tdmt4"um Na (PIN) wolo 714 NC.4(" A2C.',QV?0 or 7f' 'nWO 01oll Coamracipon Pandardu
and Owe arc c-q�r , (y tho rarand bag, bdwPzpP,owdo&rFj Ahe mill owftw.
Sh. Latitude. and longitude in or dt6mW degrwsr,
(wwcq ndd, atu, U.Uii4 ez suffiO@TO 9. Site diagram nradMfinual wtH deWb:
35,154867(0 -,.. M98283217 ),On njay w� e tile, W, I& of t�,jis page in provide addRtional WcH site details OF wet l
I'V Fg-wdonmenAdelaft Y0anIIY,'
J99 &Ptmch iddwuonal pages if nazirrzary
()N S-M GMIM 2F�TA IL&O
&A. Well 11W. T�Al -8— . . . . ......
50
6b, Tots t well ideptb'g
075
ew. Matbolk diamder. ' * - _-jinj
&0. Water level hekm gmind �,iuwfkcv . ..... -jrf-s
5VIBL ITA'.1-INSTRU MnNk
lfta.,EU -
Submit Ofin tbun wihm 30 days or cornpwian of well
gibmWonment to lhtl, 17011Dvanr,
DiviMon ofWaker ROMIATCeS, IUfQIVWRfi0n Prft(% INLK IWt,
1617,Madq.Service Center, PwWgh, WC27699-1617
lob, fair twnfieeduua14_ft .LI_s. qua additRon w seneang the fom to the adduress in 10a
alme, also "abnIft one Copy of qW., ibrM %nhin 30 days of Complefino of vVeli
ab=d9gvmwRI to the "MoMmr
Division of Watru, Rf.sonrem Vadiergnwad hi)ection QWrol Program,
I 6'M Ma H Service C'.P.n tm P-Aleigb, NC2 M199-111636
6e., Outer casi ag twgth (ir know n):� (A.)
N' neli aNindlixonent U) Rhe county hcaldi de;xtrhymi of thr countV -heIT
6C Ineez-vuing(tubiny & abandoned
, length (if known); ---( )
6P Screen length (if kAfiWM t,.' - .......... - - - — --------- 00
Funn 13W X0 Rcvmwl ? 12-2416

WELL ABANDONMENT RECORD
L. Well CoatraetorInformadoo:
John C. Schappell
Well CortroctarName (Orwell owner pissaaally abandoning well on hisarer property)
2332-A _
NC Well Contractor Catidcation Number
M&W Drilling, LLC
CompanyNaroe
2• Well Construction Permit# W10600036 a
List oil applirnbk nellecnrprrcl+aa prrmin T,e UIC COrmv. State. vane— etc) fkn -
3. Well use (check well use):
❑Agriculaml
❑Geothermal Wesdmi#Cooling Supply)
owustriallCommercial
OAquifer Recharge
[]Aquifer Storageand Rwovery
❑Aquifer Test
❑Experimental Technology
oGeothamal (Closed Loop)
4• bate well(s) abandoned: 3/22/23
13MumcipaYPublic
OResidential Water Supply (single)
EIResidential Water Supply (shared)
INGroundwater Rcmodiation
OSalinity 4arrier
O5tarmwaterDmivago
©Subsidence Control
❑rraccr
00iher tet:nloin under Tel
5a. Well location:
Fort Bragg
FaedtrylOwnerName .... .�..
...... Facility 1Dlt (if apPliWble)
FrBR-0691SWMU-39, bounded byKnox. Butner, 1Naodrulf & Varsity Streets
Physical Atiftsa, City, and Zip
Cumberland_
Cauary rami Identiliazinn'slo. (PIN)
Sh. I atitade and longitude in degteeslminuteshseeonds or decimal degrees:
Far Interest Use ONLY
WELL ABANDONNIR+VT DETAILS
7a. For GeoprobeJDfT or Closed -Loop Geothermal Wells having the same
well consttuctionidepth, only 1 OW-30 is deeded. bullicate TOTAL NUMBER of
wells abandnnerL ..... .., ._.,._
76: Apprordmate volume of water remaining in wetl(s)t _ _m� , _,(gal•)
FOR WATER SUPPLY WELLS ONLY:
7e. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Selling materials used (check all that apply):
B Neat cement Grout
Cl Bentonite Chips cr Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
17 Drill cuttings
❑ Specialty Grout
❑ Gravel
❑Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Portland Cement 13 Ibs
7g, Provide a brief description of the abandonment procedure:
Neat cement funneled from top.
S. CEr:i($cation: N
31271'23
11111111
rater ofCerhfiedWell Com wtrarort allOwner - Dole
13y signing this form, 7 hrrehy certify that the wells) mw (were) abandoned In
uctnrdame with 15A ACAC' 02C.0100 or 1C .0200 Well Construclrrm Statrdimhs
rmd that a copy of this record has been provided is llte weU owner.
(tfwell field, one 1WAorg is suffictem) 9. Site diagram or additional well details:
35.15489643 -78 98286i067 You may use the hack of this page to provide additional well site details ar wall
,. ........ N ��-- W abandonment details. You may also attach additional pages if aecaNW-
CMSTRVCTIONMrAIL40FWELL(S)BEINGABANDONED SURMITTAlINSPRLICTIONS
Aaachnetleonsrntetlar,recard(s)ifaV0MUhte. rOrnrulNpteinJeutanortwa-iralcrsNpptp+tells
OIV1YwitbNoeyppieccrrrtntdtoroahandolrM¢1rG lDRransr7MritarrefprPt 1%. For All Wells: Submit this form within 30 days of completion of -well
6a. Well FDO: _TA1 _7 ......... _ E IT. abandonment.iothefollowing.
6b. Total well depth: IT5 (it )
6c. Borehole diameter.. 0„'75 (in.)
6d. Water level below ground -surface: �.._,,, ifft•).
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
lob. Forrn'e�et(od Wells: 1n addition to sending the form to We address in 10a
i<bove, also submit one copy of this form within 30 days of completion of weal
abandonment to the following;
Division of Water Resources, Underground Injection Control Program,
1636 wail Service Center, Raleigh, NC 27699-1636
Cic. Outer casing length Of known): __Aft-) Inc. For Water Supply & Injection Weill: In addition to sending the form to the
address(es) albove, also submit one copy orthis farm within 30 days of completion
of well abandonment to the. county health department of the county where
g S (known).,,—, (fl.) .abandoned
6f.lnnercasur Lubin length (if ,_
6g• Screen length Of known);. ....................... ____......��- O
Form GW-30 North Carolina DeWrneot of Environmental Qualily- Dittman DfWater Resources Revtsod 2-22-2016

. . ............. . . . .......
WELL ABANDONMENTRECORD Fm lwarug 11scONIA
MBLL, ABA h7DO�_JNMLN' ' P _ F.FAU—
John C. Schappefl 7a. For Geapmbe/DPI'or Chwf-lAup Geothalual Welk h R.M.09 dle5amc
lndmate'r(.)TA,,'I,NI.HABERilk'
F2332-A 7b, Approximate volume of water semaining in iveR(s):
qv-%71� q-poanar —ren, ficaftab N %iinba
....... . ................ .
M&W Drilling, I I C F UR WA Ir E R 8 UP P1 � V W I I E L 1 A (NN Lk%l
Cwnpany Name W10600036
2.. A'all construeflon Permitoo, - I I 1' -1-1-11---.-
LYN# Aff. CMC� Slate, Avrowwa, ekj ffkwua 7daAmmwc of ffiawfixiant med: . .... .
3,. Well ase (chimk well usey.
W-0 . ........ .. '7e. Safing wateriaLs osvi febeck Al that nppNYD'
Mgrieuli,VW 0 New. Cemt-w CM)ut [I I. -le r.'hips or peflels
Dacotberinal (HewigqOCoohng Supp�y) [Mirsidential Winer Stipply dsmxk) D Sand Cement G90W 17t Dry Clay
ciResidenual Waier Supply E.] Cor-ete Orout 0 DnH Cuflin&n
El spezialh, Grout Ggavd
NORAVAter Supply Well: 0 senEurflTe s4lny D f0wher (explaw undcr 7g)
0,Aquffef Rechaq.le
LlAquifer Stordgeand Rwxawm)i
[lAquiferTes1t
OEXPaWexlW Tochnololgy
_lGeolhermal (Chised 1,0(41)
4.DR##.-wrM(s)ah9x%d9Aedu W2203
MGmundiloater ReAte6afim�
ostolly1waux Drainage
F.] Subsidet= Contol
M"racrx
5 1 %'Well jamdon;
Fort. Bragg
FrBR-0691,51MMU-839, tnunded by Knox, Butner, Woodfuff & VarsRy Sheets ........... .
Cumbedaw,id
NVM Id"Wk.1kian No (M)
r - Tafibide;had WaSitude in Aegreeiijujoutwisecandq or decimal d,Wrfts
,jE For each terials uim , . ekd aljove, prot4de amount of nAa d.,
�::Iorfiand Gement '13 lbs
7* Provide Na brief description of the abmideament praceduvn
Neal't cement funneled from top.
3137/,23
dnsfilrw, I mreraf# v vertij)p limit the Vverift) Wax (Were) abanderwed in
ac,cardance t,,Wh 154 AVACON"..0106 or 2CA200 Well OmstruMon Standards
andrjust a 6-,Ppv qfMfre, recce rdisog bwnpnwwetedlgo the well own, er.
�JwOi GvW, ow bdto,,-s lufr=M) % Sitediagram or additional well defxib.
"MRE,2891 85 you may use iyg& of tbEj poge, to prav�& mj4.ftwnsiwvrH ate detffiLs w well
35A 5492493 N "' flbandanmentdeta0s, youmavaiso attach ad&onal pages ifoccemarY . . .........
Lok.5:r EING S1G7Bmn'T4L INM V37
QVQ Subuift this fbnn withfis 30 dqy� of uvnipladOvi of" IveH
68. Wal "rA 1 6 abandonment to the fhU1-,YNt-iY%
0
6b.'otabVell deptt", 5
r
6c. Ranihole tfimneler: An")
6d, water. ieve kvdow grouncl marface. ---.(N
Dheklea and Water Revjurce.,% InfDrrmalion PrOOM10109 Unit,
1617NURI 'vice ((enter, Ralkigh, N(7 27699-161?
ob, at ftaiggA %Ve&su In sddman W ganding dw- fami lo clue addraSs M 03
,above, aW subndi, one impy of tho fmm waRun 30 days of campff.'Aiiia Or WeR
,+.,mdonmewd to die folbwiag
INvision ofWater Rmarcm% UndergrOaDd NeCdOR COOMWI prGIVRUL,
l636%Mj;tjj servie.e Center. Roeiph, NC 27699-1636
lee., &LnLq!%#pn W ., �n Wkiman to swding the Ram to the
6L OUNM 1-2MRR Nblith (if kROWU)- addrcnqcs) above,, albo submit ayu. cop AMA
V of W,,; rwrn wiftn 30 bys arennipN000
aA' wf.Al abandiinnient to ilia cowity heafth dqyamnenz iff flic eountv wbcn
6f. ["am, casbr/MvWag length (WicnWWO)l aband.oned,
6p, Hkvean fength Rif kaDwn)i .......... .... . . ..... . —I
G)V-30 �,Oqju cfftaNq,,, Depwi'vient, NFEgWW0TYnWATuA Qwhiy - 2. =NW14

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John C. Schappell
Well CanoactorNannt (Orwell owner personally abeadonitewell on hWWrpmperty)
2332-A _ _
NC Weil Cnntmwttr Ccnifioalmn Ntanher
M&W Drilling, LLC
Company Name .....� ...... —
2. Welt Construction Permit #t .W10600036
Lot all aplficable t+el! MnslrNCtlon permits (Le. (lit , Comity. Slate, Fai7nvr
3. Well use (check welt use).
For tnrereal List amtr�
. . ...........
WELL ABANDONMENT RETAILS •...._ ..�... .,_ ...
7s. Far GeoprobeJDPTorClomd-Loop Geothermal Welishavingthe same
well construction/depth, only 1 OW-30 is needed, Indicate TOTAL. NUMBER of
wells abandoned:. ,,,,-- —� w . ,
7b. Approximate volume ofwaterremaining inwcll(s):,, „„„, _ ,(gal.)
FUR WATER SUPPLY. WELTS ONLYs
7c•Typeofdisinfectantused:
ijknamw�
7d. Amount of disinfectant used:
Water 5uppiy Well: —-
.......... .......­
7e. Seating materials used (check all that apply):
OAgriculttual
17M=dpal/Public
IS Neat Ccmen( Grote
❑ Bentonite Chips or Pellets
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
n Sand Cement Gmul
❑ Dry Clay
❑lndustriallCommercial
❑Residential Water Supply (shared)
13 Concrete Grout
❑Drill Cuttings
❑lq!vation
13 Specialty Grout
❑ Gravel
Non -Water Supply Well:
El BentoniteSlurry
❑ Other (explain under7g)
0Aquifer Recharge
❑AquifirStorage and Recovery
OAquiferTest
❑Experimental Technology
❑Geothermal (Closed Loop)
eGroundwater Remedistion
❑Salinity Barrier
❑Stotmwater Drainage
❑subsidence Conhol
❑Tracer
thcgtttel (Realm 'Cooltne Return! ❑Dthtt(e�lttin under
4. Date well(s) abandoned: 3/22123
5a. Wall location!
Fart Bragg
Fnedity(Owner Name Facility M4 (if applicable)
FfBR-MISWMU-69, bounded by
Knox, Butner. Woodruff &Varsity Streets
Physical Address, City, and Zip
Cumberland
Cotmty Parcel Identification No. (PIN)
5b. Latitude and longitude in degteeslminuteslsecands or decimal degrees:
(ifwill field, one laWorg is sufficient)
35,15481803 N-78.98279831
7f. For each matetial selected above, provide amount of materials used:
Portland Cement 13 Ibs
7g. Provide a brief description of the abandonment procedure:
Neat cement funneled from top.
8. easion:
m.mmm_ ... 3'll127/23
StanatuuteafCenmfied WcllCon tarot ea :•.��.•����� _ . Owner Data
B.v signing this farm, I hereby cvrtify that the well(() rues (iiiam) abandoned in
uccorddnm with 13A N( 4C t12C A100 or 2C..0200 Well Comt,action Standards
and that a aapy t+f, this reivnivl iras been provided to the well owner,
9. Site diagram or additional well details:
1Y You may use the back of this page to provide additional well site details or well
abandonment details, Yommay also attach additionatpalm ifnecessary.
CONSTRUCTION DETAILS OF WELUM BEING ABANDONED
Attarhncllranrinrctianrecvxl(s}rjayaila6lc Fbrnnrpiphttycciinnorrwa•itatersnpplywc/Lr
ON6Y101 rfir•some canrtrrrcrior,faGandnnrnenJ, yan can nibarit arse fmm
6n. Well ID#: TA1-5
6b. Total well depth: 50 _...,.(ft•)
6e-Bamholediameter: 0.775 _—(in.)
6d. Water level below ground surface:
SUBMITTAL INSTR ICTI S
1.0a, For All Wells: Submit this form within 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
10b, For [niection Wells: In addition to sending the fort to the address in l0a
above, also submit one copy of this form within M days of completion of well
abandonment to the g1iwing:
Division of Water Resources, Underground Injection Control Program,
1-6367*11ait Service Center. Raleigh,NC27699-1636
6e.0uter easing length (if known): (R,) Ne. For -Water Suaaly & laiection Wells: In addition to sending the form to the
address(es) above, aM 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 casingltubing length (if known): Ift.) abandoned
6g: Screw length (if known):. ..... .. ................_ ., _� fft.)
Form 0 W-30 Nonh Carolind Dcpnrtment of Bnvmnmenvd Quality - Division of Water Resources Revised 2-22•2016

WELL ABANDONMENT RECORD
1. %1WIP'll Contractor Infora2gh"01M.,
John C. Schappell
WPM Covarader Name (orm-.9 wmwrrwmxfly abandunmSwdl on Wher pmTrm,)
3.....
NL. WeR C".icniaa NunhxT
M&W Drilling, LLC
1 Well ("UmAraefior Pernik #- I WI06000.36 .. .. ......
J'Bar rill afvficable or# ar. Fj'IC, C.'banir Same, Ebnzw.e. eee,) wfkoensw
3, VVell use (Check WCM Unp);
FAff lawmat Use ONLY
7& Faiu- (.,oFwspn)bPJD1T or Closed-L.00p Geothermst'Wells having the, same
well ongy 1 M-30 is, nm.led, Indicak TOTAL MIMBER, of
we'11%
FORMATER SUPPLY NVELLS ONLV'
7r-Type0disinfectont, used."--
7d. Amoul of disiarms.ant. RAmid:
— -------- 7e. SWIng, materials used (chock 0 thal zipply).
0Af piculrural 19 Neal Cement I moul
supply) oResdenfial warm ISUPPIy ('11ml; -) 0 Sand cmmt orou! n Dry Chly
M nResideriond Wmv Supp)y (51mm-0 Q 0XIMU,'09'00 C.1 Dfill C.%at dngs
2 Ggavel
C5 sf'mcaafty Chm.ft L
S-a—ppily W—eff: 0 Bwtonfte Squaur R-.,i Otier (expWn ander.7g)
OA4uffim RmImugm,
.n Aqu NCcr RoiAge MA RLOODVCryy
M r
ArqpifiwTL mt
rDEmpumrnt-A Technology
ClOmtheinmT, (Closed Low)
4. IDate well(s) Abandoned, 3122/33
So. Well location.,
Fort Bragg
. ...............
sGuntridwalet kmodiWan
n8formwa&x DrswAge
C"Mubsidence Comm al
0 fra"V
EX-Mer a mnrqua a Under,%
FwAily IDY Of-whpable)
FTBIR-MOOMAU 59,, boundird lby Knox, Ba,gb%er, Vftmdruff I Varsity Sfrw—s
Mwmv'M Addnnm 0N, wd Zp
Cimbedand
CGURWY
peml Wf"'Pv ficsfion No M10
Sh, LoOkide mid lom(ARLUde inn degms/Wautishecond% or deciffial deArm::
dd WA rvtd' are„. Worw, is
M15484242
-78,98�282915
6a. Well IDN: TAI 4
51
6b. Total we,,H depth
Ems, HOm4iole ilia melco'.1
mend, Vlratff' damned lockm praund surfm:�v-. ft.)
"M F1Dr emb guaft Piet wlecuml. abivve, provide amount of mater419 ased,
Portland Cement 13 lbs
7g. Provide, a br4fdaseription of !he shandeniment Immeduft:
Neat mmeat furineled frolm top,
3127/2-3
4U,
. . . . . ...........
8y mgning 9141 fimm I hereby irwrlify 11tat she wed(T) we.; (lorre) abandoned in
as awnrrine:wrre:°u wilh 15A RVAC 0)(" ARMY or 2C 02.00 WWI C'mrTmemoo SfundurrA
x1ridd,V4111 c'tgry ark dus rem".1bim beva,pre"iekdeo dye ewe dziwner
9. Ske diagram or a4ftoasl well delaRv-
w you rnay i2se dw tydci or tws page to provide ,. df.11tiiRIZA *eflshc deatib or %,(all
dyandommAdtladr You rnay Aw aftaph addifional ymacs Omvcw"Y,
.. ...... ..
J(hs. EqLAR_W Clhu Submit kNs fonn %!Wn.':0 dayr of cawrl)Wian Of wafl
abandoment to the ffiflowing,
VMWam W'Wafler ResmArcem, Infannadon Procasing Cimh�
1617 Mail Servla: CiDmtora RaI6,wVVC27699-Ml7
I oh. ter !p mztng IV �� In aMOon 4o smd�qg ffip fono W rh ', min � jL - -� e addm" 04
above, Wow subyyM. ane mpy oaf dRis Whrm wWun 30 days, al'completion of,we N
abandonment to the 1,"Mbmng:
nhishm aWater Remarces, Underground Rajection Central Prnrarw,
1636 Mail SerdeeCenter, Raleiah, NC 2'7699-1636
OQ Egir waltr. SalJ�jlV IIJW too Welb: In wMition io wndanj!' the fbim w she
--& --- jedL_
Ge. Outer casing liguTt.1 (if kimwvi)� I adrr-m,(rc,,) Owe, alm Nubmid one- copy of this Amwilhin 30 uapinfcoynpletwan
of well sbandommi hi ffic 4°4)onphosIgh kPorimml Of the Mumv MMu,
6E toner csMnW!Wb!ng leng4h Wif knawm)n . .. . ........ . ....... . ........ 91bandoned
Fenn OW-30 Nodh Camhns Diew.mlymm of (,-.'mviir*nmnW Quahty - Drnswo OMMM'Re-Murcem Re%igcd 2.22-2CH6

WELL ABANDONMENT RECORD
I. Well Contractor Information:
John C. Schappell
Well ContmciorName (or well owrrer personally abandoning well on hidher property)
2332 A
For [r3emal Use 4Nl.Y
WELL ABANDONMENT DETAILS,
7a. For GeoprobelDPT or Close&Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 isneeded. Indicate TOTAL Nt7MBERof
wsllsabandonetl.... .-.._....... ..
..
NC Won ContradarCaaficauon -Number 7b. Approximate volume remaining in wcll(s); al. MRW Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
t:amparry Name
2 t#
7c. Type o f disinfectant used-.
Well Construetioo Permi
Llstalfo !art/eu°l/cartrlraetion ermust%e. TJJG lamrry, Stole, ia/trmee, Eh/iJ/ar0llNm
J.rd P .., 00036 � r r
7d. Amount of disinfectant used:
3. Well use (check well use):
Water &apply Well: 7e. Sealing materials used (check allthat apply):
DAgriculttua) ClMunicipal/Public a Neat Cement Grout ❑ Bentonire Chips cr Pelless
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial DResidential Water Supply (shared) ❑ Concrete Gnmt, ❑ Drill Cuttings
Non -Water Supply Well:
❑Aquifer Recharge
KGroundwaterRemedistion
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑ExperimegtalTechnology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑000thermalMealmw'vcvolingReturn l
❑Other(exp4inunder 7S)__
t Date weU(s)abandoned: 3122/23
5a. Well locatio a:
Fort Bragg
fFTBR-Ofi WMU-69 bounded h Knox Butner Woodruff ly
..
Facility TD4 (� applicpbre)
y d Varsity Streets
Axpicat Address, City, and lip
Cumberland
County,...W,.».......................„..� "' ......
Pan,,,,...........................m.m.,,.m.....,..,-...r,.......,
TdeoficahonNo. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifmall field, one lat/larg is sufficient)
35.15487203 N-78.98286201
❑ Specialty Grout D Gravel
❑ Bentonite Slurry El Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
Portland Cement 13 Ibs
7g. Provide a brier description of the abandonment procedures
Neat cement funneled from top.
a. Cem eatton:
_ 3127/23
... �rw �.
7
St¢natureofCenifiedtilat- Conirsatoror c11awner Date
,Vy signing this form, f hereby cerrlfy that (lie well(T) uvrs (were) abandoned in
accordance with 15A NCAC 620.0100 or 2C.. (1200 Iirell C.omtl.uation Standards
and Jhui a cony pjthir record ht+s beep provided to the well owner_
9. Sile diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
ahandonmentdetails. You may also attach additional pages ifnecessary,
CONSTRUCTION DETAILS OF WELLMS) BEING ABANDONED
Ala[hrreltcWatffuclfarrreeanJ(s)7favalioD/e, Formoiliplerli; Uio"ornatmi%itersnppIT ILe
ONLY nvth the x6tae rnrerrrtmlo�dabapdanmrN, yan arrtsnhirril arrajorrr
6a. Well 1DN: ,TA.I. 3....................... _.
6b. Total well depth: 50
6a Borehole diameter:, 0'75
,(in.)
6d. Water level below ground surface:
SeIBMTCTAL INSTRUCTIONS
Ift For All Wells: Submit this form within 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
10h. For laiection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days or completion of well
abandonment to the following.
Division of Water Resources, Underground Injection Control Program,
1636 51nil Service Center, Raleigh, NC 27699-1636
6a Outer casing length (iEknawn):___ _-....W.......() toe. For Water Sunnly & injection Wells: In addition to sending the form to the
address(es) above, also submit one Copy orthis form within 30 days of completion
of well abandonment to the county health department of the county where
6GInner essing/tobing length (if known):._. mm .(tt.) abandoned
6g-Screen length or known): ................................._......... � ' ""- � �. ffQ
Farm GW30 Noah Carolina Department of Environmental Quality - Division of WaterResources Revised :-a' :016

.......
WELL ABANDONMENT RECORD Twl Use UN
. ... . . ........
I. Well C.antmetor Inrm foabom YffiUARO—D-Orl—LE ff—DE-11AMA
Jnhn C. SchaplmH 7a. For GeopirobeADItToM r isd-Loo ep Gnihernial'Wells hawngthe same
ica-TCYTAL NUMBER of
Will On ludkV wel9 constnigedepidt%ft, on ly I GW-30 is nccrddd Ind
v&.H,s abandonW' ...........
2332-A . ....... 7b.Appanximate volange ofwmter rentaining ad WR*mIa
NC %Ven CmtrauorCedffication Nijimkwr
M&W DOUng, U C FOR WATER SUPPUY VVELIS ONLY.
2u Well Conalractior Permit is. W10600036
IJO old slap h"nible Cara my" "kaw, V#Orjnvfocj Y'knaww
L QVell ase (check vni.11 use)-
UAlppcuftaml
00withermw (11vaine)Coohng supplylI
Libdust6aYCOMmercrAl
Supply Well:
ElAqmifer Recharge
ClAquif= Storage ani
0 Aquifu TeJ,
Techm0o.-Y
Cineoffininal j0amd, Loop)
3122-123
4. %tewPH(s) fAlboindaned: " ---
53. Well lDalaiom
Fort lBragg
IFara:u8etlyf4'aauanex him
7& .hitg =Wrisls used (Cberk all that applt*
OMunampWftblkNeat Ce"U Glow 0 Rentonae Chips can Pelkit;
131twidential Waim S"Pply (Shngle) CD %.nd I. Grout 0 Dq Clay
Water- Supply (shared) I ED Concnle GTOO] 0 Drill cweRv
Pr3roundN"teir Rpmedisfian
ClSal,inity Bania
L.Swomwawr Drainage
nsubsldenaaa:. Control
ICE
00Wh.4itr1z%,*H11 lirdpr
rmhkv ID4 (uFzpphcable)
FTBR-Mgl'�WW4,W, bounded by Knox, Butner, Woradruff & VaYady Streets
ON, als Zip
Cumberiand
Counly
Pjavxl IdeiniflosinanNa (PEN)
5b.. 1. a litude sisal lo ogit ode in degmm-dm inute0econds a r de hsmsl deurces:;
(ifuet fiA� i, one ?aVlong us saffiment)
35.15489917 ., -7&98289353
t.,D— ALLIA&HUMNLMA&M VINER.
A
ONLY toh ehesee w
An. Well 1D#- Thl -2
I
file" Tom1weHdcpTh,.
fic. Borehole diameter. -0. 75
6d. Widcr llevv.f. below p ,yound surface-
10 sipmnity Giant 0 Grmrvel
0 Bollonke shiny 0 oibo, (wxjpWya ander 7g�
7f. For each mzter4 selected uInAw4 prom dde amount ofmateA2119 med.
Porfland ("Pervient 13 Ubs
7p, Providea b4efdracriphan of thL.0awdesiment pirbobdurel'
Neat cernent funneled torn'top.
(left' flies 6 0.1 'e
la 312,712 3
"4nsmre AFCLO�'Oj WP5 i"n''utraraor or Xwn 11'k-
By signing dmvfiArxnI lrurzbY &0.r1j& dulff dand svieurs) was (Werp) ahandejoled hl
zAaordatntt with I JA ff�"W' ALA ' r 10 1 Of) or 2 C "0200 0?adl ( `ram sirm"dron NamkinrA
and fisag a capy of dus recoed has boe n pt-r,vided to the wed awnpr.
Yon im ay use ahe Ilsr tlk of tNs page to provide addmv-*l vefl site dewls ot,61,vil
abandonviient details. Yots mkv ahva attach &1difional pages 0"niimenhaq,
SUBUIr
100- E.'a-A.U.-Adal '%divivi tbis fivroi vAdiiin 30 dnv.� of con.iplautin or werh
ash2ndonmeni Ran the rallrivvi ne
Division orwater Re"IlArce", Ink"'ItsistioR Proemiag Unh,
1617 Mail 1-iervkm, CealeRsd r, ejglu NC 27699- l 617
qla 0 vel hp In add i6on U7 mi nf- mdthe fio ai to F.h e adhrm Its I Oa
k--
above, also sutirnit cne Copy Of thlrs fbrin mnihin 30 days of 0ornPiLth)n ofVvell
6ondonment to the gtsflovwmg°
Division of W"aller Remuroe% Id Cot trol Prograft,
106'Mail Seirvilre Cejioer,'Ralei�hNC 2769%1636
KO r WAtPLA-q2z1t, & KAign W�&, , In isiftion to sculding the fi.-)rm to1be
6e, Oute. r essing iefigtb Of kvoWn):� W) � Or. II�gL
addr;s�s­lcs) abism, ail-s sublw'ut of 015 f0m wkiflwin 30 ehys 0frompledon
a& %�vfll abinidemment. M the couvkv hvilih dripmutment a4 the county wbete
U. Inner eggineftubing longth (if knasva'P� abasidoned
6?,Screen length (if known)n " . ......... . ­­,--.--,- ---00
Fom. GW-30 �.knh Carrojow Depnqmv *fEnvivxYnPwi,1A QJddv - Dkvswn OfWawr Remra R old -1"!2-20 t,