WI0600037_Well Abandonment Record(s) (GW-30)_20230530

DEPARTMENT OF THE ARMY
U.S. ARMY CORPS OF ENGINEERS
SAVANNAH DISTRICT
100 W. OGLETHORPE AVENUE
SAVANNAH, GEORGIA 31401-3604
May 23, 2023
North Carolina Division of Water Resources
Groundwater Management Branch
Attention: Michael Rogers
1636 Mail Service Center
Raleigh, North Carolina 27699
SUBJECT: Injection wells associated with permit numbers W10600030 & W10600037 at Fort
Liberty, NC for site FTBR-103
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-103: Multiple Injection Wells (Al to A6; 131 to 136; C1 to C5; D1 to D4; E1 to E4; F1 to F6;
I W3)
k. rirg ciiri� i � � �r°mum �miri�H
If you have any questions, please contact me at [phone] or L,i1�
Kevin Moon, P.G.
Kansas Registration No. 912
RECENM Geology/Hydrogeology and HTRW Design Section

Department of Environmental Quality - Division of Water Resources
STATUS OF INJECTION WELL(S)/PERMIT RESCISSION REQUEST FORM
Permit Number: WI060030 , WI0600037
Permittee Name(s): Fort Liberty Directorate Public Works...
Mailing Address: IMBG-PWE_M,....4-1275 Rei1l Road Stole A
Physical Address of Well(s) (if different than mailing address) Honed cute and S Lucas Rd
City: Fort Lib. ----------- - ----�.�..-,-,-,-,-,-.County: Cumberland ......... ......... .__._. .,.�.�.,Zip Code: 28310
Daytime Telephone No.: 9-10-396-4009 ._ ______ Cell No.: NA .........
Email Address:
Please check the selection which most closely describes the current status of your system:
1) ❑ Well(s) still used for injection activities
2) El 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
Wells 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-103
11111
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."
Signatur.. _ _..... m�_......a.. �..., �...
e Date
Kevin E. . �„
Print or Type Name Title
GW-68 Injection Well Status Form Rev. 3-1-2016 Page 1 of 1

Well Abandonment Summary Report
Fort Brag, NC
FTBR-103

WELLABANDONMENT-RECORD
1. Well ("Untratiou. 181hrimadon.,
John C. Schappell
iVi.i -Cli -,%,a= qx-vnerpfnmm
2332A
Na.;. WTj 7L , c;; �:.T r en � fi mwm N I..
M&W DrAng. LLC
W106100037
1. Well Construeboin Permit . . . ...... . . . . ........ . .................
UIC I Swm jlbrwwx� d0jrhamw
3. WcH we (ghcr.k wi-41 ose)i�
WU,L- _%Rj k N D QN 16LF L41 DET A I W.
dam. F or Geopinkii or Closed -LOOP (;voermal Wdh hav ing lbe Winne
well cOnrAmictiva(dopth, wdy I GVF-30 us pea hwhrAte TO" P.L IsRUBER. of
wedls abandmnN —1.1,
7b. ApprDxhaate Volame of water rewsWng In Well(o). ---(FA3
iiiwwW'
it Ty pe of di ,sinf�celnt aura, d'.
7d. Mrounit of dh;ii umnl--
. . ...... . ...
fir,.�Wrmg materints aied
(Checlik all that 9PPIYA
ClAgricuftoml r.3M,1UxnC1p9/PUbfiC
I IR NeW Cement Ormg,
C.3 Berlonitc CInps or Pellab
Supply) ORw.udajmW Water Supply (slir&)
ID Sand Ceatent Gimil
0 Dry Clay
Waif %ipply bshand)
0 Qyncrtto Gina
[3 Mill cunulgv
, AOm
S"iVcI'u
Gra
CWW
NOR -Water Supply Well-
0 B
(epi under jg)
oAquffor Rcchwge
ImGmvamwaw RemodiWon
OAqwfer Sirwagens nd Rcxvjveidy
IOSahi Wfn�
Subskkncx ConVal
(Oosal Loop)
E]TYWAX
i'il Rcaurn k
00dwr iexulain under 7,,
4. Date vvelhs) absistlonell . 3121/23
.. ...... -- -.—
53. Well I location.
Fort Bragg
FTBR-IOWS"I'MU-103, S Lucas DrNe @ I loneycutt Road
Aldnw, Ory, and Zgp
Curnberlarld
FZ-1 . ...........
ft, L20fade and longlitude in or d"hnfil dogmlm'
Of'We 0 fiel d' Opic W" um3 Ori'venk.)
35A41710135 , -78.97607367
f,'flINSTRUCTION 1161AUS-OF-RUIMAIN
OhVI V U109 APPOW CWTV"ddPw avu,"'NaR vue'am_
6b. Totil well dii 5151-__'____
6rrchate uuvimeter:
6d. Water level below ground ii
W Foreach inateriallselected above,
Pid'irtaind Cenwit '14 lbs
7& Pinwiden bdefidiescrilpflon Ofifficahavidonnumt prea.-.eduay.
Neat cerneint funneledfro m top,,
S. Cerd
312812.3
i;;�d. F cem p ftmd V e" III PaM 06 n1i"jWdIe-V Px*,,,c
Hysigneng INT jiwma I herdblv cerqf), thot shr sili waS AVON) O&WRA511-1 In
occordance with ISA NCAIC 02C7,01OU or 2C.0206 Wall l"OnsProuli4eg St Aelayldv
exam tharacop,ygay Ihn moordhaq been 1prowdodito she weffAwpalr.
9. Site diWam or' dditional weIll detads;
YnA may use the hick of Nq page to proytde additional wd'�rn te deWIS ON-w%:O
IN, abandonment deteds. You may aho attach addiuoral papes ffnC=SSWY
'M BUMEALLIKE
lea, ft-A&3M: Submit this Fom tothin 30 days of cuniphi of well
aNindonuww to the lbfinulng:
Division amster Rewurces, Inforinaflon Preto-ii Vdit.
1617 Mail Service Center, RgWigb. NC 27699�4 617
1011t. &r-1jU'eq:Mn Welij. in addimt sendinjl, 1he Nbmg to the addm,•s in 104
Auve, also %ulsmift one copy of this fimn within 30 days of comp1etion of, iwfl
almadonment to the fbHo%Ym&
Ethdation ofWater Resources, Uiadergrouod Injecdon, Control Program.
16% MOS*rvice Center. Raleigh,,NC 27699-1636
loo. F9j nd in tea: rolm to fl»r.
6r, Onter casingleqgth(ilknown),
addrezfes) fibove., SpSw) Submit one copy of flus fai wkbiin 30 z1ays of conI
of wej0 abwAwinemt to ibe eaunty^ h=.1d'A delmnmexv of the courly where
fad inner casiog/tubing Wugth (Wknown A abandonc&
6p- Screen length 10known)-
Fayn GIN',10 mAh carmlons DVwr11IVxn1 OfEnvummmve

WELL ABANDONMENT RECORD
1. Well Cootmetor Information:
-John C. Schappell
Well o.......,dor._a well personally a�nkinin....... � ),
" naact Name (or par y . g will on higher property),
2332-A
NC Well Contractor Certification Number
M&W Drilling_ LLC
CompnrryName
2. Well Construction Permit ft: W 10600037
List all applicable uelt cansaucviori permits (U. 124 Coamy Sfaic, Yarfunce, etc) ijkoaim
3. Well use (check well use):
Water Supply *4.._,.,.,......._.-._............................
❑Agricultural
❑Geothermal (Heatigg/Cooling Supply)
I71ndustrial/Commercial
❑AquifcrRcohatga
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Teettnnlogy
❑Geothermal (Closed Loop)
4. Date well(s) abandoned;, 3/21 /23
❑Mtmicipal/Bubtic
❑Residential Water Supply (single)
❑Reside ttial Water Supply (shared)
®Groundwater Remediation
Usalinity Battier
Ostormwater Drainage
❑subsidence Control
❑Tracer
For Interval, Use ONLY
WELL ABANbONI►1ENT DETAILS
7a. Not GeoprobelMP'T or Closed -Loop Geothermal Wells having the same
well constructiorddepth, only I GW 30 is needed Indicate TOTAL NUMBER of
wells abandoned
7b.Approximatevolumeofwaterremaininglawell(a):_
FORWATERSUPPLYWELLSONLY:����
lc. Type of disinfectant used:...........,. �............................�. m _ ...........�.�.....e ........
7d. Amount of disinfectant used:
7e. Sealing materials used (check of that apply):
M Neat Cement Grout
❑ Bentonite Chips or Pellc_ is
❑ Sand Cement Groul
❑ Dry Clay
❑ Concrete Grout
0 Drill Cuttings
❑ Specialty Grout
El Gravel
❑ Bentonite Slurry
17 Other (explain under 7g)
7L For eseb material selected above, provide amount of materials used:
Pordand Cement 15 Ibs
7g. Provide a brief description of the abandonment procedure:
Neat cement funneled from tap.
52. Well location•
FortBragg __..._,,,,,-._ .,,_.....................
(.
FTBR 10315WMU 103 S Lucas Drive Honeycutt Road
(Owner Name Facility MAE (ifappl,eable) & C,!Mtir9 n
_......__�...._.........—_ _ 3/28/23
Physmil Address. City, and Zip Signature ofCcrtified Well Contractor orGlell Owner Date
Cumberland By sigrift this farm, i hereby ceruy that the ivell(s) was (ware) ahtw4ined in
Caunty Para,( Identification No (PIN) accnrdarrm With 15A MUC 02C .0100 nr 2C A200 Well Consbhrctian Standards
wrd that a copy 9f this record hair been provided to the well owner.
5b. Latitadeand foogitudein degrees/minutesisecoods or decimal degrees:
Orwell field, one lat/lon3 is sufficient) 9. Site diagram or ad ditional well details:
35.14173453 ,v-78.97596773 N, You may use the back of this page to provide additional well sine details or well
�•••--•• -• . abandonment details. You may also attach additional pages if necessary.
STRt [T[Oslb TAL
f.1F,.11!J5tiI3P.lNGawBANDbAED gETBfYlECTALTIVSCRllCTEONS
melt constntc�ianm»,d(s)iftivatlablC.!•ormnllTpleia)eetianarrrsrr-tratersu�lywelts
OMM01hthe sarxarnra4ntliorriabaWoponeig.)oucan sobmirorrefamr; IOn. For All Wells: Submit this form withitl 30 days of completion of well
6a. Well [ON! A 2 abandonment to the following.
6b. Total well depth: 56 (ft )
Cie. Borehole diameter: 1.75 (in.)
6d. Water Level below ground surface: _(ft.)
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Inieetion 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
ahandonment to the following:
Division of Water Resources, Underground Injection Control Pragrsm,
1636 Mail Service Center, Raleigh,NC 27699-I636
tile. For Water Supply& injection Wells: In addition to sending the form to the
6e Outer casing length {if known): ---- - (dl.) address(es) above, also submit one copy of this form within 30 days ofeompletion
of Well abandonment to the county health department of the county where
6L Inner casing1tubing length if known ft.) abandoned
6g. Screen length (if known).- ..,..e........................ .­...n......w...(it.)
Farm GKr 70 Npnh Carolina Deparmxnt ofEnvironmenuil Quality- Division of Water Resources Revised 2-22-2016

d. °d"Wedd Caaw n:bw Inforrrewaaaflon.
,John C. Schappell
"V!4"edB :'k1YkrB♦1£..YN'Y "daauznu der w d6 aswraw„.0 estu &,y ua0sauadtrrn0aav, nefl Or, the er aresepmum�d
2-
Na"W awl.& a:aarcunMelor f%xili is UOR Nwrowr
l rUling, I,,,1,,,,,
37
Up W -RJ- a�da,Ma..... ........... ._...____.......... ............
....�.�.......�.�,,,..
jjsl all ap he'adsdr wn9tpowpaaarnwa'°Arp ei ppamij,w fe.e: b7f,",, djum6jL"2re, &; .f #kmmr wpff
1 Well Mwe (a daeeda'wredd Huse):
�W _...,,mm , ..........w ...................�_. ,.........
DAgricullUnd
A"uw:mndpaa:urraard dd~6a:�z�r'd:"asanpa.u:n�'�uupspall',yy
n1¢nadausaaaaN9d3rnra memafa.6
wM
MAWnferRimhame
f.::da' quuifer Swomuge mand Re!acav ew,)r
C.::dArtduu fer
C;7#d"xT=iuU1r,auk 1%."admrnolog*A
h:':.tld:irraa'u' ha mW (Closed Loop)
[7GewwrcrtnPrauurad 0Ita8avm,'caynhda"rue
CVdw3rusuaeipuund Pd'aadnd ae
in. For d"da)pTmda dFT" a r Clowd••Uop Geothmnal WeRs having §:be sdnane
ww4l eranw•tianzeupaonidep ffi. em6W d QW,30 ts, needed, d:wMcawe TOTAL dWd'dk+dBE of
nandfl.,nuY6awwttdmeaea'd .......e.�„�,� �,�_
"Ada. a�qu,urwu'rvuuaa�r:awadem¢eaorvaaaacr a�xuwaasrspimdm wv^4��k� _�._�_�_............_..���-��
....�._ _.�..a..,. x�� . ...��.,.,..m.�. .............
F' 6etltuW'T dA "'�d.ldwd°A dd mWWA.i.d A At3W'Y[A'.
7e. aasmNa. apg umuuuac:rc Mn used (check apd ft'll apnPdd).
New. Cement Grow 0 AdaV ange Chips or d"wspda:as
ftsd�dmhW WWMe 'dnupro,u9'W Vaame.Ne)
0 Sand Cement Camuar.
0 CBH:y Clod°
inRnv dmdW Waw nnnpfply ( asrreadd
0 C ozneua.w Gmm
a Ddit Cmada%
m•.
"d nadaryp'ffnwur
Graved
a`3 Braaazmte 58uuny
d:dr.hcr (explain uuWA."r 72)
M+ewvery
..................._........... ............. .�.�..........�,.............�,."°,.�.....«,................�..
Ida P'qrS'Yae(h material l Weeled Phowv, kRIPa'trvmdIFWilEoNRyG„R,l of KRk16HWN,"rWa RII:61L4`d'.
> dau•aa�waad'unru r RennGA,IIX�Wd6�on
N� rila rdd'� � ement.
1'5 i s
CIi i''' ddarraar
'd,�.�mm�mwmk'aw'aaa^t• d:'Rxranw:ane
17,°Wuudoaaadeu ueCaawnW
M d was er
u,.Jfl:dadner tt%pdanuua Under "nr'0
5au We'll daaaatw na
Fort Bragg
FV4Cdnag+(arwwrra,r Na"M Fo+tpii IDN
S I ucas Ddve @ Honeycutt Road
w0uy urrriN aN dvdw�x�. �"� _ww..w_..e.. . .....
:m d,Zip
Cumberland
nd
.&"ezMA 1d?., nNrra:aadaVHB._..�...m.�,..�....._
No t PIN)
br d..,sudinde awuad daruag„dfimade in a BegreeaNaminutrs@se:ounudw or decimal ud re m
duA awa.d0 cenudad, ore dlaWdoM is suffl :vunA
, . Provide a darned• adewrnWadauun of the ab aund nnanoewns,aa'auvr dnnre.
Neat cemerft funrided from top.
1. A':eaadr dda&aa
r µvuapaa+u - tl'drrr;daaw.N "M1"Pe.di d "avto&rsaccmr C've RIP`wd.."�ovvm
__ .. om
....
By iqueng mNwiw ftprm, P daereb,y era;r6fy &40 ehe uwrddp°dp va°ar�,r drwurcb 99hOwnr�rmOd em
aerrruran'anvsr a eth 15A �d'a:AC 02r 0100 yr 2t' , a"d200 Well a .oaa rrun<'aaa rr n'M7aerxeawv1x
wan dibdi au a, anpv ofebie rervnrrdhaan hbeurn,( rovawdeadran Ute ww48 aawwamer
9, She disgpam or a dw&aauwnirml www,'.°dd rdeanwds*
y'aaau unadr uuse%a N.aaa'ula or this page le prrovWe axdd i iranM aw"eU we udeaada yew WM
w a aadraanmeemna xRasaa;.das. W'a,un may aim aaaaa h addhional pages dIncc=wy.
C�.�ra�n°d UCT111Q °dC_ QF- Kd hd� EN d�a�. rrNdadd
a6n'ea'rwdaar's"d°Fu:wseacewrrnca'err.rrrraea2ddvdud'„anasadmadrkc,.danenrpreuKPrapaPt•ttwb�swaaaunaarax�a rranK�rws®N,d+Yynvud'Fx
���� ruriadw d�ure.nuvrPais ru�irrs6�s&^dsa.n"ralMnwe�Beawawdar�aua, ww� auraau wu«Ndd aarsu,Faarrera.
Ana. wqql Ulpl:,.w_...,�....­­__._._
6h. " oul wwedd depM _5edd y
6c.8reholeadd'amaele , . _.fdn,)
dad.Woler Pev d dnel wv Prunwwunrd aaarftcez
to,%. r pr ,A,dd WVla. "d'aal nni fts reran wwdu.Nn . 0 day; of completion n and 'web
.. band n ma.nd to ft reddaawnran,g:
Diviagarwa of Winker Reananurcm. dauAnrmatio n Prou.euw' ing d. niL
dad, T Slaadd Service Cvo aer. R adekh, INC 2769946'17
dddftn" IIFaQr AuwjeeAa�pu WV egg ,,R " Inada.dnWmn an rswddarrad, flu:flu:farm Bran floe addrms in Ma
aa,t )ve, advan sand nut owe c%W ed adnas rewumu wwaddnpm 30 daYs, md'oampadamdaon mm"wwaald
abandonment to aflae d"audd'v'a'an°>bgaa;.
dar6suana1 wn(W4Paaer Rcsn wea^:r�w'Ip Underground Injection Control Ip?raue:,raw,
16'. w;a°Andtierviced.°dennaer,Raleigh, N "27699„•'1636
fia„ aWaaer amraedm des. p» elr known): d.rdr N`mr�d nududw d pm Bwu_ g W ems°dm a"darana�n dsn arRdaad r�e drar aaa nkua.
ad9aa..ia eza) above. alw srdnnna7 sandwu:opad re rthis form °awaadaun 30 day : wnd"aximpsfiea on
of well aabundaanaaaent ass die rw unu y heakh deputment and' the aununky where
d'd dengthffknowwwndn_.rc;da,p uudsrarndonaead
6 .Screen length (Wknown): rddo�
Firm MW:Mti9 'Adawuttdu a'm"aaarcadnv%ar lC'nd.:,ars'wswunan md' rnw�avearoarmu.rraW'.ed d,'�ar, dvkr...9'As'waawd�en�u'.d"9 naker'SZu:v;nanan•ra:aa ll~c ugpo:. "m•�"'�-wd'�fld

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John C. Schappell
Well ContraatorName (or well owner personally abandoniogwdl an hiAter ) property)
2332-A
NCWell Cornraaty Cert6cation Number
M&W Drilling, LLC
Company Name
2. Well Construction Permit N: ,W10600037............_.... _._ ....._.,--- _....
ta1 art applicable cell coasorrction pewdvs 0.e 046 Slaw Yarlaxe, efq yuaity
3. Well use (check well use);
Water Supply Well:
❑Agricultural ❑Municipalftblic
❑Geothermal (Heati4Cooting Supply) ❑Residential Water Supply (single)
❑industriailCommeacial OResidential Water Supply (shared)
5apply well:
❑Aquifer Recharge
®Groundwater Remediafion
C]MquiferStotage-andRecovery
❑Salinity Barrier
❑Aquifer Tilt
❑Stormwater Oraibage
❑ExperirneatalTechnology
OSubsidencisControl
❑Geothermal (Closed Loop)
❑Tracer
OGeothermal(Hentl .CoolinaR,eturn)
❑Other(estPtaintinder 7p)
4. Date weli(s) abandoned: „3121 /23
59. Well location:
Fort Bragg
PamhtylahvnerNeme Favility
DriVeQ7 H �.....
# (ifapplieable)
FTBR- l03l5WMU 103, S Lucas oneycutt Road
Physical Address. Citq, wd7.ip • ••-��
Cumberland _
Canty......... m� W .--....... Parcel lderiKiiemionNo �...........
(PIM
Sb. Latitude and longitude in. degreesfminuteshseconds or decimal degrees:
(ifwell Feld, one IatLlarg is sufficieot)
35.14177346 N-78-97583999
CONSTRUCTION DETAILS OF WELLISI `BEING ABANDONED
Attach ari/cMutnrctionracard(.{fffuvaLlahla Pnrnu11HP10lnJccdaliprran-n'aterrrrppf}�KrelLf
QNLYvlth the some emsimredomabandamrrenl. pu tds wbW1 ape fork
62. Well MM: A.¢
6b. Total Nell depth: „�,$•._ _ , (ft)
6c.Borehole diameter: „0.7 ••••••••••,_,w._ .,.,(iu.)
6d_ Water level below ground surface: �•,„„, _ ,•,--www_([t }
� ............
Far lidemal Use ONLY
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 ate"dowil'. — ­. �......_........ _.� . ,......
7b. Approximatevolumeofwater remaining in wel](s): vm(ga1J
FOR WATER SUPP[.Y WELLS ONLY:
7c. Type ofdisinfectant used;. �.... ___.._......
7d. Amount of disinfectant used: ,._............ _..�.�
7e. Sealing materials used (check all that apply):
R Neal Cement Grout
Q sentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry pay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (expWn under 7g)
7L For each material selected above, provide amount of materials used:
Portland Cement 15 Ibs
7g. Provide a brierdeseription ofthe abandonment procedures.
Neat cement funneled from top.
g Cerlifi fmn: ( , ,
X28123
SignWell contract to vifell 0 r ••.• pate
fay signing this jonn, 1 hereby terrify that the we1J(r) was (were) abandoned nu
accordance with 13R A4;4C, 02C_A100 or 2C'.6200 Wag Caasiruction Standordr
and [hat a erns aflkir record hrar been proveded to the well owner.
9. Site diagram or additional well details:
You may use the bad: of this page to provide additional well site details or well
abandonment details, You may also attach additional pages ifuccessary.
SUBMITTAL MMUCTIONS
10a. For All Wells: Suhmrt this form within 30 days of completion of well
abandonment tothefollowing:
Division of Water -Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10h. For Iniectiou 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 Mall Service -Center. Raleigh, NC 2769M 636
6c. Outer casing length (if known): w ....... I,R.} 10e. For Water Suoohv & lniection lMls; In addition to sending the form to the
address(es) above, also submit one copy oftbis_ form within 30 days of completion
of well abandonment to the county health department of the county where
6E inner easin tio bing length of known): g abandoned.
6g.Screen length (IF known) . m.......
............. .................-,�.r,,, :ft.)
Form GW-30 North CarchnsDeparunent of Envoowmntal Qualitv - Division of Water Resources Revised 3.22-2016

_WELLABANDONIMENT R�ECQRD
1. Well Contractor
-Jo.hn - C . Sch.ap.pell 7a. For Geoprobef[IFT orClosed-Loop Gealkwowl WepNsdmamf
MICH rawradar NUMC, per well amer.&T wsormU%, %wA on 1-dfw PrOPArkY) vw11 cwvtrAr1iovJdqM% o0y 11 GW. 30 i� nev&A. Indicate 1Y)TAL KLTMBE R. �D
vvvUv abandone& ....... ... . ....
2332-A
7h. Appruxintme volmne ofastpr ir,maaauafluadra. in WHI(s).
MGM &W DdEling, i I L 4 FOR WATER SUPPLYNVELLS ON Ly�-,
C�arnpwvv Name W10600037 [?,C�Tyrw of dkinkebint wed. . .......
, %M1 2Con5trilefien Permit M.
I, ts I affev.phrnble �wflcvavnw-, I 6*n dw/7,2YU 6.e Uf(.,r" CUrerpty Srale, MDA6V#M-,� cic� IV 71iinjount. ordisinl"nuctflnt Used".
............
1we'l8 Use(cheekweff
Mgncuhural
CjGCath6=s] (Himling'Coohng supph)
ZMEM=
r..1AqwfarRP'Cha4",C
CAquNfr,v %loraggeaM R.Ccoven,
nAqw.Rx
nGimthmmw (Closed Lwip)
'Te- SeRfing Materials uscd (cberlk 21K that aptiky)..
ONunicipaYPubhu M! Weal Cemeg a Goo 0 Brob)"Ille, chips ar Ipeflets
One% -1 CM0 a 'ANA l 0 Dy Clay
idenfig Vhate� Supp�ly (ongle) L SMW
Mesidwtgal Water Supply (uhMTO (..I CeMmrkc Gr(wit Drin CutfizIF .A
T.3 spa.uilty GTOUt
0 Beatonke Muny 0 Other (rypWn ondeT 7g)
PAGmundwatcr Rierrmdiatkm
n Sal i R i q. X.wyi ey
con%.A
112"Frao"T
ro [:101him (
52. We'll pac w tie n:
Fort. lBragg
. ........... ---
rMiday"Chauff Nmmq" Faclky.0k kid apphcablep
FTBIR— I G.31MMU-1 03, S Lucas Drive @ I W.eycuft Road
PhyskDd Addnw,, 01ty, wd ZCp
Cumberland
.. ....................
&un;, "" No (PITO
5b.
dwell fidd, unv
35,14180252 --18,27578534
C N)dplllaC:`dddlWN"dbMxydV'TppdCwdddAMYdVfid
RA
—81M
168. Well UM A,
MCINW well dept.,
6r, Barebak diametem .0:75 _ GIM3
U For each m3terial aeNeetvl above, p,tw,wde amnuma ormakvrii,14, owd,,
Porfland Cement 16111S
7g. Provide as Mef'descripflao of the obwodw5imant prwwAillre-
Neat cernientfunneled from 'fop.
. . .......... . . . . .......... .
S. Cerfifica
308/23
w r", it C 0 ��Mdor F WoM Owme Daze
&J-p2twe 0 ev, , ! 11
Bv wgvv�g dusfarm, I heirobly rerljfy thas rJia weff' .q) wem (wre) gwbaa&dpxv1 ?n
awcorduace with U4 NIC4C 0."M! 000 or 2C.0200 Well if-'aawnicTion
wedthata colwof,,ki r&,,corddraws bwvpr,,,wvidYde,r) Me wefi owner.
9. Site disprom or "Jitional well details:
Yoj may rose thu. Lmck oflhispage to provide addkionW wCH sm detaiLs or well
IN abnn4onmw daaits, 'Y nu mmy atoo atmrh iddffional pagts &ae=mary,
glB rrux, ms ur"noriff,
',
lo.furor _All WAL�41: Submit iihis fhma withm 10 dsys Of ConT.Aefion of Wefl
dbwdonment to therfaflo%vingl
Mviskm of Water He-soureei, Taformation Proceowift, VOL
1617 MaIll "'W.Mce Ceat err, Raleigh,N4727099-1617
10b., Ee i dtion to qcmdinp the rc= to i1headdiesi. in i0a
Above, AN submit OFIC Copy of ibit, fhxm whhha 30 days of cwtipletion 4 a%CH
�amndonrnctkl w ft FiXowng-
D&visk�jj of %trr Rewnwers, Undpireround dnjwmflon (ankrol Program
6d. Walew hwel MOW FTOUnd SUW'fficx . . . ........ 106 Mail NL�rvigg C.'eater, IR fifth, NC 276TMA'.%
[tjc� ECj�M�p�jv AjqLo Am In addition to sen6 ing the flbnn to the
— �02R2�Vg ..
abovL-a1w submh one capy orwhis form wkhw 30 day,; oftv"plailon
nf %wfl abandonmeil to flic cotuay, hwhii deprimont auk'1311C cowy Wb,.. _ re,
abandoned
Sereen levxglh (Irknown):
FaRMOV-10 Mofflh 4"Mam4na Vej%v1mvM DI'nuan ofVY'amp
.v

W1 x DONMENT RE CORD
1. Welli COT111TUdDr, Tarognmation:
John C, Scha ppell
WO cogffscnar Nume tor %rfi malwaglevII abumlo6rop wdl ort Whin pmpevgy)
2332-A
gqC Well.Carguadof Cesuglacian NuMber
NAB W DrUng, LLC
CompawL Nwir-
2. Mdl C'nstruction Permit Ill. 00600037
. ................ . . ........ .......... . ......
mw all weTt vamouction i'��We c*aRru"p, Slaee, NuftnT, CJC,) ffbwav
1. Wall II (eJxzjc well ese)..
10A.gricultigual 0municipallplibUC
O(Rimthrruial (Up eapast /CmAing Supply) CU?xsidenh4l Water Supppy (i6ns8e)
aUnaaEa& a u ruwwcn u V Mmidmfial Water Supply (.,I
DManitwing
C]Aqififer li.w.hagrge
EgGyroundwaler Remediahorg
11JAquffiv lultavago and RnowAy
n"Ahnity Barcier
ED"Mquirex Tmi
11-0amnowterDigninagir
nUmtherynal (ClaseAW Loop)
DGebthw.nal 0-ImfillOC"("in ,, ReAREn
00ihew ia�Agn un&-r 7n
I.%, Well 101CONOw.
Fort Bragg
racdftyomw Mage FkaRty lD# (Wapficab ge)
"-1:3 R-4031SWIMU-1 03, S Lucas D,rive @ lioneycutt Road
Plhy w�=R Addiremi, City, md Mp
Curnbialland
("Minty I'metl ideniRricalRoul No. (PIN)
511b. iLatitude awl faiRI in deg mv.0n nutettseconds or deegfflmw dearm,
(6 well fidd, one WaM vs mawmvnt)
3514184337' ,, -.718.97569012
CC(LNEF kliOM. TJ)L,'-r6TX �`O q % �-EL
ONC11 alffh J90C pio Coll 4ob"FU wV16m,
3 6
6b.'rolgall weA delpth., __._ ... .................� �... (it)
fir- tkirehalledigniater. 0.75 - in,
(Ad. Water level below grwnwd surface.-
. ....... .
'Or tnlermd WDIDNIN,
WMILLADANDO VMT1A
7a. For GeoprolbODYfor Cinwd.-Dwep Geothertual'Welit qxi pmrtd Ow some
wdl corstmeficaddepth, only I GW-30 is needed, Indicau-, TOTAIL hH.N.TBrR of
VvCHS atrAndlinext ------ --------------- - -
F i ',%-UdP—PL1,Y-,V V E-L-L—S, 0'
'A.Typeaf 111higaIr"thng used.,
7d. Awoungg ot d1ifilfixftnt used-
7cm r=figig nisterutis used (ibeek all thak applj):
0 Nrx Ce xnew Gnaut 0 Broonhe CIRips Of MILL%
0 Sgand Commt Girula n Dry Oay
0 (:,'one vo., GTOUI n nwill. onfinr.
1.1 spexialty GTOUt ('3181rd
0 Bentonite SlurTy
7L For e4th ragit, rialsew fiel abavA 1pravide amotwat af niateARIS uscId g
Portland Cemel,-A 1 (3 ftm
Provide a brief descripflop of the sbandnamhowt prortd gure:
Neat cament fixinineled from top,
. . . ..............
128/23
I VnFr
. . ....... . . ...... .......... .
-
By�,qpgojr e)?!$ I(A"#4 I A,,,veb mr1ifv Ovy? aline Was (WeRI 01 in
Y
accarflance wah 154 NCAC 02C',.0100 or A.'.OAV Wall (*bnYtY%rrUon Slanirlareft
anrlfhata g:!vpyqffh1!r re4ordbw hweaprovidedto Ike IvOlowner,
9, Ste dligFraiiz or additional well details -
You amy use t1m tnak of this page go pumde aRM hional wql ,Ac dli hilg oir,wefl
W ftbandonmaRI YfwmigI attach additionM pagcsofnwessary,
j ffl. 8'
.. �117MAL VgSTRU � .. . . . . ......... _ LCT N. __ ..... . ............... —AQ--J
l0a, JEU A.tJ B�r& Submd this fbnh wniffin 30 days ofcompletion nf weH
abandonment to Ibc foflovanI
Dmaiaift of water Reigurequ% InforTnatio R lervegwimp Ill Nda
1617 Mail Service Cenonr, Ralellob. `NC 27699-116 7
161y,FOU 1.n.,JLC0qLrk- enit: In ar..Hifion toscmdRng dge form to theaddress 6 Ma
Anw, gib submil coe copy or On :faTuarr willo" 30 do rya OF Coffillslailon ofwdl
abandaninent to the fbllomns�
DbAsicon of WnterRv*nuT-cr.$- Underp ,ruiiagad Injection Carib:
1636 Mail SerOmCenter, Ralt6gli, NC 2769946U.
0r. Fa -C n nd na to t
tie.. OtAter rwing leiii.ft Of huwgyn)�� 111'..& !,.1mw&.A._LgLcLtLion Weflr� kd4 N a L rfi� i to se ink the fo be
Riddrass(gos),above. also vAk fig te copy ofd& Rum Mflilin30 drays efcow nplitnion
49 W.N abondonmewt to the county beaftly dolmmnent of' t1lic county where
(if knawn): ____J'AA abmildoned,
FORM GW-30 blanh CRI VrpartRnert of Tinvilroam.,"tal QII - Dlykian girwRaer Rewor=, Thmme.dZ.,22, 2016

WELL ABANDONMENT RECORD
1. Well Contractor lafaiinandon:
John C, Sd1--iappell
wNPrffl ConirgOorNsinekiv %m-HiNwrwrPwrans111'y alrandolurqu WCH ksI,Wfim �wopony)
-
NC' Well Cordiactor Cert-licalion Number
M&W [)rifflng, IIIC
Compalky Nanic
PermiM. M0600037
2. Wellf Construrb - I'll .......... ..... . . ..... . . . ................. ..
1"JO all OP19107Me fix WC', Cmulty, skar, 11kiewaive, ac.) ti,hmmy
,3. livelil ow i well use
%yatin', Str PINY WeM.:
Me picultumil
00cwhermal (HeatinWCoi Suppl)1
Chi hadulakraaxdPiM"eaaaaraearuad
Nwa-WHur Suppke Well-
OAquffiw Rtzhargc
clAqui r4.-.r Swrage nand Rmavery
OAqulfrz Asl
Meollhermal (Closedl Loop)
rMendlem-Nal i 1hqbww1(,uAAw�
4,, Date "01(s):abitildilrEed: 3121r23
- ---------------- -", ..........
RELL AB �AKDON M EN.LRE, r_AH -S
7%. For GeaprubeMff or Closed -Loop Geothermal VVells having the a Mrie
Aw,111 cowitnictioWdepO, on %, 1 (M-30 is nefAW, Indicalee TOTALNUMBER of
vvrll,g zbw-ldonni: . .... . . . . . ...................... ........... - - ------ -- - - ---------- --------- -- ------------- -
7h, Appimtriwatevolumeafwater M-m2ilranp . . . .................. . . . .
IFOR WNFER SUIPPLY WE$ JJS 01MIT N:
%'Type of diainfircuat used:
7d. Anittunt of disinfectant used"
7e. Scallop materials ased (ebeck all that upply).
a NealCVneull Groul C1 Ben,longe ChtM. or FckLs
[" 3pmidential Water Supply (mn&) 0 Sand Cement 0 11 1:21 Sky 01%
r.11tosiderna9 Water %uqpply (shtwad) 0 Concrete Gmut 11:1 hill Cuttings
A(.3rawidwatcr Rw=Vahan
13,8afirnit, y, Bamey
rilkon"waten, Drounge
Contiall
01,MCCI
00ther t"Aain under 7-o
an, Well Nmfion.
Fort Bragg
---------
PhnMylOvona Nanx- Faeilty IDV (if appkable)
103/SWMU-103, S Lucas Drive @ I ic)r.Pycufi Ro: ad
Phy,mal.Wdrow, Cilly _ end Zip
Curnberilaind
E71111 ; PwrA Ideft,ficrum NO i
5b. Latitode and Ilongitude in degrmilgisinutes/seco"d5 or decimal deLrm,,-
rtiNaft Fe.K one tatAnn'; m mf%acPfl
3514164213 N
g3n.'XgLJ( dldiL .,pM1, ("ff..W AjI 811MMARA-NDONEP
UNI. V wigh firesairw camrawdan, �zbamleymhaw, wVT eus Tkwie Ona APON,
6a, I'Vell IN: B .1
tih.'raftf swell deptir.57
6r. Borehole diameocr. 0,75
. ..... ®__......,,,,,.µOatmp
6d. Wafet-leviA betowgi sii
* Specialty Cii u Girevel
* BentonatzSluny C Offier (explain uip,-W 7g)
1'. for eAch maw.rhal seleded above, PrUvildeawount Ofimaw-615 i
Portland Cement '15 Itis
7g, Provide as brief dffmwipfien of the abandonment procedum.
Neat cement funineled from top.
ce"i
V,
,Onlrr� 4 04 0111 OINTIff Der
Ffiys�ii&NA IMVjorm. I hprgby ow dre %vellfT) wmv fiwev ahandogend Fit
are.xmikew, v with f14 NOICO21C,V410 or 2C A200 Weld
arut thar a volt'), Offixi's ry"cared bw been provk.&Ne fen Or well o ti
9AW- diagii or additional well dewillm
'You inay toe, ache fiwc,,afthfit pagr to provide, additional welf 14e deli prwell
albandon=H&I
SUB $111ir 1. ."ERE—CUPW
!on. ERE_&p J�jl& Submit *,s, form �within. 30 days ofacarpiii ofwa-11
ebmuiumnew to the fii
Division ofWater Reswors, Tinfartandon Pmcesskg Hall.
1617 Mail Senice Center, RaliejgjN,N<276994(M
ltih,f Ujg.j.c Vells: In addkw to serding, the lbu Tn 1.0 de im, ldrex..s ale I Oa
g jj2jIN__
ftbove, also tk.flbma one cqV of this Form iwiun 3D days of'c=pkttLoyw of ewfl
akwandonment to the falkwofiq,
Whviqian of'O"NTer Resources, Underpround Injectlen Control Program,
1636 MMI Ser-irice Center, Raleigh, NC27699-1636
6eClaw- casing kngft (0 known): I Or. Ear �W 1� & Igigg.42in WallE In adddwrt to sundmr, the fison to the
addramfes) above, also mtbTinit one copy of thda Fiann vinthin 30 dsys of compWmm
of welill jbiarcionnii.,!rt. to The county, Imutith def.mr1nwm of tim cowfily where
6E Toner e8qiOrjtLuMjKw length (if abaridoned.
6g. Screen hangth (ifknowiii)., Aft.)
Foom OW JO Nnnh Carmilne CRepsavewarua^ava E&EnwalfignmW Qkwhty - Omswn of Weyer Rewarcess RUN Osei 2-22,,V 16

WELL ABANDONMENT RECORD
L Well Contractor Information:
John C. Schappell
Well Contractor Na ine (or well owner personally abandoning well an basin :r property)
2332-A _
NC Well CantrwarCernfiaaoon Number
M&W Drilling, LLC
_.....--_---- -----------
Z. Well ConstructionPermitPermit #: �....._
Lai all apyrl/rnbfetincR ceartrucltopperadFs(!s Mr COMW Srae, 14W
3. Well use (cheek well use).
❑Agricultural oMunicipal/Publie
❑Geothermal (MeatiWCooling Supply) OResideatial Water Supply (single)
❑Industriat/Commercial C1Residential Water Supply (shared)
Non -Water Supply
❑AquiferRecharge. INGroundwater-Remediatian
OAquifer Storage and Recovery ❑Salinity Barrier
OAgwfer Tcst ❑Stormtvater Drainage
❑Experimental Technology ❑SubsidenceContwl
00cothermal (Closed Loop) ❑Tracer
4. Date well(s) abandoned: 3/2 1 /23
so. Well location:
._/Bragg
o
F1'BR Neme FaciLtyIDrl(ifapplicpble)
Paaanty Lucas Drive @ Honeycutt Road
Physical Add�s3s1S� M zipl O3, SLU ..�.
Cumberland
C.W W W W. ._...... Parcel Identification No. (Pf ,1
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field. emu Iatllor-S is sut)icleno
35,14172356 N 78.97594225
�i Far inurasl Use ONLY
M ... _ _. _...,.. ___.
WELL ABANDONMENT DETAILS
7a. For Geopiobe/DPT or Closed -Loop Geothermal Wellsbaving the same
well construction/depth, only I OW-30 is hooded, indicate TOTA7L NUMBER of
,ens
7b.Approximatevolume ofwaterremaining inwell(s): (gal.)
FOR WATB Sw._...Y.......... ._.._..
R IiPW!y[.LS ONLY:
7c. Type of disinfectant used: . .
7d. Amount of disinfectant used.
7e. Sealing materials cased (check all that apply):
Neat Ccmeat Gfout
❑ Bentonite Chips or Pellets
❑ Sand Cement Groul
❑ Dry Clay
❑ Concrete Grout
13 Drill Cultings
R Specialty Grout
❑ Gravel
❑ BeatondeSlurry
❑ Other(explaintuader7g)
If. For each material selected above, provide amount of materials used:
Portland Cement 15 lbs
7g. Provide a briddeseription of the abandonment procedut x:
Neat cement funneled from top.
$. CertiSm Q
3128/23
Signature Cr4ta7iNdwell anrracfnrolVpOwner Date
8b signhtg this form, l hereby certify that the wtll(sj was (were) abandoned to
accordance with J3,4 NCAC 02C:.0100 or 1C ,0200 Wall Cmtsmictipn Standards
curd that a copy of t(:Lc t ecord has been provided ro the wel/ owner,
9. Site diagram or additional well details:
W You may use the tack of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRkTCTIONDETAIG5 OF WIMUS) BEING ABANDONED SUBMITTAL INSTRUCTIONS
_4ftach iivltwnslmeltmi rernad(c}ffanaiYahfe. t%er nndHpk 7pjeclrnn nr rrrn-rrafEF.enfr).rlY�iefls
ONLY wth dre same emu7aMrtirtlahandatanenr, ,t+ru can stAwk oneinfHa.
6a.Well IDN:.B2 w ............
6b. Total well depth: ,56
6c.Borehole diameter: ,g0.75 --(in.)
6d. Water level below ground surface: (ft.)
i0a. For All Wells: Submit this form within 30 days of completion of welt
abandonment to the following!
Division of Water Raources, Information Processing Unit,
1617 Mail Service Centex, Raleigh, NC 27699-1617'
101, For infection Welk: In addition to sending the form to he 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 Coutml Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e.Outer casing length (it Icat)vm): (g) 10c. For Water unnly& 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 We0 abandonment to tha county health department of the county where
641uner casioghubing length (if known): eft.) abandoned
6g. Screen length(if known): ...................... _ — _iQ.)
Form ow -In North Carolina Department of finvuumnimtal Quality- Division ofWater aewurces Revised 2-32-2916

WELLABANDONME N'T RECORD
III " WOR C%nkrachrr Information,
John C. Schappell
il;n C NMSYaa Cufu -X—Mekw wwt& amw —PewwrW —DaWlIrt P"FQ—Pan",W—Vd
2332-A
NC, WdIl Coincacter C'n iqfication
M&W Drdling, i LC
C'Unquay Nanw.
2. Well Canstraboo PermitA, W,� 06(.)0037
U'a alrapphroble ¢qerl
3.We9l wine (e1wck weR ave);
OAquifiv Recharge
C)Aqua'cr Stor4�c aW, Rxovery
)Aquifer Twl
kxop)
Ethe cot hermal
4. Dake well(Q abandonLd: 3121123
Fee Intefful Uvc ONLV
L,AW'P.QH�% NL AKEAELA
7a, For G,wPwhfJDVT or CkNed-Loop QuAheravild %VdIls having the Same
Ny:H caigrucuor.'depth, only I GW-30 �i nPoiltA, fudivateRITAL NUMBER of
7b. Approximate Vahime of wakw weanalaing in welks)u --, , - Wfl-)
-fak < vw i" ...... — — ----- -- — ---- . .....
'?c T,YrLw Of disinfttant used-
ed. Amoming crilLsinfoclang ww.d:
. ..............
7c. SwUng nAuftrials eased (ebeck 0 thal appljr�:
[3munk"IPATublic
", t&A C'emunt Grout
c.1 Bentanne Chups, or Pefiet%
OR=dwfial Water Supply � vngk)
0 Sand t ci-n=l Groul
0 Dry Clay
ORes,idenfial Ifflaker SuppIIy (,sharcd)
0 Concrew, GFew
0 DO Cuvfin�m
D sper'lalh, Grout
0 cirawi
[3 Bentanke Slurry
0 Other! explam under ')'g i
cRecmw, y
. . . . . .......................
7E For each wunterialseleewd above, provide amount of materish ", d:
fflG(nwdvrLW,r R=cxl"Tan
Portland Cement
'12 lbs
O,Sahnitv Barncr
c.Ston,nwavx Drainage
. .......
0 SubMdence Ccntrta
7W Provide a btioldescripfina afthe abandonchent proceduren
O'rraccr
Neat rementfunneled
from
OlDther tcNxkiu-#
. . . . ......
.5%. WeH $acnfiow
Fort Bragg
Fic�Vtytflwnrr Name, � fappNwWO
F'FBR,. I 031S)NMU-1 03, S Lucas Drive fla@(iiHoneycutt Road
physicall •X&Iwass, C`fty.. and ZEP
Cumbedand
. .................... ....... .. - -- — ---------
County pwccfl IdiuIlTmAwn No (PINO
Sb" Lafitudejod tcuotudo, in or dm..nial degrem-
(d'wdl fir, d, WYL 130011K is waste mvop
35.14169,176 N "'78.97596136
. .... . . ..... .
63. Well ID9. B 3
48
64, Total weO depth
6r N�rclwle diameter: �.7
(A.• WaWr WeveJ b0aw ground imlace: . . ....... .... . (VQ
312.812.3
----------- -
Un ractior vqp Nj R Owwar DWI
AV qopng Illss!,fimm, I hereby cewjjr deny Me wcfi(rml Wax l"n ere) abawkwed rra
u=)Y-dc?Fxx wedo 13A 'VCAC OX APOO or 2C.0204 WoR Vangkird&,
apHishat a cujq 9flin't'ree Vrd has boon prowded a M, Ow wed wner.
.,
9,84te. dkigr%m or addificinid welt detaRm
You mHy use ffic 6hck of flus page t) pgavide adddwrW Nvell suits dwafis orwth
%V atvandonmeiddKaffiaYou May also aftach Oddiliarawfl Pares off 'rMcV?SarY
lox. Submit this ron'n vyigiin 10 days nfcompWion of well
ahandonman to IhL UwAnnW.
D1104an ofWater Rewurem Information Pireces5ing Unit,
161"Alail Servicr Ce. atew, Rml6gb, VC 7769SM617
10b,fq Ljj u loaddiogin Can sendingthe form flea dwaddwns km 10,1
above, fonyu wfihi13O lays ofccnipMwifi lAwr-11
a6millowncm to ft Vollowing-
DiOsinn of Water R m-nrces., Vadewgretwnd Mjmhan (.7antrol Prognawn,
16% Mail ServiceCenter, Raleigh, N C 27699-16M
loc. jar W, !Mrs -OVIVAR In j-
6c. Outer lwgth (if knowo): . . . . ........... Ahiq 30
ukhwqes� atanw� ak-a vybrnO ona colly OfThis rogin w% r., of COMO'm4mql
Cup` w0l abandopment to IN, county hadth datrAnmcnk of Ike. ciiiinw Acre
6E lnn#.,,r Vaingth (ff known) . ........
6q. Serven flew Oflina-wn)z . ....................... . . . .
Fwn aw-30

WELL ABANDONMENT RECORD
I. WeU Contractor Information:
John C. Schappell
W,gContrxwrN.._.� personally
_ y__. _ s ., ..... �..re,ey7 _...
arc Orwell owner ersonall abandonin well on hsshier m
2332-A
6
For internal Use ONLY
4 LI.ABANDONMENTDETHU
7a. For GeoprobeWPT a Closed-lmop Geothermal wells having the
well construetianldepth, only 1 G W 30 is needed, Indicate TOTAL NL MBER of
wells abandoned:
NC Well Contractor CeniS®lion Number 7bi Approximate volume of water remaining in well(s): •-,.�_.(gPl.)
M&W Drilling, LLGFQRAZE»sirrr �.",....._ ... �ww..
_. ..... LY WBLfS ONLY:
Company Name
2. Well Construction Permit N: W10600037
7c: Type of disinfectant used: w�
List all applkobtc,utll cwizrmcaonperariis p.a, Ufa Cotrmy Slate, Nalwnce,e ifbioun
7d. Amount of disinfectant used:
3. Well use (check well use):
w...
. _ ............
Water Supply WeU:
7e. Sealing materials used (check all that apply):
OAgrieultutal OMunicipaUpubiic.
R Neat Cement Grote
13 Bentonita Chips or Pellets
❑Geothermal (Heating/Cooliog Supply) ❑Residential Water Supply (single)
0 Sand Cement Grout
p Dty Clay
❑IndushiaVCommemiai QResidenhhl Water Supply (shared)
O Concrete Grout
❑ Drill Cuttings
P!E> .,, ..... .............. n.
O Specialty Grout
17 Gravel
................._.
Ko nt W Supply Well:
Ka
O Bentonite Slarry
0 Other (explain under 7g)
❑Aquifer Recharge
❑Aquifer Storage and Recovery
OAquifer Test
❑Experimental Technology
OGeothe:rmal (Closed loop)
4- Date wells) abandoned: 3/21123
11 Groundwater Remediation
❑Salihity Barrier
DStonriwaler Drainage
❑Subsidence Control
ClTracer
❑Other (ors l tin under 70
is. Well location:
Fort Bragg
htylt]wner Nana FTBR-1 03/SWMU-103 S Lucas De @tr Honey u mm oad
FanFaabty IDk (rf�pLcablej
me cuff R
Physical Addn:ss, Oty, and zip
Cumberland
County
Parcel IdenuficalionNo (PIN)
Sb.Latitudeand longitude in degreeslmiPutellsecondsordecimal degrees:
V-11 fiAA, Rot latilms is tu8kient)
35.14171917 ,�-78.97587955
7L Foreaeb material selected above, provide amount of materials used:
Portland Cement 14 Ibs
7g: Provides brief description of the abandonment procedure:
Neat cement funneled from top.
I
ti. CertlVer
n
. ° 3/28/23
n
sm
r$rcata,�wcrhfied Welf Comi �wr.. u w Well Qtunnr Date
By s0lin$ this farm, f hereby certify dwl Ilia weilrs) was (were) abandon(( in
accvr04ottto with 15A NCAC 02C.0100 or 1C .0100 Well ConeYrncllon Slandardr
andlhat a copy of this mrord has been provided to the to -oil owner-
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details Orwell
abandonment details. You may also attach additional pages if ueoessary
C_ONSTRUCTiON DETAILS OF WELLtct BEIlVG ABANDONED
ANacbuxilcon;Ilucfim�reca�i�rJlfmbiiabla Form�dtipleFi�tpparnon-mater.sayolyn^rllr
0Z1,Will the -saw cruulnadlowabandaunetii, )na am sahmh otirfwm.
6a. Well MIN: ,-B 4
6b. Total well depth: 55µ (ft)
tic. Borehole diameter-•0,75•••••••••••.,. (in.)
6d. Water level below ground surface:
SUBMITTAL INSTRU—MONS
10a. For All Wells: Submit this form within 30 days of completion or well
abandonment to the following:
Diviewn of water Resources, information processing Unit,
16/7 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 ofthis fort within 30 days of completion of well
abandonment to the PoUowiag
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 21699-1636
fie. Outer casing leagitt Of known): �..._. (g) 10e. For Water Suooly & Injection wells: In addition to sending the form to the
address(es) above, also submit awe copy of this farm within. 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casingitubing length Cif known): _w•, (ry,) abandoned.
69, Screen length if known
Farm GW-30 North Carolina Department arlinvironmenlal Quality - DI%ision QrWaler Kewn ces Revised 3-22-2016

WELL ABANDONMENT RE CORD
.... . ..... .
i. Well Contrictor Wonvation., MEM-DETAMS
John C, Schappefl
la. ForGi*probeYUPT or Clomd-Laop Gmtherinal Welk hamng the, Me
Well Canirmtof Nwirm In wv,9 owv" pa,sweHy abando"wng weD off hWIrr ptecny)
wah constfud'Wdepth . arfly I GW-30 is nw- ded, Indicate TOLAI, WL'IvM-. ER of
Welk, AxindontA
2332-A
71xApproximate Vniumefifivntrr W-Maining iD Mfflft
IM&W DirMing, U C
SUPP. ........ . ..
FORWATER LY NVELU ONLY,'
("UmfNiqy
`?c.'Typc of dilOnfoegaint uned . . ............ . . . . . .
WK)600037
2, Well Constracdon Permit 0: -1-1 . . .... . .. ... .......
emt UTC Counzy, %rdic, varifiv40".) ffAvown
7d. AnewujM ordwafociant ined--,
iclieck uric)',
. .. . ...........................
YgAr
ape. Scaling owerhils uscil (check all 621 apjpty)s
FJA,.pcirltuml f GAduWmnraprtd9 ruimNaWOt
Ncal rcment Group r, Bmwitc Chips a POW.,
UOtothormal (Ile AIIMIC.Ooling Sur.Pky] Elftcsidcafial WOcr Su M., ly Oinrk)
I:::1 Sand Ccnicmt(iroul Dfly Cay
Al.. (�Iaam I
:0 lndialniaWorniincu W E'MesolmlW Waxer Supdl
Ef Conciete Gra-A, DIA Oann&p
Nawwatgr SUPPIV Walk
OAqufficr Recharge
LAquRrerStorapeal Recovexy
ElAquifea Tesl
DEXV,ximcnod rechnology
9-K`wtjar,mzfl (Coscd Lacpi)
OM
3/21/23
. . ..........—
InGmundimtet ftentediation
O.I.Winny B=cr
EX'Stai-mAvater Draiiiagv
Mubsidence Qwtr,.5I
OTTIcer
sc WA WA60D.
Fort Bragg
FrBRADWSMU-1 03, S L.u.ras Drive @ 6 lone-ycuft Road
P6piicaIAddres*, 01y, mid Zrp
Cumbeidand
V=411dernflunhanNo MN4
T16. Uffludle, and ImVetude in de&nwslininutriisecogids or deximal de.4ma:
35,14171863 -78.97581652
Ej spociully Grout rj fira"c']
0 Bentowe "Ouny 01 (Aher (u..,:pWn mider, 7g9
7E Foreach meteirial selected abov4 provideannifunt of xfialerisLi iiied.
Portland Cernent 12 lbs
7r., Provide a brid desviription ofthe abandanimens pr4fredurc
Neat cemerAlUnneled from top.
d eel
.3/211/23
WP11UNn*r DWc
h r ,Vqjnmg Ibis ffiren, ( hen,"hi, cernfi, diar 11re werifc) fWas (were) chandimed AV
accwrdance with 15A W(W702C 010D rip, X A200 WWJ Ovolrollon Slap0cords
audilyaw a rnpy qf1his record hwr hgeyg propulexi jo the, meele o%wer,
% Ske fflagram or addidoeml well detalk,
Ycm vay use wife back of this Ipaage to provide aMnonal weIl site damflf; or woll
abandoaxnewdeteAs, 'You rnavapse attarb additiond pages i1rnrcxWM7,-
IMMANAN OLNED S 5A
Vmx wah Mew,74c abotulonmrne, izv cop sTehynR onefiw&, -h- 4F,,fwn -flim 30 id— ofccn Icdon cit'vmM
6b.'rotaltwAl dep1b.- 48
6c. Drarehole diameter: .0 11 75
(in.)
6d.WMeriemi below 19,08nd aWrffica:
u Wn du
Onandonmem to die kucmin&
DivWan OfWaker RMUM-S, WOMHOOD PrOeMMOZ Unit.
IMI'MaO Service Center, Ralclgh,,NC 2761V�-1617
woh. EarWeesion Wah: In adilmon to Nending the m forto the address in Hh�
I -------
ifliove, also submit one copy of 1his fmm vyHhIn 30 daylq of octnfpWman O'Wdl
AindumnLat To ffic fiAalwhw
ffivision nflftter Remuirce%, Vnderpround TnjectWn Cownral lrragram,
1636 ktsifl,%nice CaMer, IRamllffplgl ,Nr 27699-4636
J� Ile. 1LOr Vater Suj1jL1t& I qLech(Ln W U-1 I: �rf wki iI ion to sw.d infa the rotm to
6c, f3uter casing Iength (dot" known)- above, abn sulml One vmpyofllus form wilhin 30days nfcofnpVmn
Pf weH aWndannim asp the county health deovanment of the MuntV Whc.rcs
6f, sb2ndcfwd
. .................
6.%. Scricen length Cog known),_ . ...... — — --OW
FOM GW-,'.to N'Djul cwwnla mviximent arcin,nmwimaud QWfly - N"5io"ofWzmr Rescaumm Reyl5ed N,22-20M

WELL ABANDONMENT RECORD
1. Well Confractorinformation:
Jahn C. Schappell _
Well ContraetorName (or Well ownerprrson dly abandowngwa on Nslher property)
2332-A
For Internet Use ONLY
WELL ARAMpN) XNT DETAILS
7a. For GeoprobrMPT or Closed-LoopGeothexmal Wells having thesame
well constractioNdepA only I GW-30 is needed_ Indicate TOTAL NUMBER of
wells abandoned:
NC Wall Contractor Certification Number 7b. Approximate volume of water remaining in well(s): __ wµ w_._ (gal.)
M6vV Drilling, H C
amc
2.
lCtl 'it 060003
List DiloFplrrnbLe UH as.n.r.y.�.5..,1,.me..,e..Yanax.. .e.t.c..). iJkronw
..
3. Well age (check well use):
❑Agricultural Omunioipalftblip
❑Geothermal(Heating/CoolingSupply) 13Residentisl Water Supply (single)
IJlndustiial/Commercod ClResidential Water Supply (shared)
Nan -Water Supply Well:
❑Monitoring
❑Aquifer Recharge
®Groundwater Remediation
OAquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑BxperimentalTechnology
❑SubsidenceConrrol
❑Geothwmal(Closed Loop)
13Tracor
❑GcaihcrmalfHcatin PCoolin,r, Return)
❑Other(e rAainunjcr7e1
4. Date well(s) abandoned: „3121 /23
3a. Well location:
Fart Bragg
Fao�rlownerlv:une, aci
� . Lucas Drive aQ Honeycutt Road
lity tog (ifrppticablc)
FTBR 103/SWMU-'(U3 S
Physical Address, City, and zip
Cumberland
County Parcel ldentifica:ionNa 1N)
Sb. Latitude and longitude in degree0minateshieconds or decimal degrees:
(Irwell field, am latllong tr sutrrcicno
35.14175783 N 78 97573438
CONSTRUCTION DETAIIS OF-VVELLf9I BEING ABANDONED
�tlfxhwellcwrsrruuipnrernn!(sJifavol,fob/e F'6rnnrl/1p/einfedPoaar�rar•nwiersnynrywelts
ONLY uwth the same cansa'aGlptrplrgndoamen, jail carr,rrrbm:t nae rote+[.
6a. Well TIV: B 6
6b. Total well depth: ,7
6e.Borehole diameter:
6d. Water level below graund surface._., (fL)
6e Outer casing length (if known):
6Eboereasioghubingleogth(ifknown): .....,.,..............., .(ft•)
6g. Screen length Cif known): , .... (ft.)
FOIIWATERSUPPLYWELiS ONLY
:................... __ .�.._....w, ,.. ...................._.�
7c. Type: of disinfectant used:
7d. Amount of disinfectant used:
lc. Sealing materials used (check all that apply):
Is Neat Cement emu[ 0 Bettonite Chips of Pellets
t7 Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
Cl Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Portland Cement
15 lbs
7g. Provide it brief description of the abandonment procedure:
Neat cement funneled from top.
vroo :b
m.i � 8123
Sr snae 1c.xttt;� welt contractor or V ell owner J3uc
fly signing this fonn. I hereby certify that the uORA) was (were) abandoned m
accordance [pith 15A NCAC 02C .0100 or 2C.0200 Well ComVraction Standards
andThat a copy of this recrndhas 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 wtdl
abandonmentdetaits. You may also attach additional pages ifneaessary,
SiIB : i" ] AL TNT_ on
Wn. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division ofWater Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-16]7
10b For fppection Vi"ell,,s: In addition to sending the Corm to tte address in 10a
above, also submit one copy of ibis form within 30 days of completion of well
abandonment to the fal lowing:
Division of Water Resources, Underground fajecdon Control Program,
1636 Mail Service Center, Raleigh, WC 27699.1636
IOe For Water Supply & Infection Welts: In addition to sending the form to the
address(es) above. also submit one copy of this form within 30 days oFcompletion
of well abandonment to the county health department of the county where
abandoned.
P
Form GW 3n North Caralms Department ofEnvrromnenrst duality- Di%isron pf Water iCesoarces Revised 2 22-- MIG

WELL ABANDONME NTRECORD
1, Well Contractor h Fommadon-
Jolm C. Schappefl
. ....................
2332 A
I ,4C, Wr.�% Cosqmdor CW±ffimnon
M&W Ddfflng, LL-C
W10600037'
I'an all, "qjpficablc nall c Goadmaw M onyva rm e- ?YK, Gaunqt '54mr, va"Ume, ffnk.kj Ann"'a
3. Well use f1cbeck'wt1l use):
DAW1cUftUW
Weorkwal (HeadnF.Cwhiag Supply)
I'MaduskTIO/comirneraw
Non -Water
UAqwfrTRecfiargc
F Mquifox Stomp and Rocavely
DAqWrer Tesq
EW',xjvnmcntW
0(kmLhLmW (Closed Loqi)
4. Date wefl(i) abandoned,, 3/21/23
DMuntapil(Public
. ......... . . . . ................
[R, h,101.1W L�v ON LY,
'To For Gixvrobewr or ciosvi-imop cefoite,mnil %yeth pxiving %hvmxnc
wcH vwn1rucficWdLp#- My fl G%V-30 is ne.Wed Ind ale TOTAL WAMER of
7b. Appimximatc vahopt, of "a ter Iremamlwnamg it, vVeArim) :
FAR 11 1 ..UPPLYWY34SONLY;
I 7z Tj
7 . pe or disiniectuat nwi
d. Amount offflMn(cclant used:::.--
7c.Scafing nioN-whis used (c.Wck 0 that applyp
"i 11cht cement (1-Mut U Beflionite Mps 0, pallev,
dmxuttpuuG lftler&g4y Oingle) L', Sand Cement Gmut Z] DrIv Chq
Mfzsidenbal W,,av Suppky (shvel , 0 cf.mccute, 1lrTO11 n Dno cutinun
PGrmmd%vater RemedhAion
osahvity'B'Wicr
cSioly"%witer Ummage
Mubiidc-nve Control
01'Mccr
E10thex dart r1aAn undex '7 L, P
S I q. W01 1111=60D.-
Fort. Bragg
R°r'run—t� ­­ "
FTBR-1 031SWIMLIA 03S I ucas Dfive ira_) 1 loneycutt Road
Phymal 1kddTk'S%' rnap. and Zip
Cumbeliand
— - — ------- - - -------- -
filenuficrmn M, (PrN)
5b,. I.,ifiNde sad lon%itudv. in dcgn.%WudnnteVsccond,1t a%- dedmai degm'Lln
Rflwca field, Mao 8aulonz M gadfiwoxt)
3514159114 ,, -.78,97604,819
L(LNQKRLffT - .QE3LLLLLS -A 9BFNL
(AV1 v Wdr ehesaaff can gubmft emv'fioma.
69. W0 TD#c I .. . . . ................. . .. ... . ... ....... ... ... .. -
6b, Foad well depth: 54
6c. Bombele difinveter. - . 0 —10M)
6d. Water 1cvL1 helOVY gMuOd 10r&M� --.10L)
o Sp=WryG out [] Gravel,
n Fievaonhe skun, [I Qhcr (explair uM&r 7F)
'7E For each wateaura sticeW stwvia, provide swount of"nalViall awk,
Flcbrtivind Cement 14 lbs
?p , PimAdes bwiefdm- PApdan NO the abandonment
Neat cerlwnt funneled frorrw top.
3/28123
. ................ . . .
d Vp -Wall(Mar toaf("cmfic� MCnwf anr ag r DaW,
AW, :qgyggnp Ibis fijrm. I hercquv cvrt6 the'll the W011(k) was (we eftw1oned in
acroriffmce wah L5A VV.4CO2(',,rJW or 2(%0206'P Wed/ r'045thwcPeV0,9andar&
andiben xu cxpk ofthis ravard ha'' b&'?x prowtlezfro Me well w—r-
9, Site dingram am- additimnall well deMik:
you rn4y tm tht bact; ofthis page to provide gddifional wdw mtc diftik ar WM
W abandonmemdelafl.,
& r �LB L111 113 TAL IN.Ij rlt%�Ufjp C.
IOU. aj,. A V �JL V %bM ft Jbig JbrM %Nrltt�Wn 30 dars of compk-mon oF 1-'t1111
abandonment Io the rollovying.
DWWon ofWaker Resoure.e5, inirbirmation Pirecessft. Vyik
1,61,7 Mail Servicc Cent.or, Ralailgh,'4C. 276994617
1,0b.,.Er Ir M.'eIN. In addnion to vmding ft ft= Ta the address ljn 111m
above, aiso subinft one, rq3y of iihit fbnn i0thin %) daim or vcmplebon of,weN
kindmiman to ihe Wlovnngr
MvWan ma' eta Remurre& lindergroaml kkierflon 0",Wd Pragrflm,
1636 Nbo Service Ckmwr, ksleiph, NC 27699-1 6M
t0c. Ear addlition w sviidinF
6c. 0uter casing length (it knownh 1h: �n g the Wun to khe
W�oN�c, W,-,u %fi)rnik one c(#py of Diis fonn. wahin 30 days of cconpletion
of wcH sbandonimprd. m The Luunla- heakh (1gannicnt of Whe vmm�r whorc
abandoned
(yg, Ser"m length (if knawn)� - - - ------ .. ... ..... -.014
Form 4;i'W-39 Rv'ew.d 2 22 20 11 &

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John G. Schappell
Well) -Carmactor Nano (Orwell cwner p,xsonally abandoninswell on hWher property)
2332-A
.................... �.
NC Well Contr000r CerriSeabon Number
M&W Drilling, LLG
._..... ..,..... m ... _. ..� ._
CompanyNarne
2. Well Construction Permit H: W 10600037_ .,,_.. .
Lift Ulf opplhxrble n+a!! canrrnretMn permrrs p.e torn Comte S+ote: Pardar+eo, deaf lbrdiir,
3. Well use (check well use):
❑Agrictiltaral DlvhmicipaVPublie
❑Geothermal (Heating/CoolingSupply) ❑tteddential Water Supply (single)
❑ lnduslnal/Commercial ORtsidential Water Supply (shared)
❑ Itrislion
Won -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
[]Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
4. Date wells) abandoned: 3/21 /23
ecrollndwaterRemediation
asslinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
So. Well location:
Fort Bragg
Facili /OwnerNsme F*ih 1130(Ir ._ ty (�fappliceble)
_ ty 3, S Lucas Drive @ Honeycutt Road
FTBR 1031SW MU-1 U
Physical Address, City, and Zip
Cumberland
County
Parcel IdemSteation N`a. (PIN)
5b. Latitude and longitude in degrees/minutesAccands or decimal degum:
(Irwall field, one iaylotg is suffrciem)
.5-78.97696706
35.14184A0_..
ONLY-. . ,. Fdrinternel ......... , ,...w..--­­ _­........_ .. --.,,,,„.,..w
WELLABANDoNMENTDETAi R
7a. For Geopmbe/DPT or Close&Loop Geothermal Weds Having the same
well construction/depili, only t GW-30 is needed. Indicate TOTAL NUAMER of
wells abandoned:-
7b. Approximate, volume ofwaterremaining inwell(s): ............._ tgaL)
FOR WATER S[iPFLYWELi S ONLY: �.................�.�. �..- ...................._......_
% Type of disinfectant used: , wmm�„ _ _ .._, ..................
7d. Amount ofdisinfectsntused:
7e. Sealing materials used (check all that apply):
B Neat Cement Croul
❑ Beawnite Chips orPellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty count
❑ Gravel
O Bentonite Slurry
17 Other (explam under 7g)
7L For each material selected above, provide amount of materials used:
Portland Cement 12 lbs
7g. Provide a brief description of the abandon ment procedure:
Neat cement funneled from top.
8 CcrbGrna n°
It 3128123
e ,
,� _ ._.
Si"ureofCertified Well ContractorortAlellOwner 12atr
gy sfgntng this farm, 4 hereby car1ffy Mal the well(s) wqs (were) abandaired in
ae=rdancie with 15A .NCAC 02C.a100 or-2C .0200 Well Construction Standards
and that a Copp of them record lraa heeti prm fde d to the well owner.
9. Site diagram or additional wen 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,
" Ot, NSTRUCT!1)]M DETAILS OF WF i (fit ll(,;,�IG AB D OWED
ilnach�rellcvnalfacriottircnid(sjJmnilabte. Farmrrbiplalnjrcrla+or+ma-ivarersupplyivcTts
ONLY wish lhe.tr w eonmualauahanrinnarenr, yore consubinre one,/orm
6a. Well IDd: C 2
6b. Total well depth: 4$ (it)
6c. Borebolediameter;
6d. Water level below ground surface:
SUBMITTAL INSTRUCTIONS
109. For All Welts: Submit this form within 30 days of completion of well
abandonment to thetollowing:
Division of Water Resources; Information Processing t)nit,
1617 Mall Service Center, Raleigh, NC 27699-1617
10b. Fgr In: ectioq W el3: 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 rollotring:
Division of Water -Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-106
6e. Outer casing length (if known): __(fL) 1(k. For water Susmtt&°t & Tn'echl t n Wg)Is: In addition to sending the form to the
addresses) above. also submit one copy or ibis form within 30 days of completion
of well abandonment to the county bealth department of the county wbere
6E Inner casing/tubing length if known • abandoned,
6g. Screen length (if known):_-­,N......._..-.......................................---(B,)
Farm GW 30 North Cutdit,apepa lment ofGnViroamenW Quality -Division of Water Resoorms Revised 2-22-2016

MTLL ABANDONMENT RECORD
1, Well Contractor Informaties:
John Q Schappell
. . ........ ... .. . ..
wah CoWSUIN Nwyt (Dr wt" lowwrIpawnely AandoxwgweA on hisdher propedy)
-
NC wou Cow"kaor C"tificatkin Miunbel,
M&W Diriffing, I LC
Cwupw,yNagpe
'L Nveft,conmtruLdoa Permit M., W06010037-
LivallappAviNe UIC." Coldnl�t Sydie, Mvemwe, Meer) O'bmsen
3. %VeH tme febeck weJ1 wie).
.. . .......
rey Rfternyl Upw (NN LY
MM L AakNDQN,$WEWF QE.UTL.$
7z For 0:.,wprebPVDPT or Clm-d Loolp Geothermal Welh Sus' ing ilia sa"m
well vmly I GW­30 is wwedrA. IndicateTUML NUMBEA of
Wt119 nbandOYICAI . ....... . ..
7b, Approximam vwume or water mawnwg, in weixs): _(PL)
IFOR NIVAITR ST.TPt;V WELLS ONLY -
Ice 7ype&ffMNIatbc#Ant used - — -------
lit., Amount of dishAlactint uw.d.
Wad e I u-'s Up -Ply W A 7e. SrAfling, xanteriah nsed (ebeck ift thal applyp
DA.SnciAhimi ElMunicipal/Pubhc a Neat Cenlent COMA 0 B enkamic Chipsay Pelh,15
06ealbermal (Meafing/Coohng Sii,upply SU i � ) 131(mWenval Wow pply sagla) 0 Send CM91ent 01100 El Dry My
OhaduixinK-ommexial Al =dwMal Www Supply (shard) I ConeweGivid 7.1 Drill cuthags
NO=
n A q mi fe r It w1org p,
ElAquifer Swyne a.%A Rmnvoy
EjAquifer Twa
0GwA1ydr=W (Closed Ump)
L'.30oottaxnal fl, I e�wuo,6,-,dhr,�,y
4. D2W VV019Q ASEWIDned -. _3/21 123
WGTn=dNva1er Rrmeduiron
USAMIfy Han-lex
UslioxyliAlwaler t.)ninay.%,
LlSubsideice Conrol
01"Mw
00dwt d ox, i 4,6n wgd= 1i
9m Well larm don.,
Fort Bragg
T., _0nV/011.11Zw_"k NeAny TDP fiNgplwable.
FTBR-1 03/SWMIJ-1 03, S Lucas Ddve @ lloineycutt Road
PhvwrAL-kddw=s, Cay, zxd •Kiti
Curnbedar'd
. . ... ... . .... .. .. . ...... . . . .
cpwq,
i lb. Lalftde imil longiltude in arch grees/micutaheco ods ar d mWa 11 de%lmes.
(iewelt fleld, ane larAw,& n ivfffuwon )
3514168134 -78,97589665
............ .
L.'gNURlXMj f(WjftEXAMS N WNG ABANLL�LN D
ONE V wffi 1&.wMe mpv sabMii ewfam
rM. WWI 1XIM: C 3
Q.Totiel "Al depth., 5'4
4r. Boreftle diameter, 75 �0
"' - __010
6d, Watpr leyd bck,w igrowid inirfacir. __ __00
L 3 sperialt Grout 0 Gravel
Benforuteslurry
)ftr (ak&Ui widen -�g,)
7f. Vo r w"geh. woasewisl seleir.a-d abuv& provide amaunt of as vourial,a used
Portland Cernent 14 Itis
%Providea briefdewrlpfien of theaslamoadoniauesat proceduinn
Neat cerrient funnisled fromtop,,
W,8123
Py signseg dljiyfiamj, I hgereby comp shat Me well(#; �was jrwrq� wlxpidnmed m
a.rcm-danev wah i5A M At" 02C 0100 ok, A' JU00 Wall Ow.,wwrnag# Neaadeinfv
and than atepy,afAw red"onihm Mang omprAviddia0pe wello4wer
9-13ite, diagram ON, additionall WCH dewHs:
lw Ycox may use lie bark ckHM, page data pyovWe additional weH site detaft, or well
tab andotirmeoldetafK You may also aftach addibonal rpagm Wricecssar.y..
wr SUTIM]"n'Al. INSTRUCTIONS
Ift, Submit ftr form volhia 30 dalys of rpmpkwn of wrH
abm-Wonmiwt W die fAriwind.
ffiviqirin al'WatcrRe.4mbrce� hiforination ftneessirig Unit,
1617 1419H Service Center, Raleigh, NC 27699M611
Ift E(jr WeLefign Wellp In addition to sendmg ffie,forin to ache mq le addi dn, MA
_
abnve, Slim gubink alize COPY Dflh% finm row "lira M days of c3impWfion ol
abandonment ki the rh11Dwinj.,,
UNision tdWaler Rwmurws, lJoidergirmund hi�jecfion Control Pre gxwat,
1636'N'lad Service. Center, Raleigh, NC 27699-1616
hie, Outer easing lengtb (if known), ft)
addmFaw,) above. zfxi submit ane copy of fts rhm,4 with un 30 cAd^.,Eif coinjAciftni
of' well abandonnient to the counry healfli dii-qydnment of Oic capint.y Whore
K In eming/tubiag length (iflknown)g _-,- (R,) alAindaped
6q, Screen lear ,th (irdawn own) . ................ ................ . . . . . . . . .. 00
Fam G'W.10

WEELLABANDICINMEW RE, CORD
la Well Cb1ii bdomatiott.
John C. Schappell
(cx,any l I[ any per^rxnaaaally nbandgmungwd! mu Wdher property)
2332-A
TjV— gunjNnbg,,T
, Wq7 ,7c;T— --"
M&W Dril"Hing, U Co
CanipmyName
.2� Well Cbmstr=flen PermIlt a. W10600037
...... ..... .. --- . . . ........ . . . . . ..........
LUO all UIC. Qirexfy,,Vp�p, Mwippaiyo eir.) fiAvano
3. Well rime(Ocvkwc)ll nxe)W
I r Pic marml We
. ............. . .. --
A"A ij?_Qfq ArKYAM-41
7%. For Geoprii or Ciload-Loop GeotharqW Wiefts having time me
weffl ronsfmiAan/deph, only I GW-30 is needed., Indicate'R)TAL NUNMER of
w0h ubandanpd- 111- 1. � - . . . . ............... ...................... —
71.4 Approximate volume of svniter rengsli"bagiAl u.al.)
. .. . ...... ....
FiDift WAITR SUPPLY WF1J',S ONLY:
7r- Type of dishifixts at uiedt __. .... ..........
`7d. Amount of dfidurectsiat &wd-,
Water Sul:liply WLG:
7e- !mHng materbilt uspd (check 4. Mat appItloIj-,
DAgnicallwal
Mot.90psVIFlubhe
9 Neat Cement Giout
11 1
Moff,xi 04C.M6111101rflabing StApply)
CRA-siidaaig Water Siijpply (sini
0 S=dCar=tGwut
W. DrV Cloy
101ndust.M.A/Corninercial
I'Musidettfial Water Suppiy (shwal)
0 ComrmW Gmul,
C"I DdIl L%littingg
ILI IV6�m�,On . . .................. . .
0 speciaINGTOut
n Chavo
Non-watLir Supply WPM;
0 BenfOr.dW SJUT7y
C Offier (explain under'7g)
r.1mouitonng
C]RrA*vMr
le i welb
. .. . . ...... .... ..
74 For each materfAil selected,
above, prwv1da arnount of acaftxiAir used,
M,Aquifm Recluige
PJGmuxtchiratm Rm.edialion
PortlaTid Cerne
14 Jbs
DAquirer Storagemird Roitoveq
0SWinity Banier
M.Aquifer. Test
E3E.xpLrbrncj9aI. Teebaology 1."3Rub%iic1rnrrC6rayo1
130cothu,mW (Closm' Loqi) 0 TTACer
4Vale w0l(s) abow4oned: 31' _21 /23
So. Well IrrafliflouT
Forl Bragg
ra'aintVIOW00 Narre Femlity
F,TBR-103ASWIMU-103, S Lucas Drive @ liomycuftl I -Road
Nysrcall A ddress, Clty,wd ZP
Curnbeii-land
P or W Wei V r i A 4 i m i N 0 P TRi
5b, I.,afitude acid to"xitude in or ale ireal degives;
Cifwell Fri ime Ratnrrq; ts sulfwaw)
35.10 64926 ,, -7&97582021
DE. L LAMINS'LAD. A
6a. WAI I EW: G 4
fwbm Total well depft 55 11,C.)
0 75
—12— ._(in)
I Milialer li below grviand suirface., _(fitj
16e. i umship ., fenrth (if knii
S& loci LT casimp.j,'i lenob Cxf hnown).
S& scireen Ian?
"th (if known):
71p, Px-o)4de,,s brieftle4cripfion afthe strandaiii procedure,
Neat cement. fuinnWed ft-orn, top.
U.
H, T� Mae,
3/281�' 3
... ..... . ........... - - -------
&,rwili'm ot 'emifir0irell Commonr vwl
Bygnft snuffs firm m, I hereby (,=,tDjv Mat Hw tveffi's) wax (sttvw) abandoncel in
rpah LIA M-,41C 62(3-6100Cam 2C,02.00 TY0 C%PLv=nan,9a.nderrdq
and Up a v m4, a
� r Ithis revart.11pas bern providedrasa the wen arwer-
9. %kadjagrow ar isdidifianal wtlil idiehdis,
You may use thin bacL of fts pige ibo provide addifitzral well At details or well
W abwidanmeirI YaarnAy ahm attach addii1ional pages lf necassary.
"1.U14'%JDA
108. E.91-AlLWAb. SWAI-ft DR% fbmw wfthin 30 dkys of i'malph-1imi ot Nkefl
abandonment to ft fWai
Division Proomssing Unk,
.1.617 1120 Service Ceateiri Raleiggli, NC 2769!9-1617
lob. r "k In sddMcm to si.Ming'dw form N the -,Kldmss in lift
al ove" ALWO SYjiroMft rafts (cf)y Of this fbmk %14thiiv 30 (ISY5 i cornpi!etinn oftvall
abandonment to Me IbHovqn?,.
Divislan: off Water Itesi llqwda:Wnrairkd Injecting Control Projitirsim"
1.636 rkbillService CenteirAstentyk, NC 27AMCM
10c. Pot, Water SumAy, & In addition lo scading the fiI to the
addTmNs) al)ove, Mw mdardt bane: cap y ofthis &Tni willoc 30 days oftomplation
(if 9-vdl abandionnien., to the rmuaty hcalih &T.Nwrilment or the Covilryty vu'°9ne°re.
abwdonad.
Fomk OW 30 NOdlb CMtWnG DOP-OtOMM Of EflVITOUTIrCri QUWu� - DAMuMl OfftftF RC.MFCANI RevoeA i-247-7.4ifi

RE, I J, A-BANDONNIENTRECORD
1. Wea Contractor jurarl"adlign:
John C, Sckmppell
wep contrwor"aaw (or we" 3bWAIO"iU.gWA OR ltdSb PrOVWY)
2332-A
WC W4 ifwgainumlaar rehfication Numbrr
IMM'Diffing, LLC
Owqwy Namt
W10600037
2. weU ("'Onaraction peranit, 0. - --- . . . .... . .......
4,!� !"'IC rawaySwee, Kwxajwu.,ah.,.) iftswwn
.3. Welt use (check w4l wc):
_ ...........
Water SuTpry W.Ih
OAfficuhumi Mmum6pavpubfic
Fou Wee aW U,, 0\0(
., WNT DEIIii
...........
U. ror GeoprobeMffor Closed -Loop GeathermssAiVebw Ihavingthesmne
wall caT*tnirbcn)dcpik, r4fly I GW-30 is iraewW, indicawe TWAL NIAMER of
wON PhanclonM . . . ...... . ........... . .... .
WAS)'__ —(gal-)
. .. .......
Ire, SwEng waterlah uimd (clumIr all that apply):
91 Reat Ck"Inew Grout F3 DtwimnAe (2hips vir PeHeIs
O( IMith:mW
Supply) Ufkw�iWeri W&WSuply (vn?,10 0 Sand Cemdol G"trym 0 Dq 03V
[:"VdutATiaVCOrnMeTcMI[ rIRr*We.nwiW Water Su IVy (sluved) 0' ConzwMIGroul D: DMI CUAWkefb
a Spe6aftyarout 73 rffaW
-- — -----------
Non-WaterSiapplyViVeW 0 bewonite. ShArry 0 Odler (expi nin watt cr 7g)
rJAquifer R,,.r.har&c
E]AR.1,afer Storage PjZ Recoyexv
MAqwftx Test
v3E,Xpcyunv�1031 Tcchnn�agpy
OGCOfficmug (OwAl R.
RCLUMa
4, N, te vwpffl(i) abawrdoinfxlz 3/2"1123
MGrr%rndwWtx Renx-Aisfien
O"MOV Banier
Ostam1w,vaer DTawage
Mubsidenoc. controll
0,17mcar
sa. Ave'll JOUVIOnt
Fort Bragg
. ........ . .
FmIfty'Chmor Nwna Tazihw MO vrappficakrk)
F'I'BIR.-�1031,S'WMU-103,SIU-u(.- s Drove IHaneWcutt Road
PhysicW Addrma�g, Cay, xv.1 Zip
(FM
Sh. Lantande, and Wini in d M..reesimilaideWspeonds air datimal degmvj:
(4'wA rieNg, ane latqairkom, ss wfficaent'�
35.'14165886 , -'78.97578433
('..(JN. `LONDFFAJI� ..;
!if LQ.T-MILL05 .ING ABANDQNEA.
ONLY as 11,4 s0nv &AWAIrMaly abOMMMOO, )OW 440 -TRAM11 Ormfirm
6a" WWI U.M. I C 5
5 S. 5
fib.,111,0tall %you deptitc ­­_
k,,. Bareholelfilanpefer: 0,75 _00")
6KI, Water level below grosund Fmrghce-,
7E For cock material Mectedabove,. pirei swuloost of rVaiDaw iials Ii
Portland Gement 14 Ibs
7& Pwyide a IbrlefdewapIWR afthe abandonax4mi pirwmdure:
Neat cernent funnelfA- fro rn top.
8. ("m^remin
3 r,? 8/23
i roinuminvw or ��Wvwr Date
,j7
nff'Ot Aed VI,
Hy sig"frkig thm fivrA I hereop rv�rj;p,& Mal the well(a) ww.ts (were)' gsbandaned dad
accorairince o0h IIA PRMC 02C.0100 air A'.0200 Wed/
avel Mae as copy qfehix rearad hwv hiarn providediia elpa, welJowmv.
% Site ii or addidonial mv,11 dipt,015-a
You may ust the back itfihis page to provkh- aM60nai 1,Neill srti!r detail� air w0l
w ai��rdOnMCI'11 CleISRSr V-�u mo ii awmrh ad&towkI fxkg,�s Wnccc"ary,
5ONVU,
leg. yff i Stdinw, lhis hwan wMiip M days ofewnplahon Ofwell
mviiiiian smater Remiurrx,.% Infirmisfian Precasteg Unfl,
1617 MaR Service Center, Raleigh, NC 276991617
j jal eign WON: biadd&a w quirdus LNa Ibrun 1r fiu,. address ar Ma
llixwe, a%O submit Orle copy of this Form svilhin 30 clay's o@, CornpleUn of VmH
abandonmenw to ffir, Foililoviving -
iilRvhdon ini'Woter 14muirecs, Underground Injetfien Cnntrol Progireiria,
1636.MaR qervice Cienter, Rgleiph, AW 27699.1636
I
fiv- Ouler Pw,9ng.Ieq4,h (irknuwnp MI, Rua adddion to riemfing the fivni o Ihe
above, a4O subnriil one copy afffis fann Mithin 31D days orcompio lcw
,iddrm
oC %yeh abandonrawn to Am cmma y health depwMien'l of the coway %whMe
6E loiter ontaftJohing length (ifknewyri): —M.) abandowd
6g. screen length (if . . . . ........... . __qMt.)
Perm GWJO Noyuh iramma i offnwanmmW 22,21316

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John C. Schappell
Well Contractar._.._.,,.-��,w.m..Wm._._....._._........_.w_._...._�_....._._...
Name (or well owner personally abandoning well on JuAw property)
2332-A
NCweIlContradorCerr � tfieaMn Number
M&W Drilling, LLC
Company Name
2.Well Construction Permit 6 W10600037y�..��..�. _........_ �... ,. .....�_—_-..
Liar all eppllMti/e n elJ crvrrmrcltaatrermiu (r:e UIC Comity. $rare, Ydriarxe, e1c,J rfbrot�ir
3. Well use (check well use):
OAgtieultural
❑Geothermal (HeatirejCooling Supply)
❑lndustrial/Commemial
Well:
❑Aquifer Recharge
❑Aquifer Storage and Rceovcry
OAquifer Test
OF.xperimental Technology
❑Geotbetmal (Closed Loop)
4. Date well(s) abandoned: 3/21123
So. Well location:
Fort Bragg
❑Wuniap&Public
For internal Use ONLY
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DP9' or Closed -Loop Geothermal Wells having the same
well constructicn/depth. only I GW-30 is needed Indicate TOTAL NUMBlilk of
wells abandoned:— _ _ .. _...--......
7b. Approximate volumeofwater remaining in well(s):
FOR WATER SUPPLY WELLS SON � .. .
ONLY:
7c, Type of disinfectant used:.
7d. Amount of disiafeclant used-.--. w ...
7e. Sealing materials used (check all that apply):
e Neat Cement Grout ❑ Betnortite Chips or Pellets
❑Residential Water Supply (single)
O Sand Cement Grout
O Dry Clav
❑Residential water Supply (shared)
❑ Concrete Grout
O Drill Cuttings
m
❑ Specialty Grout
17 Gravel
❑ BenloniteSlurry
0 Other (explain tinder 7g)
MUroundwater Remediation
asalinity Bawer
OStormwater Drainage
OSubsidencc Control
©Tracer
QGlherlexrsh' it: under 7pl
03, S Lucas Drive @ Honeycuft
Facility/ONmerName .... ITmmmm,�FacrhtylD!(+f�P1i
FTBR 103/SWMU-1UttRoad
Physical Address, Ciry, it Y.ip
Cumberland
CauntY Parcel fdmWfiralion No. (PIN)
5b. Latitude and longitude in degreedminutestsewnds ordecitnal degrees:
7f. For each material selected above, provide amount of materials used:
Portland Cement 14 lbs
1g. Provides brief description oftheabandonment procedure,
Neat cement funneled from top.
f� x
S. Certifies n
3128123
St wareorCernfiedWellConuactrgrWallOwemr Date
!ly signing this fops. I hereby certify that Ilia we!/(s) was (were) abandoned in
aeeaMon.ce with 15A NCAC 02C .0100 ar 2C .0200 Well roustruction StanddrrA
and that d copy of this record /wet' heerr provided to the well owner.
(ifwall field, one latilorm in sufficient) 0. 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.
CONSrtTgUCTIONDETAILS OF WELL(S1 BEING ABANDONED %TBMMAL INSTRUCTIONS
AnaehtrrNedoarnn:pwireeo+d(sJlfalaitahte. Fdrmull+pk++�aiararerm+-rnorersdgrfytrella
0MVidih (he.wmecqu1eudknldbaud4?mnwrd )vwcan submitwirfanq. 10m. For All W Is: Submit this form within 30 days of completion of well
6,9. Well iDN: m.,�. �...._................� ._____...........
abandonment to the following:
6b.Tota1 well depth: 5.5 w............ ___ ....._......All.)
75 (in.) 0
6adiameter. mITIT',,,,,,,,,
6d. Water level below ground surfacew.www
6e. Outer casing length (if (mown): ______,A)
6f.Inner easingltobinglength (if known):,
dg. Screen.length (if lmown):.._..�....................._......................mm.Aft.)
Division a Water Resources, Information Processing lint,
1611 illail Service Center, Raleigh, NC 21699-1.617
IQh Far 1ri ec ioa�; In addition to sending the form to 0te address in 10a
above, itho submit one copy of this form within 30 days of completion oCwell
abandonment to the following -
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 2709.1636
l0a For Water Surly & Injection Wells: in addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the count', where
abandoned
Port GW-30 North Coroliaa Dgranmeni of Environmental Quality -Division of Water Resources Revised 2-22 :alb

WELL ABANDONMENTRECORD
! ell Contractor Infarmssimu
john C. Schappell
We. tl Comrwwr Na= (or %vH ovnw pffson*Vy atendontmA 16WA no hmthOr pwpeily)
2332--A
NC Wefl ('Mdrador Certificawin Number
M&W DrAing, LLC
CompmyNamc
2. %vell CUDSWUction ra-mit 0. W'06090'3�7 . . . . .......
I. ju all o'wpafa.mid wwfi ri.c fjV"-, ("(Sway Srate, yanwwr' eu
3 Well uae, (check well use).
F" I wesvol US& ONIN
-MMLLADAMMMINI RUAM
7a, rar GeoprobedDYT 6j, Clased-Loap Geotherws$ Wells baying themine
mmU con.MracdoWdepth, o0y, I GWI-30 is needod. lrdicaw'F(YrAL INUMBER of
YA-lh� abandoned . .....
7b, Approxi mate wm am e e I water re ma iai ng i iim we(q) : _._ _(raU
-7 V i Y-.' ................ . . ................ — — --------
pp d
7r. Type of qJWnf&ln%t usxh,
"Id. Amount of dlsinfbnant useM .....................................
---- .... . ....... . .....
-- .. . . . . .............. . - . .......
Water supply W01" 7 e. &m.ling mAteriab awd (check all thst apply):
E2ALTIC111tural 0mumvp6luhk Neat Cement Gmat 0 pia reanae Chaps or Pa: kxr�
DGeothennal (H"wPX0WAnp .., Supp�y) 01kesiftnUal Water Suppy fmngk) 11: 1 Smld Cement Girour. C Div Clay
01lidustindiColagnm6al URemdvov 01 Wawr Supply ftrvd'p 0 Concrete G Imur ED Cal H Cutuntc
MEMM
[jAqqAiferRcvhaq?,c
0GwOwnnal (Closrd Loop)
4, Date, vvull(s) atnndbned: 3/21,123
RGroundwatcT RCIPMiHlinn
Q%afimty lfwfim
f-"IONT rUn under 71,,
54, NVOI NkRtian:
Fort. Bragg
... . .......
FTBR 1031SMU-1 ID3, S Lucas Ddve @ 1-Ioneycutt Road
PSys,QW Addrraa, City, and 2-2P
Cumberland
. . . ............
q1b. Lafitude ind longhude lwi or dimimal dwees:
Artd, cne Wflonq m wAcvaid',
35,14156893
WUNDONEft
OXF."Y'odo dw
68. "101 Ino: D I................... — - -------- -
6b.'roha wyea,peep o. 48.5
6c, Rarchollediameter: R,75
6d. %wer level beWw ground suirrai:e-
* specmity, unnu 0 Cinlvep
* ffim.tonite SAarry" M C)flwx ( expWn und" 7S)
7r, For eRch maleviA selecta.A albove, prcvide himovAl afmateflats Vmh
Portland Cement.: 13 Gas
7& Provide a bdei'descrillifino at The Atianda"meal prfxedurtz
Neat cement funneled frorn top.
3r28/23
dr
Cedifinj W09 Cantralao, w Well awwer Date!
Eft, z,-,ggnesh.ts,.ffirm, I herety mrq& jiva the! w0fV wos (were) ahandeiaed bay
accordaric,,a jjqrh JS�,j AP( AC" 02,(,%0jr)e) tar 2C 0200 Mdi CriaWnecelon SdandwTh
andMal as co.vY atfeldi- evronihax beCa parrsleel 00 IhO "Irri owner.
,9. Site diagram ar addifiamal vvell dewi6,
You may use the back of ffiis paga to provide additional ViCH m ddaills or vw3l
IN abandon mentdawns You may Ww avmch add4vmO [wai ifneceliswy.
ID& fpE-&ft-jVL1k: Submit lhas fonn %vithm 30 days ofe(milple0an of %vell
alswWorament to tha fokwulp,
Dhision ofWaler Resources, Info ma Procetusing Unit,
1617 Mail Rmvice Center„ Fbleighi, NC 27699-1617
h%addftPmay svj,4ng die , foimi to 1he 'Idd-w awn103
obove, also submit one copy Of rpmd,i. fann ivithki 10 days or ctenpklion Qf weli
abandmiment W dic fbflcmviiiqp
1xvision of'Witer Hemmirerm, Vniiergxmyad lajvmfian Controt program,
1636 MaflS'Prvice Cenftrmfeigh, NC 2709-1636
gpdr pa & Ou Wr casing pampa (if knowa)- --- . ......... . .. Vt.) Tit atUhux't to smdaig 11he fourn to Ow
a6ir m-,44x) above, a�m m1mit ona copy ofibLq form %vi0win 30 da," orccenpuon
or mWll abandcuunelt to the County hw, BAh deparwan ent of fie County M wirt"
U Inner ecasing, abondoned
Aubling Wngth (if known):
6g. Scrun fength Of Tknowu) . . ................. . ................ . . .... . —.--M)
Form CAVIP N00h c4rohwga afNVMvr Resourco, Xcvi'O 2-22'201t

WELL ABANDONMENT RECORD
or Internet Use ONLY
1. Well Contractor Information: WELLABANDONMENTDETAILS
John C. Schappell ___ U. For Gooprobe/DPT or Closed -Loop Geothermal Wells havimg the same
Well Canuector Name tar well owmr persoean Rbsixion _ � � . on ..._....
y ning well on his+her pmpeny)
well cooshiretion/depth, only 1 GW 30 isneeded Indicate TOTAL NUMBER of
2332-A
wells abandonM ......
NC Well Contractor Ccrti6can ... --
-onNrsmbv
7b. Approximate volume of water remaining is well s - .„,__ a1.
Pp R ( �tS )
M&W Drilling, LLC
xo waTi astreeiY WELISowLY- __......w.....W............................
me
cam Na2-
7
'�'rypeofaisinfeemntnsca:
W10600037
Well Construction Permit
Ltirall appltmblt tnaRcarrrnrcdon pecan/s (ta. UIC Cmrniy. Starr, 4'aNmcv, e!4) ijJvMh'n
7d. Amount of disinfectant used: .......
3. Well use (check well use):
.".. .............._ ............ -_ �..n .......,. ,..
'Water Supply Well:
7e. Sealing materials used (check all that apply):
OAgrieultural
❑MurticipaLTublic
8 Neat Cement Grout
❑ Bentonite Chips or Pellets
170eothermal (Heating/Cooling Supply)
Mesidential WaterSupply (single)
❑ Sand Cement Grout
❑ my Clay
❑industrial/Commer©el
❑Residential Water Supply (shared)
❑ Cdncrete Grout
❑ Drill Cuttings
❑lm^ elicit
❑ Specialty Grout
❑ Gravel
Non -Water Supply Well:
13 Bealonite Slurry
❑ Other (explain under 7g)
❑AquiferRecharge
❑Aquifer Storage and Rewvc:y
❑Aquifer Test
❑EXperimental,fechnolo.gy
00cothermal (Closed Loop)
❑Geothermal f catin,�,+Coolinsz
& Date wells) abond oned: , 3/21 /23
DGmundwater Remedi ation
❑Salinity Barrier
riStormwater Drainage
❑Subsidence Control
❑Tracer
5a. Well location:
Fort Bragg
FoWiv/Owner Name Facility iDli (if opplimble)
FTBR-1031S1NMU 103, S Lucas Drive Q Honeycutt Road
PlrySica(P ddress, Cih, sod lap
Cumberland
foamy Paroel Identification No. (M)
5b. Latitude and longitude in degrees/minutesfseeonds or decimal degrees:
(ifwell field, ono lut/lang iasulfcienl)
35,14159854 ,a—78.97597142
7f. For each material selected above, provide amount of materials used:
Portland Cement 13 Ibs
7g. Provide a briefdescription ofthe obandanmentproceduree
Neat cement funneled from top.
S Certificatu a �..
SaturevfCerhiicdWelt trxtorNzN' sm�si23
i gn .a WellOwrx� bate
tly signing ibis form, 1 hereby cerr ft that the we/l(,,a) wHns (were) abrmtktned in
areordancewirh ISd MCAC¢?C,0100 or 2C..0200 ifell Conbraerfon Standards
and eha/ a cagy of this record has been provided ta.the well owtte+
9. Sitedingram or additional Well details:
N, You may use the back ofthis page to provide additional well site details or well
abandonment details. You may also attach additional pages ifnecessary.
CONS'I'RtiCTION DETAILS OF WtLUSi RFMG ABANDONED
Atkrchtveilcatur&etianreconl(sJijovalhhlx TtrmntApk7q/�dlullwnCq-�varersnpph�ret&
dNLy frith fhe stance auasfrrrcrlo+x"oGattdonnten+.)PH CQJN 5[rtleiit O/rt'flaYr-
68. Well ON:.D__2.......... ..... .
6b. Total well depth: 49
6c. Borehole diameter: 0.75 ,.(in.)
6d. Water level below ground surface;
SUBiVMAL iKSTRUCTIONS
10a. For 11 Welly: Submit this form within 30 days of completion of well
abandonment to the following;
Division of Water Resources, Information Processing Uolt,
1617 Mall Service Center, Raleigh. NC 27699-1617
10b. For Injection W S11s: in addition to sending the form to tte address in 10a
above, also submit one copy of this form Within 30 days of completion of well
abandonment to thefollowin.g:
Division of Water Resources, Underground Injection Control Program,
1636 Maid Service Comm Raleigh, NC 27699-1636
6e Outer casing lens h (if known): „ (R.) 10c. Far Water Suotttti & Ingeebon Wells-. in addition to sending the form to the
addresses) above, also submit one copy of this form within 30 d3ys of completion
of well abandonment to The county health department of the county where
6E Inner casing/tubing length (if known): (ft) abandoned.
6g. Screen length (tl'lmnwu)..____.....................—......_.................- 00
FoanGW-30 North CarolinaUeparunenrofEnvironmentalQuality- DivisionofWalcrResoarcec Ramcd 2 -2016

WELL ABANDOiYNLENT RECORD
k,'kW elil Cowatraa:te r dand"ennaaddaaaa:
'��Va,"NNiG'us„iu�a•�ai8au^iMU�aao�di.rn�iam.0..._.��,.__....�..�..w� .�.,,.,.�.......�.m.........�..
�� r B aa�asa' rc°avuaro�ap0y annuga'urr�.agv��aBl Haan Bnti. �dt�a Naar4o-Vavaw4�,'p
....
*UC' A�'ro911 �"naafiu�amcunrt"tarft>.fk�raaaaa�ava'�SsuuraYua`,W mm�"
M&W
IDfdffpng, 1_1,,,.
U.ems all argaaimirk Welt AM ITICAMIpyraT2ar,a Rug, kv'dl„ (;°monrvr5., Manrar MaHtvxe err) &Iw+aami
I Went use (check well aanO'
Water I.;Hllrkakkwu WOM.
EjAgncuftuM 0,11 kaatatt:ppaad9psupapie'
MjlrvernW ii eaun.2"' nrswkan SzsPOY) A da.dentingWaaer'Suull i1v (wri F.") SAW Ce m tOmma
ElInudnaaamsaircoganmietarap iResidenakak'Water SurplY Ohaavxi) 0 0311ca»am:4arvz A
Foi parmervA U.UP& UNLY
fan For GeopirobeAPPT Or CkaaSaaa14,00pu G-ri Web, ffnanvyap the tame
wept c anroaaacttuaUaa/dejN0n, only p GW 30 is nrvkdpN niche " '9 NN' BPVtBER of
wvut is mabaxnadarvuarad .----- -,,. ,m_ ...�..�._ _.�s....
2b. a pp roll wane VOi1naMa;-fVVMftT mw^a airing, Viam pp(s) _......... ,.—WO.)
"kU,,"k"u�sauk'a'Dp>a&waffa^uc�umalE nu�r i
bad. Amount of dimiri ur d . �. _ .. ...
Nain-Water r Supply
kAtpaupttuur'kmeeba gu,
F.RiGmundwmles Rmaam6'ahon
U�! a8�urksaarrau,veaarv'nkdanw�a.
u p p
k::xratdiianua;p u�aatrMr
k::.r: ,apuuaa
cl Stoymwater Drakra ge
&'tkixaarruarwmaaratR"1["�a,hntrcskau�;w
��a'frrsprcNeaaeauem!Rrad
33,entdaerrrna (0m xd i.NmasJ
O,rraaaaa.a"
�rP. say, aa,t, *:aw , d�"rea°nlfino i
006tr a:rdd"Ua'iiundw7t"R
21/23
4, Due n ells} aduaaaaaumuerd�a �
N"mrtipurkaidawwnnea Dianne raedity n"ii i (U'&pjtaneawrcVan"N
FTBRA 031 1 03, S Lucas Drive @ F IlokNeycuft Roard
a"kaa«rua;aNAaarcloe.�sws, a'.",S�kgy. and 76pa.._........�..e,..�.
ddlik"ibei fl k"k
_....�, .. ,,, „_ ....... , �..:. ............... _. Parcel
sere ep 4akeshfix-Axw �_.m.,,,,.....,,..,_ ._..,..
�hMtn9nap" Cv No (PIN)
2&s. L akidtnrdti and dL%rvftJminjmtW,,Nmnds air deginial deari
ppu°w�rcnNk ficki, m tr Ba0enaa2 n' vilrQ0:mw)
5A416 0 a: -78,97589464 IN
-_Q'W"K(RIpk p.QD11ffi TA kk ask'kUy � kkkaUfa" Vk �kV�akp cka,k
�aPrwrdo rm�dm a.roaararrraaAaraau rrraramuvd�'ti u,V"�wvaUrupaia, U°mr raaurtlPk,�fm duiyam'.xuaxarwsmm�zNu aNrpaak8°anaadlY>k;pPnromidx
mp���' sNrP�Vu &6� aeeererca �zanmrr9rrPtaearakrxkbattiaxarcrcnarexersar� ,purarc w'ursu ausr�N.aamka aranr,�'ruram
53
6b.'rokall well depth, ..........................A)
rne.:. wmrapma le adaanrraeaur : •.''1
kuwd. Waterlevel $jOrmwground miarfaea.a,
lea [fing Mattrials wansmak (Chn tapk tbat appskk^)a
Nicak Uulment Gioat 0 Bt aton kc C'bpas rar Ptitiltis
0 Sp=1a4- k:Srotat Q Ginvel
r'l Bepto ni&am Shirty k":k £k er (explain tinder 7gk
U For cach inswm`iad selertM alW ove, pairanarkadasaamaaeauint a mk"rrmaamer'Wsused„
7& P rovi den brie' demcripotumaru aadkdrar aahaan daaamrrwaaat paraacae^Ndilre",
Neat cernent lbrmeled from top,
di. of"anN ffk�r dpaa�t. Y ai �p r P
w
3128/23
oucnnmaur.aumffn.rRa4,IWr„Ndromtarau.^or*rbVc.Hu'.Pwrwr Date
,�pw aagprarpig aara's,farm, 9 Jsnraaedr�,A mrua& Ukumra the welffr) narxm (were) a zPuarearthrureid uav
aNa.^confaam,a nb"4k 11A iMOO Or 21"" A2109 IKrell R.aara,rRaaBFa:J` em SAa Oulaarr�.ir
and Max to xap U, a°da'dbd a aercuad h(mw berp ptrov deed e n dw 11ae11 owner.
You may east, the kmak of this ipage to provide adds ieraa.n aw J1 .44c aduaaaaiCs am well
ak»aNaaMniment adetanns.. You mapr ak�en attach additional pwapns if,meCcs; RFY-
wkkk(M 18 Na .nm'k Ck4D ' k`ddkpW
kkl�,2» fur •&kd %V < ��nabwit duv ffi»rrn wmfliiun 20 dot's ofeaatnpu8 uwsua and'wsell
aiptor dawrettu ent to the k"mrnpowirn,pp:
Division auk" Ater kkeso ui¢ ca Information Fraaarsra%utp; Unit,
161,7 Nkai gcrrlieau C'euamrra Raleigh, KC 2' 699-k62"s
kpgar„ Vpapm k.runeetffnrpu L psu pm anaddGitiaara tD sending dhe fu'um In the addrews arch UMas
aabove, xdsim gjTR v¢nat anrre etakny of &s form uiaitpanaa 'm akayir or rvramupskrcNt on Of %VO
almanakanrnmmeen4: to thud, How, tuna
IDiVkakanm auk'Water Rewuret Underground Fnieaattion Conlrroll Program,
JIVJ6 Maul Seirw°ice C'e nter, Ikkrakeigh NC 276994636
uuReir ea dur�� has pkdm�an rimpa ._ ��....�Q6R.� IQlkr 9'euur &i aptr mpp'p" a krcupafarUp2a'a don adzpuuianuu to sa auaua the fa U'uta aa're kltnN�
aadjra (es) gbtnnaa,, a9ara ;raskaaraaa one L%up y and 6Nais d"aurim awnOtin 10,days gaff"rnurtip iefianrn
of eme,np ra inrdamaaxa+.teat to ffie e*uUral paavadn6t defang.smrax of ahe rou nay where
anf. Tamer earchipj'tuharn length (if lkttaoweta . abandoned,
w ._----
kc , Screen+a'acauaru dN amp�d.ku prk 8tunaarrawap};; .-. . �.........,a� .
FaanG'WAO Il�amrahif,;:urreauNar:R.UaasmrrtmniwruanaratI'mwzuvnuamrmmtaflQuabaw-AAmsuuummlifa4FwerReaaaer s Nketasod'.,72•'.=6

WELL ABANDONMENT RECORD
1. Wet ContractorLd'ormation:
John C. Schappeli
Well ConlraclacName (or t+rell owrmr per$oaally abandaniag well oo fiis+her praperry)
2332-A
NC Well Contractor Certification Numbef
M&W Drilling, H C
Comp>anyNanM
2.Wen Construction Permit N: W10600037 ._._.��m...._��A�.,, ...�..�.�����,.....u—
IJ31 oJl appucabk well cnruMUYirrn permits r e. C!!C Carauv. Score. yarYgxe, err) iflmna
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Pablic
❑Geothermal (lleatitig/CooliogSupply) 131kesidential Water Supply (smgle)
❑lndustrial/Commemial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Aquifer Recharge
®GroundwaterRemediation
❑Aqu4ferStorage and Recovery
❑Salinity Barrier
❑Aquifer Test
OStormwater Drainage
❑Experimemal Techtlology
❑Subsidence Control
0Cmillermal (Closed Loop)
[]Tracer
❑flembermal llleatim, Cooljne: Return
❑Otherlem lain under 7e)
4. Date well(s) abandaned:..31'21 r23
Sa. Welt location:
Fort Bragg _
PFacility
FTBR-103/SWMU 103, S Lucas Drive@ Honeycutt Road
Physical Address. City, and Zip
Cumberland
Courtly arcel Identiricaton NO (PW)
Sb. Latitude and longitude in degreestaimutewseconds or decimal degrees:
(rf wall field, am iatllong is srdPimeml
35.14163802 7897683798
CONSTRUCTION DETAILS OF WELLS) RRINC ABANDONED
Attadi well canstrrn iianncnal(s) lfasvrilable For nrRAIVIC hrileciinn or roan-irwtersapply wells
ONLY itith the same cowlttictlareWwndanniern, you can submit one form.
62. Welt 11Dk:.D_ _...... .., w�....... ._.
6b. Total well depth: 57 (ft.)
6c, Borehole diameter: _0.75 (in.)
6d. Water level below ground surface: _..... -(ft.)
Fwlmwaal Use ONLY
NLY
WELL ABANDONMENT DETAILS
7a. For GeoprobeMPT or Closed -Loop Geothermal Wells having the same
well censtruction/depth, only I GW-30 is needed. indicate TOTAL NUMBER of
wrllaahandoned:, ... ,—._.—... .. _ ...... _..
7b. Approximate volume of water remaining in
W61: warms"surrir w1:Lsmona:Yo" _.._ m
7c. Type of disinfectant used: ,............... . �,,,,,,,,,,,,,,,,_ . .�.__......_....�.
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
Neat Cement Grout
❑ Bentonite Chips arPeUets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty. Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under7g)
If, For each material selected above, provide a mount of materials used:
Portland Cement 15 lbs
7g. Provide a brief description ofthe abandonment procedure~
Neat cement funneled from top.
8 Cerdflc# is
_. 3r2sr23
Sivatere arcertirled We1I Contras of d owner Date
By sighing this.rornr, I hereby comfy that the well(v) was (were) abandoned is
accordance with 15A NCr1C 02C ,0100 or 2C -0200 Well Construction .%ndarch
and that a 4ont of this record hoes been provided ra the well owner.
9. Site diagram or additional well details:
You may use the back of this pager to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL DNSTRUCTIONS
109. 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,NC27699-1617
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 thcfollowing:
Division of Water Resources, Underground Injection Control Program,
1636 Mal Service Center, Raleigh, NC. 21699-1636
6e Outer casing length (if known). (ft } 110r- For Water Supply & Inlect%n Wells: in addition to sending the form to the
addre*es) above: also submit one copy of this form within 30 days ofcompletion
of well abandonment to the county health department of the county where
6f.Inner casiagAubilng length (if known); g, abandoned.
6g. Screen length (if known): _.... (ft.)
Form OW-30 NoAh Carolinallepartmmi of 6mrronmeatal Quality - Division of Walet Resources Revised 2 22.2016

WELL ARA—NDONME-N-1—R—ECORD
1. Well Coatnxior Iii4riwifloo:
John C. Schajppdl
. . .......... .
Wi atroam Nam (ar mnifflownerpennamly abinduniog ""Oom IhWbpefty)
2332-A
INC Weiil COOMMUr canificanolm NUMInr
M&W Driffing, LLC
t"ampmy Name
2. Well construrAlan Permit M, ' W10600037 --
Ulf oft apph1while well 6 C" "'CE"t'n" U14" Sraw, Krralxe, 0, k") Orwq
3. Well w.,,e (chink well use).
F3Aj..y,fC11,fltUTal 0MIMmitpalfilabitc
UGeothemil (HeattnafCwhng Supp�Y) FIRCSW P-TAW Waliff SUPOY (singh:L)
c.1 Ind us%aiflX'mwxmf.=.W OResidermal Wwa- Supply ishw-ed I
OftaW4 Swrage and Reravwy
oAt4tafeu
rX.Rx.it,hcm,W (Mosixil Loop
4. Date sielks) alliaindoned. 3/21/23
wGrawidwamr Remedimen
Dsahnipy D%Tnew
USuorWence Conlrel
Mira=
00dierid,-sMam undeir 7o
51. Well I
Fort Bragg
FTIFIR-1031SWMIU-103, S Luii Drive @ Honeycutt Road
;,is,=7A wt., Ci,
Cumbedand
Rvu--A No. (PIN)
5b. L%ftuide and lmg�tude W degreesiminutes1seconds am" decimal deg rem
ffmA ride" ere 60*n�; a, 4offi'mrit)
I— — N . ...... . . ............
. . .. . . . ................. ...
MILL, AMA'i
7a, For Gk*pro1MMFr or Ckx%eUap GettithermaMeUx having dwslmu
well consirAh, mily I GWO it; nPi IrWicMe TGIAL NUMBER of
sieriq abandinnv.d . . . . . . ........
Fq.)jft WtTER SUPPLY WEpLLS ONLY,
7c. '111"ype of disinfectant wm# � . . ............. .
7d, AmotAnit or dpsi arectaint amM
. . . . . . . ...............
7a, liiesUng nisterial-k used (check all that gpptv)re
Nom cieni Ganut
0 Henn onae Chip% it 11010i
[3 rmd i Gmut
0 DrNr C. ay
0 Concrete Grout
EiTill C,1aa1qp
0 specialtyGmut
M Gnivel
10 Heploinde SMIM,
1.1 [_XhLi' (explain uyulrer 7sp
7E fareach materialWeeW, above, provide gliumant ofamitrials as
Portland Cernent 14 lbs
PiroAdt, a I j tseriph Agidni praceduve:
Neat cemeryt funneled fturn top.
'I re il lt,4V 3128123
V 0winer
aysWgrilay thisfirm, I hereby Ccr1q,*V shm the wefi(n� was aWLTV) ii urea
auxvrtii With 11? MV, C 02C,6100 or 2C .0200 Well
and Mat acopry qfeha rurgm1has h�nm prophiM to the 4 owdl ou,iwr,
9.!Site diagram or addidenal w4ffl detaills��
You may an the bx_-:k offfi'aq paAe to proavide addifimall wcH ailc ddlits or WCH
W &hwvinnmeFa&Wk Youme-Yal SO Bunch WidifiDWIt P890 ift-McmilrY.
r ffAfl� (
cl�01451R,Mjffiffi My �s LF�IVTJ, WS' _BE%
WWTIN jrr;rxaai hle. Finirmuldepla vqrYazwl or M­ralorvpv�ft Welb
V P ofm MM
#vWgjb rtf
6A. Well 1 [10: _ D 5
6b.'raWl well depliI 55.6
6d, Water leviti bekvwground surfacin ... —(rL)
a
l0a. tjW Y-S _IULJWA,�r. Submit thhR Funii wiNn 30 da of coropktion of We"
Annidonmenit ko the foUnwing
Division of Water Rexisurces, Infornaflon fliveessIng 1184,
1617 Mail senice Center"RaIA?h, NC 276.99-1617
I,Ob,,F r WAIWAUNVOIS. Ila iddifim� an W sending the fo to the sddws in i Ga
L
Wwe, aluo %,ubnt one Copy uf tivis Ann within 30 days of cornpleWn of well
abandn ml acre the aOLIVAV& niML
Divn,tiat, oli Rmurc^ Undervirouad Rklection Cuottvi Program,
1636 Mail Service. i Ralvillh,'SC 216"4636
6e- Outer casing length Vif known): or- f2r WaLer addificia ivwnding the fhm Tolhe
.... ...... - above. apm-i sultnut aww,, copy ofths foym uifhki 30 days of completion
of wehl abtindonment to flue count heMffi dej.-Ninvieml of iihe Court% when'
6C Inner casing)lubhmig Wngib (Kkaown): abmidoned
6p,screen length (Manown$T . ......... . . . .................. . . _'AfLi
roffla OW U, DR%Swqn of Water Rft.om= Rews4-A- 1,27-2416

'WEIJ., A.'.BA.NDONM...,NT RECORD
L Well Untractum, Iltskrimatian,
John C. Schap�pell
............
2332A
For1ruernal Use ONLY,
... .......... . .... :-, ---I
M&AAA2
7a ror Geopm.bPJDPT or Clowd.-loop Geatkfrioal We* batring th- e same
w.31 coristry on onidL7t.k oul y I G3 W. 3 0 is nwd ed. bwl icale TOTAL bRMBER of
;Z—W.YV kb. App ro xintate valume ofpirater rarnainiW., in mreli(s)-. —(gal.)
�M&W Drding, LLC FE43-fi, 'a-gui WiEs
a;'Olnpmy I%IWBRM W. Type of ftWorawat
2. Well Construe6as Permft V: W10600037
7d. Amou rit of dislutectant used*
3 Well 11 use (check wQ use): . ...... . ...... ........ .... .. ....... .... . ..........
.. .. . ........
Water. Supply Well. "Nei SeAng inaterialf, used (clW.k all that apply):
ElAgricultural [IMunimplO/Pubfic M NWI Ctmwl Gmm 0 Berstonk Chips or Peflias,
EX.Jeothermal (I"jC'0.1nWCOoIfiwg Supply) pukka sidenUal Warex Supply (sungle) 0 43and Ceninit GMfi. 13 My (ay
Ell lndu,,dTiaVCaMmerpW MesldendW WaW Sulipty (shwed) EJ Concrete Gratt 11 DnIl C,haninpp
ElAquirer Rcchaqyp,
WGroundivasw Raviedintian
Mqigfer Stwige aiA Rwwivary
r 1130.vity Baoriew
OAquiRT-TwL
MOMWatelf 13r9iVA9L
EJF4qxsi3neF,AsI Taehzoiirgy
011iubsideme Conh-o
OCAODthentud (CIOM.1 Loop)
OTnm
MeothamA ffb,*Ais� Coolow Reluin
000rer fuxvlain tinder 7g
4. Drstmwell(r) shandoncd: 312' 1 /23
52. WeAl foefiflo":
Fort Bragg
. ...... . ..... . . . . ........... . ...
e racHhIDA' T,10wnar Narny A'(ifzpplxcaW0
FTBR-1 03/SWMU-1 03, S Lucas Drive @ Honeycutt Road
VhjWwx Addrrm.% (,Nty, and Zrp
Curnbedand
CaunW Pairnal (PIN)
5b - 1-ifitudetuid longitude in or dier.1ma-, l dqmroes
(Tavel field, we frOonjg is wffimimw)
IIN------- . .....- - — -----------
MMIMMIMEMT MUMERF"L [W-1114MMELA RAMar! ER
ONLY with ehasome Moftrat
flaw WeIITDM: D 6
49
6b. Total wdl depth. , ­
6e, Rafebale &auienwr. 0"75 -rim.)
rid. Watpir Level heloW W."'raillind sur&6-: ­­ ­ - , Ift.)
* �Pecislry Grout 13 Gravel
* Bentonite Skuffy 0 Oftr(explain undcr7g)
U For encilt material selt-cfed alinrvA provideairnount afeenter"We uwA::
F3orflaind Clernent 13 lbs
7F, Provide a brid diesexilrdew of the AbandonmentproLedure,;
Neat rement firinded fl-om top.
3128123
Cos %--� -- ----- --------
')Id�'�C lc'(ae n'V"'
Ma.forng, I lrerefy cerfefi:, that (he Werl('V) oyls, (wrre� Oftindonfuj In
artarglance with IJA NCAC 02(7.0100 orW'.020t) 01411 Orn.un4mon Stxznddrela�
onVOW a col�vqf0it rerord frz bewppnv[j*,dAi lhe� wrtl ownw%
9. Site diagram or additionat mxll delafls:
yor, unay usm. tiie wxfli oroi us ipage to provide jDArIfflonal walk saki, d*Rs or- vveUl
abmidonroarkideWs,
aup
Wm� &r.A.0 � JI: fRubmit. this fiffm within 30 daym, of romple6op of weill
lbmadoirrmeM to the UWVuiM$-'
Dill orwater R=nrer,%, infaffnation PirocesSing tyni4
16%"7 N1811 Seirvice. Center, RWrigh, NC'2769946 17
10h. , E k ' c [is addition to seiAing the fhnti to the addrais in 10&
above, ah'a MAIr"Ift in fve copy or this form wfthiii. 30 days of rA)mpletion of well
OLMdontnent If'r the cluenvin?,
MvWon ofWater Resources, Underground Injection Coio troll Program,
1636 IMA Sert&eCenter, Raleigh, NC276W46-M
6r- Outer caning kmgth, (if kaewn)- __(ft,) Em: In ad
diflon tosetirdilip the rolul to The
addrms(cq) aWye, shm subinlitime ropy ofthi., finin witlun 30 days ofewnplefion
of avail abandonjinehi ki lbir, counly health department of the coumy %Awre
GF Inner cosinp Jtubing iengtb (it kinrivii). ifl,D abaridened
6g. Sercen lkmgth (if Iknown)- ­___­'­"'­­­ -- ------------ - ­­' (k)
Form CJW-30 North Carolina Departincial of Environmental Quality - Division ofWnter Resotirces Revised 2-22-2016

WELL ABANDONMENT RECORD
I.Well Contractor Infoin=11on..
John C Schappell
WCH %Vt-A% fforer pommiany 81windomingM00 an luivIN4,PWpDayN
2,132-A
Mika; Wen Cni CestArman Num1wr
M&W Diliffing, LLC
rcdmp�q Nang,
2". Well cirmstmcfion Permit, M. W10600037 .. . . .. . ...........
W�
Liw aft appWable mvill crimi'mcglayr rx'rmw Vanow," eurv0homa
1L'We ll use, (check well us0
Far Irrimenal useONLY
WFJ,,LA
7a. For Geopyabs-VIDIFF or CWsW4,00p Geothermal WeUs haymg the-limne,
wvol coia epjhCAV-30 rsmedvi, im9pc3it 10TAL ti oF
vi abandoned I
7b„ ApTym%knete volume ofWaler —2illing fiR WaTI(s). __ - --- (Pl.)
--------------
FOR WA. U.M SUPPLTWELEri ONNAft
7c. TVie of d6infectant vm%h
7d. Airamimt of disinfeckant uxe4h
� 11 ",-- . . ........ ..
W-8ii"rS —n p"p, �-y' W e—W 7e. Seoi materNh °.nwi (check all that OPPIO."
nAgricull-wal Pq 19cal CeIRKA 0irout rD Bmfumtc Chy� Felhlrf,
ockti 6 e amv CeaapNa Sap py ORndenfial Water Suppky 0 SOTIld Ceilvffll C1101-111 11 ay Chly
01ndcran0fCornavercial 011asidential'WaterUpply (shared) C ConarTe Grout 0 T..)n'u 4'.'Tatings
W.11m,gawn C] specwlty Q mut El GTax,ti
Non -Water fkapply Welk [3 HeAlonite slwn, 2 (Nfier i explain imdrr7g)
0Aquifer Rwbaqp,
1-JAquifin ftinge and Rocoveky
0,jexahzinna8 (C-1=4 LoDpj
cGeolhermm igicaiiavdi(.'ni
4, f0ateRelks� abaneened. 3/21/23
r1stilwity BaTner
ostonn=ur
lim
Urmom
f.::H'tither (c,NjAw,g
50. Well. 16e,80m*
Fort Bragg
. . . . .......
FRCdRtyA)vVnzr NAM FWAlly WDA �1 &PPficable)
FTBR-1031MMU-103, S ucas Drive @ Honeycutt Road
fty=4 Adidmi, City, and 7�p
Curnbelland
F.—,,.q, r3=0 Ideafift.a.mr0i (HNY
51), LoOrude and longitudein or decimal degrees'
(J'%wit fietd, wine hejWA4 is sufflumd �
35.14'151739 -78.97601031
AU.[.xJn BE Mir. ALAi
6H. Well 11W. E 'I
Ge. 113arebuiledismeler.- 0,75
6d. Water Iriiii 11i yround scirrace:
I E For ench mewisilselected above, Ipravideamoufft OfMAWIRIS UM.4k
F"odand Cement '12 lbs
7C. Fmvide a brio.4'destripfie n oi abandaniment procei'lorm-
Neat cement funii from top.
7
Wic H CTMvib.Wr Ar we'" 0, me's
342,812.3
Hy Vigning, eNsfimirm I hereby cvwl�w Mal the (Werq)
mxwrdunae owfx 15A .0100 or YANA() 'Wall
andthad a copy ofeju.q reono has heere prnyifloffo the well awneir.
9, Site, Mingrom gar addifionW well dictaiha
, You may wm-, the badk ofthm page, to promide additiiiciiW waH .i dewlls Or weiiii
W
I(N. EQr,_AtL W 's& t Subma NNS fim xiiftir 30 dap of Canpleb.cm or %Afth
obwdonment JID jhle f6aJ100i
Division of Water RLioare c% Inflow-ERWOU P11"ACessikg lkkh-
1617 &UH wvhx Center. Wei?bNC 27699 9617
19b, Na an dan to neadin g 1he rofm to Me Address un 111.)a
ubove, also xibmit one cap n of thin; Cam wi ffim 30 dky; atefinip1loon of Haul
abandonmrmt lo u& e faffowimj�
ftcwurcm« 11 ndergroved Rejection Control Frogirmn,
1436N,hWServiirf,- Cii ltalpighNC 27699-1636
l0r.F*rWaiorSsi 1%, Inietfing"ViVells: hil addiban to sending die Ibnn to the
6f- Outer casing k-,%4h (if ktunyti).,
ai WCH abandonment to the County health &primen, of 1he uxirny where
6f, lip neir casis?�Iiii length (if knmvntr __1%) abendamd
67-screcis length (irknown) . . .... .....
Form GNV10 Kki

WELL ,ABANDONMENT RECORD
1. Well Contractor Information:
John C. Schappell
We11 CantrecharName (w well owner persronakly abandoning We11 en ltisUc property)
2332 A
ar Intmw Use O,4LY
WELI ABANDONMENT DETAILS
7s. For GeoprobeMPT or Closed -Loop Geothermal Wells having the same
well construetionldepth, only 1 GW 30 is needed. Indicate TOTAL NUM SPA of
wells abandoned:.. -
__.._
NC Welt Contractor Cenifica6on Number 76. Approrimate valumeof water remaining in wehl(s): _(9210
M&W Du(ER
lling, LLC �FORWA5UPNLYWELLSONLY:... �._,...,,
Company Name
W10600037 7c. Type ofdisinfectant used.
,m„ ....
2. Well Construction Permit # _ .
I&I aif apphtable urlt cowtnrdiml permtrs rye UIL GawrJy Score, Yartarrce, ercJ ijlmmrn
7d. Amount of disinfectant used:
3. Well use (check well uso): m.••....................................... »_ ............ ------- ..,---------- -- _....mm
Water Supply WeO: -- - 7c. Sealing materials used (cheek all that apply):
❑Agricultural ❑lldunicipamblie BI Neat Cetncnt Grout ❑ l3entonite Chips or POUeis
❑Geothermal (Heming/Cooling Supply) ❑Residential Water Supply (single) ❑ Sand Cement Grout 0 Dry Clay
❑lndustrial/ConimeWol ❑Residential Water Supply (shared) ❑ Concrete Grout ❑ Drill Cutting
❑Im:�„�wtion _ ❑ Specialty Grout ❑ Gravel
Non -Water Supply Well: ❑ Bentonite Slurry ❑ Other (explain under 7g)
❑Mcn itoring ❑12ecovery
tin lectioa WellUF _... .. _ w,,......_._.. m.
7L For each maternal selected strove, Provide amount of materials used:
❑AquiferRoebatge ®GroundwaterRemedistion Portland Cement 13 Ibs
❑Aquifer Stone and Remvey ❑S,alinity Barrier ""- �
❑Aquifer Test ❑Stomtwater'Drainage
❑> xperimerual Technology USubsidence Control 7g.'Provide a brief description of the abandonment procedure:
❑Geotherma(Closed ❑ l (Cld Loop) Tracer
_n ,- , -- Neat cement funneled from top.
d. Date well(s) abandoned: 3121 /23
Sa. Well location:
rt Bragg
FzoOli UWner Name Faic*,U tDii if Bp C� �G 8. Gertifia as 1:
h ty ( lirstbla)
3128/23
PhsrcalAddrcss,Ci ,andZi P ..� y d Si Data 'Cc7uGed'i+Wcll ntWu, 8 �'............. ..._.
FTBR 1031SWMU� 03 S Lucas Drive Hon a � curs ei�
Cumberland By sigtrisg this form, I hereby mrfy(p that the well(k) was (were) abandoned in
County Parcel leemiiicgion No (PrM accordance with I5A NCAC 02C,0100 or ZC -4200 Well ransirbriian Srnndards
and Phut a copy arthis runic) has been provided to the weli owner,
Ah_ 1.afihrdeand longitude in degrees/minulesJsecoods or decimal deuces:
(ifwell field tine IefJlarig is sutliaentl 9. Site diagram or additional well details.
35.14153658 N-78,97595566 W You may use the back of this page to provide additional +Yell site details or well
.abandonment details. You may also attach additional pages if necessary.
CONSTRLICTIOY DETAILS OF WEI US) BEING ABANDONED
Anach%leftWnstnariannVOW lrOMVArrbfe IornmNipkirljectlonornon•rvalersappyuclLLs
ONLY wlrh I& some epurnxrdfarWMrrrdupmeai. you can snbWl araforei
6a. Well IDM: E 2
fib. Total well depth:..49 IT....... - UP
6e. Borehole diameter: Ov75 ,,,,wwww_, (in.)
6d. Water level below ground surrace: (fL)
SUBMITTAL LYSTRUCTION
100. For A- r All Wells: Subnlit &a 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
I Qh. i nr I ctr_on, Wells: to addition to sending the form to the address in 103
above, also submit one copy of this farm within 30 days of completion of well
abandonment to the fallowing
Division of Water Resourccs, Underground Injection Control Program,
1636 Mail Service Center, Ralelgb, NC 27699-1636
6e Outer casing length (if known): (tL) 10c. For Water Su at alv & faiection Wells: In addition to sendng the farm to the
address(es) above, aho submit one copy of this form within 30 days of completion
of well abandonment to the county health department or the county where
6(. loner casiogJtabyng length (i[ known): ift•}
abandoned.
6g. Scram length (if known):.......... ,(ft.)
Form GW-30 NOT* Cara) ina Department ofEnviranmenhal Quality - Divraiou of Watrx Resources Revised L2"_-2016

WE LL ABANDONMENTR
'I. Welkarun8ri�uFeurrn'wawawr
John C. Schappeli
Weil CauMM11mu- kWw:raw. kr+q nmvttl awov'r gwwrraawwdly uuFmdonu wD MWO on MOOT wmrlleft"7k
2 3—
TkC'Wa°dr(,.xnann&,*turCenifinanR.mA'MYu.me ex
'TMptaar.M ti'daarwr
^'�9vu��B�";ruwrrne urPeamit � �b�
f.wOudAIRI" CublcRrxad'@patrrnalsO'er. �'Ac, &�axaernAgo 6�eatr�, �"raw'sxr�.�e rra�,yd�'a�rrwmnu
I''WelN rcuw.. fcheck.welI anaa±pa
Water Supply Welk
�....... _ .
ClAgrar:wsk Baal
Apa.'anttkaeannaNpRm.rn&carp& makNnasuwpfpk,'yp
�drau'Nunruarda9�f�"uttuanrnras�:aat
�iNrnurWanrwwcw _
Non -water Suppbkr wadd
u`;Nf quifer R wdasrige,
?`"nAnfw.nett'd Storage and kecowry
t.-J,A.w'ftuaf"rn' Tao
3Expperdrnemad ^kr' chaMak;y
k Rnwrstfia;rrmu'rmG',, krcaw Un.T.)
#. Date rweg(s) aabawdapw el. , 12 1 L
93
..
°ebo danfl wr M & Pww ONLY
has. For Geopnr°aknwfD'Pdr or f dwarwuk-Lwwaupd GeotNttairmad "W eUs haVing ttb -same
wen rasrnstructiaav'ed,mpakir,w u&Wa N Gw--30daw kw. fxndtr:aewI"N)"f M., NUMBER of
wmkns ad;amwudo n ......... ..- w .._._ .._�. w--
�Rr, dW:preprras:'n:dsanattm. war9oarauun wf wwrmrar reaa¢sbamwkme� Ww mera6.Nfak« ........... ...._f�aW.�
"fir:". "f'.ypw wWdisinkchint usrda . .. ..�. .
d. A wuanrwtt at'Asinkletant ma. _
_,..w..�d� ...._.. ...
7a:. Swrmkpwg rwaaerammka nnarA (aka;pr akd R,Nawatl: apnpuWYP
W::k d�Y.oww a t � 9R0
Ncat Cement Grout o .ftrkonke Ckrwpau Or Nare,r9exs
U R: wide nknal Wanrwr SnApply (° ura0e)
0 Sand CR,mcnt Grout U Dq&.:flay,
N:31ke dadenttual wat., supd4yosharw)
n rnrnerew-f'rranpnr k.'MkNQ¢kttn ep
SpmWt°y Grout M GraMrwl
rj Reran r to shw M R: her I wqtiain Wawa 7V f
OR.ar�,'swv en .......
.............. .. ....m.� �,.
7C. k'"69n" e,aa.Nn aruww6a9 seJeY4"rr'd IIWR'b9Pdf'R:fu Ift:
l-acuwud ,..Rerrna':adnationn
Portland Cern nt 13Irks
_...�...
01.,WMgy Uanrrner
_. _.._.... .. ........
'Stormwwaa w f.Wr'd4HrwVlVge
—111—....1 --,,,,,,,,,,,,,,,,,,,®.........
O adpawade nce asnvor
fg,• Prnan hlea durdrrf desc rappkdawmn uiN the rukrsrxnaflawmaunaswrtt pa¢•nnrrerattwre.
Neal earn nt fL nnelpfr rn top.
"fa„ "P RO location".
..._..� .�.... �............
Fort Bragg
e /
�p — .. kaanR � nl
..................w._five rn�u'9dr r.'r�k ugayycrutt Road � ��uk�Nn .... __ ....... .........
;rew; Coy. . tadZip SwttGaaark e ¢rfa .asu�a p aia..Nll Cwwrnrm rt
Ck,ymbed n �a f fmf; wn'aar rnraxw„ f Naarrr�rr rautta�e� afrmr rPnu^ Ix'aaff6 f aaun yWwaar e8 eapnwraxare,ra new
C,"NYaawaU'..._. �.. ..IT.. .._�,••, .. �.. Y^wrd.r,W ttadarxnuk%etsriiuzRw No NM* nsnweMrrrftawrae: d6fa R'.;Pei w"V G,,4(:IY, 2c-fpjoe) a r :pa"".,af;;f w wew caaumxdd°reaerwa M.' aaamdfuarejx
rw 9PNaxa as wrfape asp`a'Wsu r«era¢nprf fsta beern prowad edn.x the wef awrpsaa r,
r'Ox I nuitu de and knrcrp niraakwin degre larwkwwmwwa^ (seca'sunda or d'm~h mak dtiuy„rees,
y k 15 U4 a way Ys:±pN iaml R aaufuaarrcwad 'Vou 975r%t&"GPo& A�wiCr6gImck �Po thfik wml g dto pro„
% Site N or
a 3, "1 �"1 51�'l�al 78,9759057 �aamn may uawn. rtkndr kwaakG abrfkaNa faa�ar Ww paruartraedas ac@niu4narnrw@ +wraWp& a°nttun akaWwz@s abr wu9tl
._... �...... _ ..w...... P rw nana? akwpe attach aapakliattruawa l kNagea of n ,=Sry
MY
rnuaasn:fdta'�lGi Jmarcrv.�rs�spraara�a.�m'sf(,F.k��o�crsfrapxdw;. �"rnrraaxrcMea„a.da<.uwpe�.waAarwaTana'�rmuncark:drragrydd'gua•rr.P'are
4�.r��. � w4'awfrt dAmsr �n�'arr�a;a.�hadaae�;ida�YttrRmrmrca9gauanaeadaroen, �mFar a:aara..rRa�iMBae nuwanr„a"n>rara
68. W e'll fir. E 3
�"ub, `f"rarak veil deptth:
6c.Roreholediamickr, .1 ._—.__..('ama.)
fdad., Water leydbelaaw p�u'rxianrnukaaumf�cbzn _ ,,,, �d'ttmf
ion, ,FX A&I 'Wuattdre: Subrwndtt dkudq 'kavrrcaa %qft Rmvu 30 days of ea.nrupte.fion ak' %AaH
anknaxAdo nmewnt to the fbiloww'arb,g,
IDIASdarwof"MVP,agar•Rewoaces,10TOW-Matie" Proceming Unit,
16'17I al{ttSerc6r^.Lf'arnttwn",Rnadakgds.XCp"ffw9 :1617
too, � pEjAj'am�V, Nadiffien to san&tl the f6nnn to the addie.n knw W Oa
wrkwaw°c. wa&aur sea rnmt rcaw aanwfry of ehna f' wmm rrah.nM 30 days of nanraapatle:niibrwn nett' wall
swdrarcnudon m,mil to the rwa owarmg
fmdnraadunnu wf J'attu^r° fka~'mawaNrw°�� firwakut'r�rnroawurad 1w�pam:Wkaarn f:rwrnptxaad Pn rtaw^varra,
1636 :W 90 Service Center, Ra'ndasdppfm,a VC I f699M6,36
N ttr awara9f�att%nfsrxtm ttkrtt93ttwmdh
ra, Outer casing mr ;¢kff arewar:
�ra„w"w&q:.+mw ,aknwnwe, aIan auuttrn g one wpy nD'Fthiis f"asrnna w'wbtt'haw 30 aSnafrw ofwaangAtuan
ant' 'wrdd eakOanrkaasamant. ttun the canrurw�y ttaa•wM wfq arttwr em of The n awuxnnrw^ wwh? nc
raL'ttruwazr'awadwpfttnnkapwm Raxm ttku df@arnunwwanyr",_..... � .pfk."W aattannaadone. d
p g. f' k — fr.D
� m. "sera a Nu^�w �'a of Puaw�umrnr a ....�.�.�.�.�.�
C^erm r.:W&'V 30 Noah CPaa+gOareum k'.'b fttw�Rll�^,mw Gflr nwwae.•anMewrwaak Qxrdd'NB:,r - dkdwreflVaan swC°wWtzmaas 7tta.�uaaa fRaew7as^w,tt �.°P".d..;IRtri➢Zr

WELL ABANDONMENT RECORD
1. Well Contractor fafat oration:
John C. 5chappell
Wall Contractor Name (or well owner personally abandonmgwell OP li omr propem)
2332-A NC —Well Contractor Cenifiaavoa N_ _umber
M&W Drilling; LLC
Company Name
2. Well Construction Permit# W10600037
tsl oil applicable vell came etion permits t9.e, Olt" County, Bate, rortame, era)
11000uu
.3. Well use (check well use):
Far alu�t.aNL�
WELL ABANDONMENT DETA>�
7a. ForGeoprobelDner Closed -Loop Geothermal Wells havingthe same
well constructionideplh, only I GW 30 is needed_ Indicate'fOTAL NUMBER of
wellsabandonedt _ __,,...........
7b. Approximate volume ofwater remaining in Weil(%)- „m,mmmmm,,,,,,, ,,,,, _(gaL)
FOR WATER 811PPLY WELLS ONLY:
7GType of disinfects at used: _ ........ , m .�
7d. Amount of disinfectant used:.,.w, __.._.............. . „m,m, ,
Water Supply Well:
7e. Sealing materials used (check all that apply):
MAgricultuml
13MunicipaYPublie
s Neat Cement Grout ❑ Bentonitq Chips or Pellets
❑Geothermal (iieating/Cooling Supply)
❑Residential Water Supply (single)
❑ Sand Cement Grout ❑ My Clay
❑lndustrial/Commerc'tal
❑Residential Water Supply (sbocil)
0 Concrete Grout ❑ Drill Cuwngs
m;ueLon
❑ Specialty Grout ❑ Gravel
Non Water Supply Well.
❑ 13cntonitrSlurty ❑Other (explain under7g')
g
❑R ecovery
�
Injection Well:. .... ... .._._
....._. e..._—
7i For each material selected above, provide amount of materials used:
❑AquiferReebarge
RGroundwaterRemediation
Portland Cement 13 Ibs
❑Aquifer Storage and Recovery
❑Salinity Barrier--
�a
❑Aquifer Test
❑5tormwater Drainage
�................_.. ,...
❑Experimental Technology
OSubsidenceComrnl
7g, Provide a briefdeseription of the abandonment proeednre:
❑Geothermal (Closed Loop)
❑Ttaccr
cement funneled m top.
Neat C$CTlent tllnTlBled
❑Gcothermal-IHeatin�t'Coolintr Rom)
❑Other fexr4ain under7g)
— —
4. Date well(s) abandoned: 3/21 /23
So. Well location:
Fort Bragg
Fy Facility
1U3ISW(VIU-103, S Lucas Drv.�..�... „W r�W N
TMlity MA (if applicable}
e @ Honeycutt Road
Physical Address, City, and Lip
Cumberland
County ParaeniientitiaationNo, 0k
Sb. Latitude and longitude in degneeslminutes/seconds or decimal degrees:
(n'wcll field, one luillong is sufficient)
35.14158538 � ry 78.9758477
CONSTRUIMONAETAITS OF WELJd$1BEINC ABANRONED
Aaarir wall Conirrxcvron recrurlFiJ Jatwflable. l ar nruttipie fn1eMloH nrnorriavrersupp(t'ttvlls
ONLY with the same capstrrrcfiortrabaad'onaten4 yarr can strbmff anti form
68. Well 1D#: E _._. _....................._._
6b. Total well depth: 49 00
6c. Borehole diameter: 0.75 (in.)
6d. Water level below ground surface:,,,
9. ccf w�in• �
3/28/23
StP ture 6 or or Well t,BgViter bans
By signing this form. I hrmeby (Velify that the µell(~) was (ware) ahandaned in
accordance with 15.4 N(AC 02C..0100 or 2C .0200 Well Conn"tct/dn Siandards
andthat a copy gj'ihie record has been provided to the well owper_
9. Site diagram or additional well details:
You may use the badk of this page to provide additional well site details or well
abandonment details. You may also attach additional pages ifne=sary.
SUBMITTAL 1NSTRUCTIONS
Ift For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Divisiop of Wsterltesaurces Information Processing lint,
1617 Mail Service Center, Raleigh, NC 27699-1617
10h. For lniection Wells: In addition to sending theforat to the addtess in Isla
atiove; 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 Allail Service Center, Raleigh, NC 27699-1636
10e. For Water Supply & Iniection Wells: in addition to sending the form to the
6e. Oater easing length (if (mown): „...... (ft.) address(es) above, also submit one copy of this form within 30 days of completiaa
of welt abandonment to the county health department or the county where
6E Inner casing/tubing length (if known}: _ (R.) abandoned
6gy Screen length Cif known): ,.... ...................__........_._. G )
Form OW-30 North Carolina Draartmeru oMnvvonmcnWl Q�taliry- Division of'Nala Rescurcrs Revised 2-22-2016

WE LL ABANDONMENT -RECORD
I Weil Contmmeat Information:
John C" schappelll
WeB COMMAOrNune (or "ALI Owam pVgT4rN114Xy a1=411unsweff an Hoarpoparry )
2332•A
"'C' WO Contrule'r
M&W rding, LLC
C"Ompam"t Nam
1, Well CGestruedun Permit. 9: W10600037
....... . ......
1'elp Mati—o"
3 WPM use (check wiell use);
Wager 511PIPty WPM',
BAXiculluj'al 010111116POBV1[^Ublar
nGe,othwonul (HwwV)Cnohng Supp�y) M.Residgnoal W,"mta Supp�y (wngft)
C31ndusO-iW'1CommmvW Mtmidenhal Water SupfA� Nmrad)
Mqjulftt Rxr1wrBe
WGroundimakw ReenmMwien
l Mquiftz Iva gr mad Recuv(uy
CIS3196T.y BaniCr
OAquiNr Test
OshlantvAtar Oninage
OEXPXlntienaal rec'kuanap
OSuh'H1cncc ComrW
Lmq�)
07riarxx
tru""VanRetum P
11201her & ex,Aain imder
4, Date weltfs) obvinione.d., �3/2 V23
5,6, NWH 10 V3 aw
Fort Bragg
FM01'y4LhVnCT Wxne V'Ud�ty TDO �'Irapphr"AW6
FTB R-A 01/SWMU-1 03, S Luicas Drive @ iorleycutt Road
—Rod p
Cumbedaind
Axed Idoobfiromp No (PFN)
Sb1-wfitude and longituide hi degroemiminutr4seimads or det%11 dowery
ink"w&fi fidd, are lava on m lwffivnqn)
. . .................
LO N— IONJ21L ffR C-L
For Radfiple
emrzywia Y&.,xarm emsvivree emelmyeg
(Ila. Well M#-. E.5
Eta. "Total weUdepth: 56
U, Bvr(�hole Manwter* .0,75 084
6d. Wauw Uvel bek-Dw g")und vaArface-,
WELLADAMORN WE M-MAL, M
7a, IFor Genpiral.WDPT or Clescd-Loep Goothernal WON Mving the same
vvell only I GW- 3m as n6aded, IndNMeTaMUNUMBER of
"'CH's dxmdomld .. .......................... . .. .. .. ...... . ..............
7h, Approximatt-voloulouf". ter
FOR WATER SUPPLYWELLS ONLY:
"' Tv e of d Winfect-ant UAed� ec, P
---- — - ------
7r- Salhig vister4aln %mW (cWck all ihat app4,),
M NLht Cement CjWWA
a Brotomix Chips W. Pel tlw
C.) Sind Cemem Ggw.it
113 DWYClay
E3 Coilcrete arrml
11:3 Drilt Cutungo
0 speA-ialty Grow
0 (3ravel
F. Hentonite, shin-y
[I Nhei (explatn undd� '7_g)
7E Foreach materWrOgeted above, providesnaminto(MMUNMS ear
F:Ilortlaind Cernent 15 lbs
7g. PnMde o brief4cwTiption Ofthe ahandonment procedure:
Neat, ceirnent furmeled firorn to
3/2812.3
%anmum �CahrW Wen Cou'Mraraw or WMt 0 Zmer DAC
By signb?g #nsfibrP4 I hineecertq' ehat Me KwIJI(s) (uVdrr) edpandoved in
y
acexprdancv with 13v, MCK" 02CA10(jor 2C QUO Weil StandurrA
dead 1hal a cqPV of rh'& rev. Oni hmi 1) aPA rro vide d in 4 he, s K,rH o wxw r,
1) Sftc diarram or Adifional weAl detaills'.
W you may use the back of this Page to Pravide ad&winai wrH -.eitc da etds og well
abandnnmmWL1.w1s, You irmulralm, Marh hdduhonM Pages WACCUSSM
MMITTAI �MT—RIMMON"i
10a. Er_ �IlWg&- &Abmo, Ibis foon withht 30 days ofcmpetion of %rJ�
abandotiment to the faflowing.
PrOCL4qig�g thW,
M7 A10 Service Center, Raleigh, NK: 7.74994.6 17
10b. ° fir N to a raan rtlCs. In addffioia la rwn&ag The form to Oic iddm,- 1101 lCla
above,, also iubmh one copy of kbis fixwn vafl6n.N.) days of 4ompWhm olfwaH
Awidwimcm to
i[NOdon of Woler Revources, Underpround Injection C'entrVA Propiram,
16.36 Mm it SeMr*, CeaWr, Rafvn.,gb, M."' 27699M 6,36
ttI In addition towndbiq the A= k) the
6e, Outer rAsing Warth (ir known): --(ft-)
addrrwqeq) above. ws o submi� m3e. cf.,�IW of ths form %Va th tn 30 da'y% of compGetion
of %vefl ahandeament k,R hart cuumv hcalth deponient of the cuuntx whLre
6C lamer caMing/labing kagille (if kaown,�- Ab"'done'l
FmaW 30 WoxthCxafimDapz1mW RzOst-A 2-:21 -20 tl C,

WELL ABANDONMENT RECORD
1-Wen Contractor Information -
John C. Schappell
Well ContractorNume or well ownerpeisonallyabandoningwe0onhis/he
( r Property)
2332-A
NC Well Contractor Cerification Number
M&W Drilling, LLC
Company Name
_
z.wul Construction na Pm;t#: _ .
List all appifiablc umll wnsrrtrrtlon perntlrrf-G UIC. Corrnpa Store. irarwi ce, &1ajl lfknarm
3. Well use (check Well use):
OAgiicultural
❑Gcolhermat (liratingtCaoling Supply)
01nduar"tal/Gommerr.ial
Nan -Water Supply Well:
CAquifer Recharge
OAquifer Storage and Recovery
OAquifer Test
ClExperimental Technology
130cothermal (Closed Loop)
4. Date well(s) abandoned: 3121 /23
Sa. Well location.
Fort Bragg
13MunWpWftbli0
For Imernal Use ONLY
I
WELL ABANDON11fENT DETALIS
7a. Por Geaprobe/DPT or Closed -Loop Geothermal Wells having the same
well c6r structioNdepdt, only 1 OW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned
Th. Appmximatevolupleofwater mmainingin well(s): ._........ .......
FOR WATER SIIPPL m � �,.. -.�-._................__........_.................... � - ......-.-.-.-..
Y WELLS ONLY.
7c- Type ofdisinfectantused:
,. -.w�.......�...........�.�.�..�.�......�.
Id. Amount of disinfeclant used-
7e. Sealing materials used (check all that apply):
R Neat Cement Grout ❑ Bentomte Chips of Pellets
❑Residemial Water Supply (single) O Sand Cement Grout ❑ Dry Clay
!]Residential Water Supply (shared) O Concrete, Grout O Drill Cuttings
O Specialty Grout O Gravel
Cl Sentonitc Slurry U Other (explain under7g)
ORccovM
7E For each material selected above, provide amount of materials used.
N(Inirmdwater Remediiation Portland Cement 15 Ibs
OSalinity Barrier
OStormwater Drainage
❑Subsidence Control
OTracer
00ther (ex aJain under 7,;e,)
Factlity/owner Name + ....�....-...�, Faclh� k {iFapp�cable}
FTB Adams City, and z, :"�' Road
FTBR 1031SWMU-103 S Lucas Drive Honeycutt
PhysicalY p
Cumberland
P.
arcel Identification No.
sim_ Lailitude and longitude in degrees/minutes/seconds or decimal decrees:
(irvvell field, one ladlong is sufficient)
O N TRUMMQ D T Q,S F WEL .i ti° II F LNG ABANDONED
Nmcleuxllen+acirrrnonreea (.sj Jarotloblr, TormillpteWEaionar";-watersppply1mllr
ONLY with the same eprrrnv tinxlobo+xinnmrarl, yore can sofimir oncfahri.
6a. Well W#:.,E 6......m...-.-................... ­_.._.._..__.
6b.Total well depth' m 6 (R)
6tsBoreholediameter, 0-75 ¢o.)
6d. Water level below ground surface: NO
7g. Provide a brief description of the abandonment procedure:
Neat cement funneled from top.
s. certi rt-rn: / `e' 3128123
.. _.
S+gnmura of Cert+Eed t ' fi Contractor or Wall �mer Date
By signing this farm. 1 hereby certify that the well(k) was (were) abandoned in
accordance with 15,4 NCAC 02C .0100 or 2C,0200 Well (:onsfmalon Standards -
and that a, copy of this record hits hemp vvided to the well aivner.
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_
s awrl'Al.LNURUC IONS
10a. ELir 11_35AIr. 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-r617
Ift For Iniection Wells: Tn 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,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e Outer casing length (if known): (ft.) I Oc. Farr Water Su i lr c,Iggger,)on Wells: in addition to sending the form to the
address(es) above also submit one copy ofthis fort within 30 days of completion
of well abandonment to the county health department of the County where
g � ed.
5G Inner casia bin 1h ( if knolvn):.,,.... „wmmITIT�(ft.] abandon
6g. Screen length (if known): ­w­,,,,,,,,,,,,,,,��_,
FormGW 30 NorthCeielimDepwaienrofEnvironmental Quahty- Division ofWaterResourccs Revised ?'?•20i4

W1 LL ABANDONMENT RECORD
jj�
"? �T)F
John C. Schappell y7r., $,tw Gapprobell)FT or Claw&[Otsp Geathermul Weill hnvng the samc
.l (,on�nw,%bj (qr ve,j himr roM) %U 00"Struebiom'drpflt� qwl,yr' IW0if, mxAc4l, ludafib. 'TYrfid . NUBER of
. ........ . . .... ..
2332-A
7b.A ppro%W%te volume orwater rrumining in well(s).
. . .......... --l"...... . ......... . ....... . ......
M&W DrMing, U-C ii-ATrii'§iWU WEI,US IONLY:
W10600037
L Vklell Canstruefloll Permit
I.I.T0.01apphruable well cmairsalionpannies (ke Id. Amount (A dMaffiIant used:
. ............ . . . . ....... .....
1 Well one (chec& Wql 00,
Water Su ppl�y Well.,
:3AyieMpm1
Non-'Watcr-SwippkY W91L
O,AquiRx SUrage weal Razovely
n A quifea Test
E1ExMjn=AM
GGcodnvmal (Closed fzap)
4. Date wej$(g) abandoned- 3/21123
7g, Sealing imMerigis used (chqwk all that Apply)�
C� t T��'nowljje ("MPS Vff peacs
0 Nut ccmefll Caout
DRo-4d, m6s] Water Su ply (singh-) El Swid Cement Giroul M Dry (Uy
OResiftnal Mfitter Supply (Shaired) I M Cu ncretc- GmW 0 Ddh Cumings
orwoundwater Remediation
l_!SzHvany Barner
OSubsidemce Conuisl
OTMOM
nOffier kmAaw wuicr 7o�
Sm Wfil lacaflow
IFTBRA0311MMU 103, S Lucas Dilive @ Honeycutt Road
Cumberland
ParrA Idestrweimi N4 MR,
sh, Latitude and kn.wgftude in degrm1miniftntsecands ow'dechnal degms,
(ivY0fl.Ad, as 4&Ouo�, Ns sufficaLP10
35,14140745
66. ToW well depik. . 513 _ . ...... _00
64, %,arr $avcl below ground «;nrfqcv:
T.2 Speradly Grout 0, Gravel
rJ Benton0eshm y 0 01her (Uxplpin under 7PL
U Foreach mainrial selecMd. ahavr, px0videamoust ofiUaftriMs used:
Portland Cement 14 bs
7g� rmwidea bider description of the abandon meat procedure:
Neat iceiment funneled from top,,
3[28/23
,ppiyjg fhxvfrjnYv� theraby cryqfy thol fhe wddirs,) was f,
act.virManew wah 15A mcdc 62r 010,70 or, X,0200 WM
aadthhw as vrdr?u• of dor evomflan bix"apmVidedia dro well owner,
9. Site dlagrMM or addiflonal %v.11 dcW16'
W You May use the bRa.,of N!'� pse if) provide addtfloaW wefl site dvWh or wr.4,�
abandonmewdetw1s.. You may alm soach addamnal pa%p ffneceRsary,
Ion. EQE_AB_3y&-, Sul ni& Jus fban within 30 (lays of a*M&fian of 1-H
ahandon=4 io the fiAlwkng
Division of Water Resmirces, Intminsfion PrOM099 Il mit
16117 t6lnil SewvkeCenter, 1R9WgK NC 2769%.4617
01). fg a -Ere ; In acfton flo scriding ffic form to ,be SUMS$ i" td4
above, ako Nui5tni, an copy ,r 4i,ps romi vyizlain 30 days of camptwi inn of w0l
3bindonmentla 6e ftfflofflng'
Division orWaletUesoureCA, Undiargroulmil fiffiection iContraul Pr%,mra,
16MY,MaUService Ccawltv, Raleigh, NC 276ML1636
pelt,alik�k[-qjjp)j kjkvWelli s: n additkm wsending the fonn to dw
gy-4— _App
6e. Outer noing length (if known)' address(es) above, Aw mibrrut on- copy of ffis form wnftn '30 *Ys ofCOMIAefion
of weU abandonmem jo d-je couwy heafth dqpftnient of, the county whaA',
-Ar
JjE inner capinpoltubing tength (if known): . . . . . . ...... —Aft.) , andoned,
6r, SeveeA length (M known).
Fa— m mr If,

WELL ABAP D4NMENT RECORD
I. Will Contractor Information:
John C. Schappell
Well Centmelor Name (or well owner personally abandoningwell on his/her property)
2332-A
NC Well c.,. �. �-��� ............_..
aantetor Certification Number
M&W Drilling, LLC
Company Name
2.WeilConstruedoo Permit #: W0600037
..w....... .
List all oplplleablear11caminic4onpermies(1,a. UIC Cmmry, Srura,YarbAv etc)i knmm
3. Well use (cheek well use)t
❑Agriculttual DMunicipal/Public
OGcothmnal (llealutg/Cooling Supply) OResidentia( Water Supply (single)
0Industrial/Commetaial ❑Residential Water Supply (shared)
• Aquifer Recharge
1111(imundwaterRcmediation
❑Aquifer Storage aid Recovery
OSalinity Barer
OAquifer Test
❑Stormwaler Drainage
❑Experimental Technology
OSubstdenceControl
OGooummal (Closed Loop)
OTtacer
OGeothcromlWeatinr./CoolwReturn)
OOtherIexklainunder 7va
4. Date well(s) abandoned: 3121123
For Internet Use ONLY
WELL APIANDONiNENT DETAII9
7a. ForGeoprobelDPT or Closed-Laop Geothermal Wens, having the same
well constructionldepf,.t, only 1 GW-30 is needed. Indicate TOTAL NUMBER, of
wennabandnned
7b.Appro:dmatevolumeofwaterremaining inwen(s):. .�, •,••,• (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used: .._ ....._. .
7d. Amount of disinfectant used:
7e. Scaling materials used (check an that apply) -
It Neat Cement Groul O Bentonite Chips or Pellets
13 Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ BentoniteSiurry
❑ Dry Clay
17 Drin (`_utdngs
O Gravel
❑ Other (explain under 7g)
X For each material selected above, provide amount of materials need:
Portland Cement 14 Ibs
7b, Provide a brief description of the abandonment procedure:
Neat cement funneled from top,
5a. Well location:
FortBragg ...mm.__............_ ............ ..... .._............._._�,
r-wilitylownur Name
�
FTB 03 SW MU-1 03, S Lucas Drivehty tarn (r eycabto) 8. cerar on r µ @ I {onsieyeutt Road s��ns,ofce�ficd ell aatorer Well Owner 312$123
P cal Addrrss, C.rIV, and Zip er D96e
Cumberland
........-...— ..........- By signing 1his form, I hereby certtry that the wellrs) tucts (weft) abandoned or
County Parcel Identification No, (KN) aecy)rdvnor with l iA NCAC 02C.0100 ur 2C.0260 Well Construction Srondards
5b. Latitude and laagitade in degrees/minutes/seconds or decimal degrees: and 111a1 a copy ofthis record has been provided to the tveR owner,
lVwelt field, one lut/lor}g is sulftotem) 9. Site diagram or additional well details:
35,14146338 N -78 9759114 W You may use the hack of this page to provide additional well site detaiis or well
-�---- -- _ abandonmentdetails. You may "attach additional pages :fnecessary-,
CONSTRUCT 1V'DETAILS OF WELL(S)BEINGA$ANDON�FD SUBMITTAL INSTRUCTIONS
Atfaehtarlfctrraamdianreemr!{sJJmailtrhlc Farmuldpleinjecrimrornma-rvater,4npplyN'C1LS
0ATYWIh t&sormoammrctioAvhandonmen4 yarrounsubmironaforap 10n. For All Wills Submit this form v iibin M days of completion of well
62. Well ID#: F 2 abandonment to the following:
6b. Total well depth: 52
6c. Borehole diameter: 0.75 ............,._. (ia.)
6d. Water level below ground surface: (fL)
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 l0a
above, also submit one copy of this form within 30 days cif completion orwcll
abandonment to the following
Division of Water Resources, Underground Injection Costral Program,
1636 Mail Service Center, Raleigh, NC 37699LI436
6e. Outer casing length (f known): 'IX') lot- For address(m) above also SSuhmtnne7 ow oof In additi(mlo sending the form to the
�...tcrs
py this fort within 30 days of completion
of well abandonment to the county health department of the county where
6f. Inner casinghubing length (if known): , _ (ft.) abandoned.
6g. Screen length ('if Imowo): , ... ._........ .EfL)
Form OW-10 North C$rohns Department of Envirouman:al Quality - Division of :Hater Resourv+ Revised 2-1,P-2016

WELL ABANDONMENTRECORD
N. well ('00tractDr ]n forinadan.,
John C. Sid lappell
WeU h
2332-A
WA cwt=C'r C"I'fimbon Nontber
M,K'O/ Ddflng, L.I.-C
canqpanw Mlwra
W10600037
2, Wen constractionIx.Perroh V . ....... . - ----v-
wil 1w Mawn prroors 0-'� I/](.*, rounty, vage, XamnCe. Cie.,� 0, ow '0
a. Well usir (check Weill 119sr)*
OAg :ncuhwal
'Suppy)
l:31nd1MfinV('0MMcKiaI
supp"Y'Velk"
n Aqu-ifeT R wh argL
C:Mquifer Storage and Rv,*Yery
0Aqi3Jfe.r1'P,a
ok.'.%PLT1MCxaRl'1echTA010sY
OGMIKTmul (�lloqfxl Loop)
r3GMberYMA
4, Date welks) abawidIM& 3121/2-3
OlMun4qallftift
EIRtsulential W:&IPPly (5-910
olkesi&muM Water Supply (%h9rN1)
lla& Rarardiabon
os".401k), Bari
If �°frauux°r
l-'brWarnal U%r ONLY
7%. vor Geoprobe;Dff or Citused-LAga' GeathezMal'WeRs lh,11011 thc same
well rj- 'R
OW-30 iq needkif Indicate TCYrAL NRYMBE of
w-11!A
7b. Approximale volume Of "Uter
... . . .......
7c.T3pe of dhhifeCUMT useM
7& AMMAnt 01rdWafectuRt wed.-
7e, Sq--Iling makerials as (rheck. all That 9PPIY)'
0 Rest Cement Gawt a Bontonne Oups or Pallets
* sand Cem mt Groul
* CancxPft (Rrout
I spocWiy Grow
0 Bentonito Slurry
Dry. Clay
Difli CUL61115.!;s
o 7g)
JE F'ew-gacb nrateeial wle.44ed sbaY4 pnnidefilmuumt ormmerudt wise(t:
Portland Cement, 14 lbs
7g� Pwovidea lb1iiLfdr%4Ap6osg of the shandnnMent PrOC'td"Mm
Neat cx-�lmerlt funrleled frorn top,,
5-A, Well 19c.'aflon..
Fort Bragg
Facility IDM bf aPpfir'Abi*.)
%
IFTBR.-I 03/SWMU-1 03, S �Lucas DrivP @ Honeycutt load3128123
7- 'r
..... . . ...... ---- 1111- 'M C... =
PhyucatAudm,m 0W. -Ind Z4Y �t Ur. ofCal&ed FA cwtnzit w'-fl Cyw'Ct Date
Cumberland I haml�v f-arpp 11jej, Ile jfelj(,T� "4L� ( r. w&-d rx1wYv,&in,,d lei
. ... ...... Van"ev U-Mbolfillim No
.7pyeig&4r a cupy dRfdng t0(N'Y")kMq beGa PrdMidetio) flip well ownen
Loatitude And loupjtude in or de0hUAJ dtqln%'%� rarav
(I'VOR Aizll� im latilaw's w "wffirww) 19, SAP dfitgrmn twaildifianal'well deORM
35A4146859 -'78 97581082 w you isy ,sr the hack orthis, pago to provide addilional %I&M ske deullis wv• vVeU
-- N -1-�",-,.-.-.,-----.---.--..--,— abandonmeptdcta&
a D All 51 AMPffi-MA75 ft
6a. Well 1D#:IF 3
54
ft 'T'aftl well depik!� - -- _... __ (M)
6d. Water level belOw 9VOWARd SUARE'-,
5,J.SMLrFAIJ!b'] �K11028'
102. ]Enj AIL W&- Submit (his ftnm wilibin 10 days of anmpktiol O'WEI 11
ftbandonment la ft fifflowing'
ilyjvlqlav 1pr%tcr Re"wrive& [An-wadoin PnwAsslag Unh�
1617 Mall f5ervice Cenfer, Ralleigl%- 4NC 276"1 -1617
10b, ftL_1jn-AP S,.MMhTun addition town&g the R)rm to the Wdrcss irna 10a
above, abn Cutsmit mouse copy ofthis Florin vn6n 30 day: of Completion of%vil
abandonmmi as the IbIllowinf
1)jvL,.N',nn srWater Itejamme% Underpround Injection ColaInd P-grnin,
16m Rnleigk NC 17094406
aE.3YAMn p
&L- Qmter CUSIRR ICQ�!,tb (jif knopB).
Wdru%4m) ShMe, aL" SUIMI onecoM., oftil flrom� wl�tljiu 30 �.br, ofcompllmir z.
of we" abandmin?'111 to the County heillb kparlincro. of kllu� Volmq, wb.-re
wbn
fang Inner CRARRAUbing length (if,known): , z ndoned,
ft, Screen lengt1b (Kkawwra). _ . . . ............
FQMu Qw-.10 Noah Canty lma of Qualm, - Dowon 4Watc r Rowwnxi Rnpncd 2 -,V-26h�,

WELL ABANDONMENT RECORD
1. Well Contractor information:
John C. Sch_appell
W....._amracuuNeme(arvxllmownerperaona........... ..............................
Well C Ily sbandonins well ark ludher property)
2332-A _
NC well Contractor Certification Number
M&W Dulling, LLC
Company Dame
2. WenConstmcdoa Permit#: WI0600037
List dllapplicable Wellconstnrrttonpermlh,.dv...UIq..Guwi......_.....ww..................... w ..... w�........_-....._
ry, state, [mtiance, etc.) rfktmmwr
3. Well use (check well use):
❑Agricultural ❑Municipal(Public
❑Geothermal (HeatinglCoolingSupply) ❑Residential Water Supply (single)
Qlndustrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Aquifer Recharge
eGroundwatcrRont diction
❑Aquifar Storage aril Pmovety
❑Salinity Barrier
®Aquifer Test
❑SmrmwaterDiainage
OF-VertmentalTechnology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑GeathermalWestia.,Coating, Return)
00therlexrJamucier70
q. Date well($) abandoned: 3/21 /23
So. Well location:
Fort Bragg
Farlreemat Um ore . ................
v:
WELL ABANDONN11ENT DETAILS
7a, For GeoprobdDfT or Close&Loop Geothermal Wells having the same
well coostructionldepth, only 1 OW-30 is needed Indicate TOTALL NUMBER of
7b. Approximate volume of water remaining In well(s) .... (gal.)
FOR WAW SUPPLY WELLS ONLY:
7c.•rypeof disinfectant used: ___.­ ..00 ...... .....�
7d. Amount of disinfectant used:............................................._................� ._......_........-ti_ _..
7e. Sealing materials used (check all that apply):
Neat Cement Grout
❑ BentomteChips of Pellets
❑ Sand Cement Groin
❑ Dry Clay
A Concrete Grout
® Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentomte Slurry
❑ Other (explain under 79)
7f For each material selected above, provide a mount of materials used:
Portland Cement 14 Ibs
7g. Provide a briefdescription ofthe abandonment procedurtir:
Neat cement Funneled from top.
ame
......._
FacmLtylOwner NFaciioy kOh (ifapphcable) 8 Certtfi t n �
r
FTBR 1031SWM[! 103, S Lucas Drive @ Honeycutt Road 3/28/23
Physical Addrow City, and x, w. c ..�... art clot .._e ...�u
Y� N'• P S+pa+rmtare afCend;od tvctl Come, afar or well +75tner Dare
Cumberland
Jay signing this form; I hereby ixrl fy that the itll fs} was (mere) abandoned in
County Parcel tdentifieation NO (PM aorardanee with 75A ffU4C 02C _0100 or 2C _0200 Well Cautrnction Standards
56. Latitude and longitude in degrees/miuutes/secoads or de(imal degrees: and that a copy of this record hao been pro vided to the well aumer;
f if t"I field, one iat/loag is sufficient) 9. Site d isgram or ad d itional well details:
35.14154097 N-78.97583596 W You may use the back of this page to provide additional well site details or well
- - abandonment details. You may also attach additional pages if necessary_
CONSTRUCTION DETAILS OF WELLS) BEiNG ABANDONED
Attach livitcaminreitanPOrorri(s)ifirowlaW Fbra+iltiple Injection or1XV-+rarersrrpplywalk
ONLYivtth she mpie canstrudtaMa imdolimeot, yan eon salma l ane fern..
68. Well off., F 4
6b. Total well depth: 54 (M)
6c. Borebalediameter: 0,75 (►n.)
6d. Water level. below ground sarface: , .. _�h•)
UCCIONS
10a. For All Welts: Submit this form within 30 days of completion of well
altandoameat to the Allowing;
Division of Water Resources, Information Processing tint,
I617 Mail Service Center, Raleigh, NC27699-1617
t0b. For Idiactian Wells: 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 the following
Division of Water.Resnurces, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 276WI636
6e. Outer casingif known • g, I ftFor Mter Supply & Injection Wells: In addition to sending the form to the
length ( )' """ "" ( ) address(es) above, also submit, one copy of this rorm within 30 days ofcompldion
or well abandonment to the county health department of the county where
6f. Inner casingltuhiog length (if known); ,(ft.)
abandoned.
6g. Screen length (if known): -,.... (ft.)
Farrew30 NonhCarolinaDepanmantofEnvironmentalQuality- Divisiono(WaterResources Revised- 2z-2016

wr,,LL ABANDONMENT RECORD
1. Well Commetor h0stwalion.
,John C, SchappeIll
wo("'OnumtorName qbq XuYhOPOVOd�)
2332-A
r th'WV
0 o=Or '67 A""n
M&W DrOng, LLG
CAMM"V%ny ham o
00
2. Well Consiruedeff Permit N:ad
W106037
(�a
wit (ebeck-well ijme);
W%_EmTs _i 51TeGF;
111AI.XicubarA
OGMahormal (Havirnp
f', fndu onal/Couanemid
ME MIM
OAqWfer Rechuge
OA.qwfev dntaunsg e an a9 RCOVICTY
4,DA,qujfn r TeM
novothemaI (plosed 1�00P)
Y,21123
4, Date well(s) abftDdOft'd-'
Mvlunic�pavpubuc
a _1'11 7t, "I",;; — Bat -oN—cy
7a. For GiNwpmbdV11Y or Clowd-Loop GCOMITMal Wells having thas=K
4,ven Woo rtmofi an 41,rh, mily I OW.- M is n", cri. jrgtvaie T(YrA 1. NUMBER Of
w0k nhandoned._., 11111-11 . 1°. .,...mom...
7b. Approximate volume Ofwatcr' UUM141"S i8'kVd1(5)-
F1V_EVWj iiiss- W.1____"'_' ---
Type ofilisinfeMant trwd;
7d, Amount ofilkhrfeetant Osed:
7e. Staling aeaterhds wqed (check aU that, ajWly)'!
M Nat iCXnua nt Owl o Hinnorite chim a'° Polem
n: Rwidenhal %ftcr SUPP1Y 011610 1:3 Sand Cement Gmut `] Clay
V OnD Cutting
ORcridental Watcr Suppy (191aml) I C1 C OMMME G rOut
ACroundvmter RerraxJmfion
0934taty Barrier
GftpgVTmM1LT IDrourage
Mu bang Crintyll
01"Tacer
150. WeP locatbw
Fort, Bragg . ......
FwihtY K14(r"�PPN:absc)
FTBR­ 11 03/SWMU-1 103, S Lucas Drive @, Honeycutt Rii,'3ad
Phymc,&IAOM%Oy
Cumbedand
WwOcavonlqf, (PrN)
sh. I sifitude and Roagkude in degreeWminutesheminds or died mal dtgrees:
Add, ore laulgirg K qWWRano
35A4156317 Pq _7&97577897
69. Well I:.IF
5
.—I-11 . ..........
5�4
6b robs went divist:
75
tie.. Bomholle diant0eir. 0.Rganw
M. WAter tesTel below 9pund Aurrace: ..... ,.�__iVL�
n Sjx.,dzhy Grow 03 GravO
0 8CMI[Tonite Slurry 0 Mher fexpWn uvxW':Tr0
7E For each ema terial Met above, prwrideamount efM8tetjM5uwd.'
Portland Cement 14 �lbs
7p ,Pribviden
Neat cement ftinneled from top,.
328123
%le'n ranwiciol D1, WA OwIler
SO C
AV sqOTIng duN fordPr" I hand* 42".1gA, that Me weufk� Was (M-em) abandonod 0
wi9d OA O'ACO2C.Ot 00 or 2,C .0200 &VOJI GOY9VFU;fnM SIORTa10F?iv
and daul Ir revewd lu"Tv been ProwdW W r9re WPM OU'Urr,
%%4e, djagram or ad didanal well dertaila'.
Yo
W ta may ze ft Imck ofthis Page to jprovadglihond %ell sate drWh yin wefl
vdbandorRr.nentdq1a&
s!.k IN Amu— EX-IMMIM
Submit ajtdq form %vithin 30 dayrnF eanaafagutron of s%X-L
abandonment to the folowing:
Division of Water ltqnwvrcPT'VCsUi"9 Pall,
1617 Maill SericcCenler, Rajrejp ,h, VA" '217699-1617
10b. 11LIgigggan LIS In addaian to scn&np ibe roj7n to tjiv Wdmn� ir KD&
above, O�so qrDhm" rq�e copy of this fi= Othni -10 das s of OompYetlon of wali
abandonment To the to wing,
DKOOwn jkr%ter Underplr'Md inieeflon C,'oatrol Program,
1636 Mall Service Ceatar.Rnicigh. N(.,' 27699-16316
fl fle. Ear wale , Iningdot Wen � In 1906M tare $cndios the fbrm to 1he
6L. Olatzr Casing IMFgh (if known), r ------ Ls—sphAID'esd wt W Ms
addwQ7mo,_&) above, also submit one co ply of this ronn within dcom*q=
Rat' walll abaudmmmt to �.Jja cuajnly ijcahh depwUnenl of 01C. County
6�E. hmer owaf#whing ICeasgib (ufhinovO:::
6& Screve length If known):
Fum M­30

WELL ABANDONMENT RECORD
1. Well Contractor Information:
John G. Schappell
-Well Contractor Name m well ownepersonally...-.�-�.__._......_._.�.. we
. ( abartdonsngwell on tris/her prapany)
2332-A
NC Well ContmctorCenification Number
M&w Drilling, LLC
Company Name
Z. Well Construction PermitiF w10600037a - .......... ..,._.......... .......�_......,,...�--
[fautt (pplicuble Melt canxoredlan pernYrS f a. UK; cGraitt State, Variance, err) ifknuttvr
3. Well use (check well use):
❑Agricultural
❑Geothermal (14catingtCooling Supply)
❑IndustriallCommercial
io;aticn f7lrr
Non -Water ..............Supply
Well:
❑Aquifer Rccharge
❑Aquifer Storage and Recovery
❑Aquifer Test
OExperimental Technology
❑Geothermal (Closed Loop)
4. Date well(s) abandoned:, 3/21 /23/23
❑Mttlicipal/Pttbltc
w,�..wIrdarnONLY:
al Use ONLY
WELL ABANDONMENT DETAILS
7a. For GeoprobeMPT or Closed -Loop Geothermal Wells having the same
well constructionldepth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:,, .... ........ ... .
7b. Approximate volume of water remaining In well(s):
FOR WATER SUPPLY WELILS ONLY:
7c.Type ofdkdrifectantused. o... .... ................ ...... ..
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
B! Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Residential Water Supply (single) ❑ Sand Cement Grout ❑ Dry Clay
❑Residential Water Supply (shared) ❑ ConcreteOwut ❑ Drill Cuttings
90roundwater Remediattion
OSalinity Barrier
❑Stormwater Drainage
❑SubsidenceContml
❑Tracer
❑Otherimx ,lain underTt)
So. Well location:
Fort Bragg
pn �
crNaiac F ilityIDA(irapplicablo)
FTBR 103/SWMU-103, S Lucas D Ile @ Honeycutt Road
Physical Address, City, and Zip
Cumberland
Cowry - _ .. _....._ mm Parcel Idcm6fievion No_ (PIN)
5b. Latitude and toagitude in degrees/minuteslsecands or decimal degrees:
(ifwall field, ane latAom3 is sfficient)
35.14158456 78.9757042
❑ Specialty Grout 0 Gravel
11 Bentonite Slurry ❑ Other (explain under 7g)
7L Foreach material sciccted above, provideamountofmaterials used:
Portland Cement 15 lbs
7g. Provides brief description of the abandonment procedure::
Neat cement funneled from top,
rt
ti CerGf , d n r
Srgntreuir� arcwufird wall Cao� 312$/23
or Well Owner Date
By signing this form, i hereby certify that the wetl fc) was (ware) abandoned in
accordance with 15t JVCAC 02C .0100 ar 2C.0200 Welt Conrtrvcrion Sidndardv
and that a copy ofihis record him 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 dewils. Youmayalsoattachadditionalpages ifnecessaty_
CONSTRUCTION DETAILS W WELUS1 BEING ABANDONED
Rir4r/iNrlleonslnrWian+>:tvrrd(rJijavgllgbla Furmuilrpklr�tionornon-u+utersupply,veilt
QNCYwirklhe soma %�sovreriomrabandonnrent, y>Hr rxur snhmrr rme forrx
6a.'Welt UM: _F .6
6b. Total well depth: , 57
6c.Borehole diameter.. 0.75wwwwwwwwwwwww„w_
6d. Water level below ground surface:
SUBMITTAL IINMLIMPNS
IOn. ear All Wel : Submit this form within 30 days of completion of Moll
abandonment to the following;
Division of Water Resources. Information Peocesbing 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 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
163611fail Service Center, Raleigh, NC 27699-1636
6e.041ter casing length (if known): mITITmm,_ _ (It) 10e. For Water Sunoly & Injection Wells: In addition to sending 1be font to the
address(es) above, alto submit one copy of this form within 30 days ofcompletion
of well abandonment to the county health department of the county where
6L Inner cosiawtubing length (of known): --.. m(ft) abandoned
6g. Screen length (if known);.......................................................... ..-,(ft.)
Form OW-30 North Carolina Department orEnvironmental Quality -Division a}: WauxResources ReviW2-22.21016

-- . . . ........... . .
WELL ABANDONMENT RECORD Ipternal Use ONLY,
L Well Contractor Infonuafisn- %VEUIA �AIVQCMLE�
John ("'. Scha�j.)Pdl
a& MiusieTCYTAL m of
74 C ii TAIrzim "v"a mt q or '&V H 0 %ff� w pu'%'�. wN, � �y ab �Mdon Png. wel � on h � 0c. r pre4mty I
lveillpshandonrA . . ............. .
2332-A,
M&W Drilling, 11-1 C
00600037
. . . ... . . . ............... --- . . . ...... .. ........... .
Liu 4 11 apphaR b k weh cowssw tion j Aenns 4' 0 z Uff " C'mPIN 1.1,11 DOW, P�'waafwe' ip dej vkpmn
. . . .. . .......
SUPPLY WEL1.8 ONLY:
7c.Ty1weafftsiali used-�
7d.AmounT,ofdisinfo,,Ioiaimi,w.At:: . ........................ .— ................
. . ......... . .... . . . . . . ........... . .... . . -- ..... ..... --- . .....
um (check vrdl use):
i��i way%vrft — . ---l", 'Is. Stabi materlah. uged (Check 2111 that spplYV
OAgncufttwaU PJ NrAt Cemont Grout, o Bcsitonile Chijxi -air N*L,
11,30eothmnal p11minglCkWing Supply OResidential Water ISuppky (single) n Sand Ctlmfflt Onlut 0 Dry My
0-Residuni Wirer Supp&y (shared) 0 C'mmiretr GaOui 1 3 DnH cutling"
qy
. . . ...... .
sentenite SIUVIN 0 Cilbrr (expWR un&r 78
nAqtdP,,-r
0,Aquffer StoxagL and Ricoxvuy
OAqUlfe.jr f,0..!bj
I501ow"y
0Ex;mmen1al,rL Mb
L "Owtha'aral (005exl 140p)
4. dime* well(q) abandaued- 3,121/23
nRecovefy
C20roundwater Kernediation
05ahnity Raniew
13sturrmwer 11rainagr
0Sabmdcncc,1C0ft0I
CITRK IV
00thurknnWn under 7�
.5%. wrM kmi
Fort Bragg
tw
Facillky IM tirappK=We)
i: rBR-1030PIMU-103, S I ucas Dri've @ Hrmeyiii Road
--- . .......... - ------------
PiIp,ca@ Add=$, Ciiiy, and Z4)
Cumberland
Z�1-1 �, ---, "
elm,
b, Ladmic and longitude in deginx%limiallitaArconds or decimal ftmel,
'Ifmv4 60d, o w» Wpmjli M PlAfiCi
. .........
ira am I 'E
-'QN LCT non --A) )KTAffA5',A&',3Y 9-;ij1WN-QAA-AMP'-N V
TLL
0MLY mob 0usawr a#-w ran 01440 0M fri"M
6j. Witl VD0. 11W -2 . .....
6b,'fotal we dep& 39.7 . .......... -jrt.p
i6e, Somhole
iid, Water level hcWw %roviii surfice'.
'TE Fair (i maWrial SLterted abeam providesnimAnt of suderlain wamd,
Portland Cement 69 lbs
Bentorifte Powder (Quikgd) 3 ffis
4 Provides brief descriphon Procedufr'
Mixed and funeledt"rrough tromie pipe from bottom totDp.
. ... . ..............
S. C'el' 1 arcane
3,128/2-3
BY siprang fpwfiarwu I hvrelsy rwsldT& draw the igellfMs� 6vcre) Obal9thined 9r,
acxw#r,Jajux, wah 13A NCACO2(,j)j( 1p a id ;rgif S�M, nel irb
well rr,pwr
9. She dhkgram or addiflonalwell irdmetaaidan
YCM MY Use d'M 130CIC Of UITS P88610 Pt0i adcHuanal well sille detaRs or wfM
w abutdonAnentdetaft You may ,dig) allach addifioni pages ifnexmrAry
MS
jchj" fjr AH_ffgi_m: tubMt this fiam witimi 30 days of compli Of iV011
abav&x-imerti to
jiliii Of"'A ",x Rr�%.uxctni, WAforwation Proees0ng Unh.
1617 h1aH SerAce C`cauw, Rupigjp ,h, TiC 27fiV7-ID6V7
oh, &r tqjCgjpq %YF'.flh: In adm dinan simdmg Ole irorm it) the address in 10a
aftve, ajj;,n anajhnjpj ine uopy nr the; fro man withua 30 days ofcomplefion of W01
abilindo=em to tht FRA100na"
Djvjqji 4uf Wtatev Re."urecia,, Underp �P) Pr rani
ground 10ject-100 Cont A r 09,
1636 VaN 1.wrvicr Cchlei %IeighNC 27619�1 fiX
6e, Outer eaAaw, la: IPA (if addrca&(cs) above aso submit one copy of ihff ,. rhino within 30 days ofcomph-Mon
of wdahandownent. to 11i witnt1w health depariment of the rounty wherc
Of, NaLr rAxinWinbing leagtb. ff lknownt::
6g. Soreen loam Iffkau"n): Jft.)
I`Orm GIN-30

WELL ABANDONMENT RECORD
I. Well Cantmetor Inforrogdou:
John C. Schappgll
WellCmarattarNorie (or welt owner personally abandoning well on hivlwr property)
2332-A
For ..al
For trderoal Usc OIQLY:
L ..._................... ..
.. �..e�_ _—
WELL ABANDONMENT DETAILS
7a. For GeoprobelbPT or Closed -Loop Geothermal Wed& having the same
well constructiorddepth, only I GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned —...M................ . b ,,...,.,
NC Well ContnuaorCeitiationNumber 7b,Approximate volume ofwaterremaining inyvell(s):_ _
M&W drilling, LLC Eii saiPlx w:rs oivi.Y:.............................�.�.�....�...._....._..—.-
company Name
7c. Type ordisinfeclontused: .,...
WI0600037
Lovell Construction Permit# ........... W, ._ ....,..� ._... ..
Liss all applicable urll was imcdUsy permits (1.e. U/G Camay, sane, Fbrtortce; etc( (brown
74. Amount of disinfectant used:
3. Well use (check well use):
- ..................... .. . . ..,...... .. .,
WaterSuppiy Welh....,,,.w,,,
7e. Sealing materials used (cheek#Il that apply):
❑Agricultural Municipal/Public
0 NeatCement Grout ❑ Bentonito Chips or Pellets
OGcotbermal (HeatinWCooling Supply) ❑Residential Water Supply (single)
0 Sand Cement Grout ❑ Dry Clay
❑induswel/Commercial ❑Residential Water Supply (shared)
I Gl Concrete Grout ❑ Drill Cuttings
Well:
0AquiferReebarge
❑Aquik7 Storage aid Recovery
❑AgtrifcrTest
OF-vpetimental Technology
❑Geothermal (Closed Loop)
❑Geothermal 111catin 4Coolinx
4. Date wells) abandoned: 3121/23
❑Grotatdwater Itc tediation
❑salinity Barrier
UStormwaterDrainage
❑Subsidence Control
❑Tracer
sa. Well location:
Fort Bragg
Faw.,lrtyrowneriqauna Faci103, S Lucas Drive Honeycutt mmmm ....
FTBR-103/SWMU- Road
Physical Address City, and Zip
Cumberland
Psi 1efenti6cation..No. (PIN)
Sb. Latitude and longitude in degrees/minates/seconds or decimal degrees:
(rfwell held, ono latAong i%suf icierd)
35.14143706 N-78.97599656 W
coNSTRi1CTIONDETAILSOFWELL(SlB _G:"ANDONED
Aaaeh well cvlarrrrrcliaa recard(� lJatnNable: !•nrmrrh7pl¢ infeciraa0rrton-rvprer..upp1V dells
ONLYvti/h lhewnre ewesavcribarahandonnrRlrl, lmr tansvlimif nnc far.
6a. Well IDN: IW 3
6b. Total well depth: " w„ --,.00
6c. Borehole d ia meter: _ ................�._... �.....(in.)
6d. Water level below ground surfaces
❑ Specialty Grout O Gravel
❑ Bentonite Slurry ❑ Other (eVhun under 7g)
7L For each material selected abever provide amount of materials used:
Portland Cement 76 Ibs
Bentonite Powder (Quikgel) 4lbs.� _.............�_._._...
7y. Provides brief description of -the abandonment procedure:
Mixed and funeled through tremie pipe from bottom to top.
8.Ceriii
G
Sir�reuuteofCcrtifiedWallContrecta�l 3f28/23
iy r Or � I C)waer bate
jay .vlgnurg this form I hereby eaearfy that shewell(ij was (were) abandoned in
occ irdtn m with 15.4 MUC 02C.01170 or 2C _0200 Well Construcri6n Srandards
and that a copy of lNix record has been provided to the well owner.
% Site diagram or additional well details:
You may use the back of this page to provide additional well site. derails or well
abandonment details- You may also attach additional pages ifaccessary.
SUBMITTAL INST.RUCTiONS
Ills, For All Wells: Submit this form within 30 days of completion of well
abandonment to thefol1mving:
Division of Water Resources, Information Aroeessing Unit,
1617 Mail Service Center, Raleigh, NC 17699-1617
lbb. For Infection 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 Mail Service Center, Raleigh, NC 27699-1636
6a Outer casing length (if known): {R } 19L For Water Su W & Infectiom Webs: in addition to sending the form to the
""""" address(es) above, also submit one copy of this fart within 30 days of completion
of well abandonment to the county health depattment of the county where
6E Inner casing/tubing length (if known): ................... (ti) abandoned.
6g. Screen length (iflutown):.._....................... ........... _.......... ice)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-11.2D16