Rowan_Well Abandonment_20230724

WELL RA 1 ' OM k N xS RECQirc: i n F.r l Bernal L'ae ONLY:
1
1 .
1.Well Contractor Intarrantivn: WELL WINDONMENT DETMLS
jtS r� __ U Fee 1.3eop.miterarr er c1 r t%:, W =. ..r:;Welt,fining the same
Well Contractor Name(or well owner personally abandoning well on hither property) Wei!construction/depth,only 1 GW 13(1 is needed. Indicate TOTAL NUMBER of
wells abandoned: !
NC WeR(ram-terCaeiuile.-stW a Number 7h.Approximate t volume of water retraining its(wilts): l L v° (gal.)
j-I f G LAND V tCrcS :FOR WATER SUPPLY WELLS ONLY: Ott u ] 1 Cotnpanv`:am 65/% CALL(�l�-1 T1 1F 14io t t Type tait�� rxtt used; o
t
2.Well t,'vtastra ctagxr Permit#:
(w all applirat'ie heti r rgzLtrti:tine permits ire.VI(-,Ctraira.States l'arianee,err.;i(frtauri Oy
7ct.Ansonia'.dtrc aafec rritt_e&
3.Well use(check.well uctl:
Water Supply Weil: 7e.Sealing materials,used t(theck all that sip tl s):
'_'Agricultural ClAtnticipatiPublic r t'cm Cement Genet S.Bentonite Chips cr Peilets
E2Geotherani flicsling,`Canling Supply) g esidential Water Supply(single) t.Sand Cement Grout r,- Day Clay
lndestrialiContm,reial CResidential Water Supply(shared) t: Concrete It f�EI Drill Cuttings
Cftri+eatian • 1::.Spcciaity m. VF-
I i i (;rate!
Nola-;dater Supply Well: _ +' ntcrt:SittcrM 2023 al Other(explain wider 7g)
l f onitorine t_Recover JUL
r
filmset.tt>x Well: if.For easels material slileetc d above,provide amount of materials melt
'. quifer Recharge ,Groundwater Remedi anent t Ilt�ivi77t + Pr 3 . r�Ufa
t_ntiuiferStcara B art Reco ery 2�Salinity Harrier
1 SQ CO • `o Co Fr 1N11AT KRoV?
CAquiter Test `':Storuawatex Dreitrage 7o I h s il%Ot-17._ L1 l PS .o.,____.......,.,,,.,..
t�Experintental Technology 0Subsidence Control
lg.Provide a brief aztription of the abandonment rocerla :
l2Geutheunai(Closed Loup) t::Trecer I n (� Q
Geothermal(Beating-Cooling Return) DOther(explain under?_•) ( /4�'Z3 1 U lr� Pu P, PLU M�lN ( W t 1�11�
a.l tte milts)abandoned: _l �_ � -Z7i Qur�Pi i G�-U£L /n1 uP -ro 36 f P�6S
:/
fi
So.Wel2 Inenriaw: l4 r,() I t bF l�fi�Zonf i rc CAI F PS ' -crN TraniL OV(i
/
-1,-0 S�� .
FacttitplOwner Name Pacility!DP of applicable) a•f carrentintor
/35-5 d oosE RP ,J ►Pous.nrc Zeo83 7-1 13
Physical Address.
_�City,and Zip S' a::tun of Certiftt yell Conway-tottarWelt Owner Date
h0 WY'!1V By signing this forvat.1 hereby certify that the weli(s1 was(were)obatuloned in
Crump Paled Iticntitiwtinn No.MIN) accordance with 13A NC.3C 02C..Mkt Or 2C.0200 Well Construction Standards
and that weepy trf this record has bee::prm'td&to the well owner.
.Ste.Latitude a and longitude an degeesfutinutestseimnds or decimal degrees:
tifwelt fiell one lattivag:is sufficient) r Q W,i.e
P.t`-s�.i$�i .�z-!"�3 it2-LT�?,sr?a��3._.d E31�1 t...Ax'Mi:
3 c-t S Z t c3C - v t 6t 15t 1.( You may use the back of this pate to provide additioatd tsell site details or Well
1 abandonment details_ You may also attach additional pages if necessary.
CONSTRUCTION DI't'.f XLS OF WELL(SIXE 9_"si:t3. ONE! I I3'S3' L'L'INSTRUCTIONS
Attach eltrotittttrtimirrrnrd:siifaro:fable. tertrmltipler j':eti.sr.nrnon-waters::t;.p?r wells ^' ""�' - "
ONLY with the ante cvastrtrc lnrt'itlt tnd,potent.tote i an submit sine form..
:Ella.Dr All 'b'lelIN Submit this furors within :311 days of completion of well
6s.Well iff. : _ abandonment to the following.
Division of Water tt,e auaretrs.Enfant:ration Processing Unit.
6b.Total well depth: 2--2-5— till, 26171420S rTire Canter,Raleigh,NU 2r l)-5617'
rldlb.For Iniectiam Wells: In addition to sending the forth to the address in 10a
6e.Borehole diameter (in.'s above..also submit one copy of this form within 311 days of completion of well
abandonment to the following
eMzei of Water P..,fts: rvs,v,nderP,Fr t FuaExtle.m.Conize5.Pscgram,-
dd,Water level Mow ground surface:_... WO 1tx36 Moil Sersire Canter,ta2er, li a,NC 296 -f53t
6e.hater cods..0 to *a,'in(if lsnerenal: _ 3 O_ MI ]il .34W.. :s.r jL kA.Apj £f t t Was:1 : in addition to smiling the forth to the
addre (ca)above.also submit ow copy of this funn within 0 days cif completion
of well abandonment to the county health department of the county where
a fttssorcadw ltNcr,4 ttiAE4;.ee- tr}.. r .t>
abandoned.
6p.Screen length(it lieeatNxtl:,...,...._,-.•. _u.,,........._ .,...k...-,JD.)
Form GW-30 North Carolina Department of Environmemal Quality-Dnisnm of Water Re,;natrces Revived 2-22-2016

WELL ABANDONMENT RECORD Far Infernal Use ONLY: •
This foim can be used for single or ruliiple.tiwells •
1.%Wef Contractor information: LX-X, WELL ABANDONMENT DETAILS
Brian Ewing • \ . 7a.Nwnber Of wells being abandoned:.1
WclICeuraciorNanieMrwi1 Mauer payaslally.abamIo ni i1.onlusAterpreperlyl Far Ontlnpie nvi!efoir Or runitarer slrrtl!h. wells .ONLY watt 1h._f scone 1
COMIPCCONIabo!u?11 L'nc,pill our diibmif rd'ie tirvi.
4240-B
7h.Approximate volume of wady remaining ---
in well(}: (gal.)ci NC Well Cornr orCenificatiou Nnir,cr
SAEDACCO Inc FOR WATER.SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:_
2.Well Construction Permit N:, , •
List etll irppheittde Weil prendir ii.e.Cv rrrir,Sloe.b urlurece.IJrleCNou.,eic i if lfrmti"ri 7d Amount of disinfectant used:
3.Well use(died.well use): '
Water Supply Well: Ye.Sealing materials used(cheek all that apply):
❑rtgricniturat phtinicip:tlfPubtic Il Neal Ccinetit;Gtont ❑ Bentonite Chips or Pellets:, •
❑Georltennal(He tinglCoolitia Supply) ORResidentsd Water Supply-(single) ❑Sand Cement Gmnt ❑ Dry Clay
.❑lndustriallCommcrcial ❑Residential Water Supply(shared) 0.Concrete Grout ❑Drill Cuttings
❑Irtifation .b.Specialty Grout . b Gravel
Noir Witter Supply Well: &Bentonite SIRITY El Other(ekgtlain under 7g)
ElMonitotine ❑Re covely
injection Wclt: 7f.For each material-selected above,provide atnottotof materials used:
❑Aquifer Rcdiiiiae . . ❑Grouridwater ltetliediarion Neat Cem.:471b ,Wtr:3gal. Sand.Cem.:lb ,Wtr:gal.
CI Aquifer Storage and ReeOven' ❑Salinity[lamer-
❑AiprifeiTest .❑SlornmalerDrainage -- . -- -- - •-- - - '--- ------------------ —__-_.—
❑E.xperiutental Texhnetogy • ❑Subsidence COMM! 7g;Provide a brief description of the abandonment procedure:.
tiGeothemull(Closed Loop) . &Tracer •
TREMI GROUT FROM BOTTOM TO SURFACE
❑Geothermal(Hcuing♦'Cooling Return) .OOther(cplain under 7;t) J F.RECEi / Ede
4.Datewell(s).a J
handoncd: 6-23-23 II PI 9 A• 7n23
Sa.Weti location:
. • ifil :-.7..-:j-- 73,---*.sai....1 11R%3
Auto Truck Transport USA ClWQMt?G •
Facililyielyn:r N;uii Facility Mg tifuppliatblci S.C.ertiflcatlon:
320 Bear Poplar Rd. Cleveland, .NC 27013. Brian Ewing6/29/2023
Physical Address:Cily,'andzip aeiu Si morceninca Wen Ciiltircciiii nal Own r um*
Rowan By Awning this Jizmr,.1 hereby cerdfi that the ire/10 was!mere)abandoned in
foamy PPaicel Idenlittcaliaa No.INNi ouorrlaucc with 1.-f: G:-IC 02C•OI t7W or 2C 0200.lretl•Co rsIruc Lion Staruk,rds
and thal,a copy oftlris record bin been provided to the.ii•ell owner.
Sb:Latitude and iongitutte in.dcgrccslminutestsccnnds.ordccumal degrees
• (if s-ett fiat a11Lt;ttilonSfsfitfuc:<t1) . 9.Site diagram or additloitat well detaIls:
You.may use the back Of this page to provide additional well.site details or well
. . 1Y . . . . . - • W abandonment details. You only al o-:atacliadditionalpoges itnecessary.
CONSTRIICGION.DETAILS OF WELL(S)BEING ABANDONED ..SFTBMiTTAL iNSTRiTCTTQNS.
:iamb Irrff coast uelien rpcurdUs)it utrei1d.Ie.-14v innitiple ii fectirite or oen-water xiippli '
treat ONLY n lth the some:wum crater ,rlr,trelese..1C•rtr-1 La ear,Slti rrli.oJc juna. IOn:•For All Welts:- Submit,this,farm within 30•days of completion of well
Ga.Well[Dif:.
TMW-1 abandonment to the'following:
Division of Water Resources,Information Processing Unit;
6b.Total well depth: 35 • (ft.)
1617 M:iil-Senicc Center,.Raleigh.NC 27699-1617 •
•lOb.j:or in!cetlor!Wells: In addition to sending the fonu to die:address in'•tOa
Ge:Br]rthUlC diaaietor 1 'above,also submit:one copy of this form within 30 days of completion of welt
(iu:) abaudounclu to the following:
•
Division of Water Resources,Lruderground lujectimi Contrail Pnigratu,
6d.Water level below ground surface: _ (ft.) [636 Mail Straw Center,Raleigh,NC 27699-1636
Ga.tlutcrcasing ten h.(iflmnwo): (ft.) tOe..For Water Sunnly&.infection Wells: In addition to sending the form,to
the addresses)'above. also sulinmit.one copy of this form Within 30 days Of
completion of well abandonment to the county health-deportment of the county
•
6L.Inner easing/tubing length(if known): 29 (ft.)
whereabandoned.
6g..5ctren length(if know a):10 (ft.)
Farm GW-3tt North Carolim Department of Enrironnicnl trot Natural Resources-lahision of Water Ttcsowcee Revised August 2013.

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or mullipCe wells •
1.Well Contractor information: WELL ABANDONMENT DETAILS
Brian Ewing . 7a.Number of hell,bein),abandoned:
Welt CmatacyorName tor%td[onieiperw1collyabanioidngncll.onliad:trprepeny) For uarfrlplc uticetinJr or rwa-Aiitr .,it.ytu\. wells .ONLY with Nye some
eO, r irer/O'1. bamitoUhffi,plo rim,t711.41N((lu frrml,
4240-B
NC Well Colrtraaor Oat ifrcatim+P+nn bcr 7h.Appruzimate volume of watir-'remaining in tscll(s): - (gal.)
SAEDACCO inc FOR WATER.SUPPLY WELLS ONLY:
Cvnotam•Name 7e.Tyjre of disinfectant u3ed:
2.Well Construction Permit N:, ,
f. rdl,rpptic'ii(de iix19 permitr(Lot Cvnrrh;57a1e.hullo ice.l,rfi'ehc i,.ete11ftizr;ti+rt 7d.Amount of disinfectant used:
3.Well use(dteckwell use):
Water Supply Well: 7.e.Scaling materials used(Checkall that apply):
°Agrinilturtl 13Miuticipa11Putitic bit Nan Ccnient.Giottt - 0 13entonite Chips or Pallets..
Otleothenn l(Hcatin)Cooling Supply) °Residential Water Supply(single) ❑Sand tcntciil Grout ❑ Dry Clay
•
❑bulustriallCommcieial ❑Residential Water Supply(shared) ❑.Coucade'Grout D Drill Cuttings
❑ht iation O.Specialty Grind G(t%'d
Non-Watcr.SupplyWell: ❑13cntottite Slum El Other(explain under 7g)
®Moniloriue ❑Recovery
'injection Well: 7f,For each ntaterialselected above,provide automata materials used:
❑Aquifer Recharge ❑Groundgatcr Rentediation Neat Cem.•471b, ,Wtr•3gal. Sand,Cem.:lb ,Wtr•gal.
❑Aquifer Storage and Recovery ❑Salinity Darner• -
❑Ailuifei•Tesi OS tOintwaterDr:iinaee ________ - • ,
❑E.xperiniemal Teeltoulaey ❑Subside+xe Control 7g.Provide a brief description of the abandonment procedure:
CJGeorhennal(Closed Loop) l'JTracer
TREMI GROUT FROM BOTTOM TO SURFACE
❑Geothermal 4Heiatin 'Coolin„Return) ❑Otlter(explain under 7g)
4.Date wells)abandoned: 6-23-23 LIII 2023
5a.Well location:
Auto Truck Transport USA .
- l+r�.FJSt�'la
Facility/OwnerN:unc Farility�IP,y(ifappliclblc) S•.Certifh atioit:
320 Bear Poplar Rd. Cleveland, NC 27013 _'Brian Ewing 6/29/2023
Physical Address.Ciry-andZip Simone orCeitiicd Wen('an1r71Crnr;,r: illOwner Dull:
Rowan fits s11,111qg ilas fr-rrra, I hernhy certify.thm the it•d1('s) was(were)abandoned in
County - It.,rccl I(.1aniifLit}aii Na.(Pp9) ac-vnfallc•c with I J;I NC,IC 02C,0100 or 2C_0200 1r7e11•C'ondi a.(wu Standards
and lhnl a copy'of this recrird liar been provided la the well owner:•
S1.l.atitudcnnd longitude in.dcgrecsiminutcsfscemuis or decimaldegrces:
(lrlscla raid,ow latrlangis pririei2i ) 9.Site diagram or additional well details:
You may.use the back bf this page to provide additional well site details•or well
. . N W abandonment details. You may alse-attaclr additional pages if necessary.
CONSTRIICTION.DETAILS OF WELL(S)BEING ABANDONED SLTRIIii7TAL iNSTRTJC TLONS
toad/grid commie-1km rrcrnrd(s1 1f orro)lurda. 1-rir nrntaple irllctitin or r✓anlru- lcr xuppli
WelkOYLY with the 10111•.av,r re(tafed'rirrch;rim;tit.you cm:snlani7 ulre linty. 10a: For All Wells: Submit this tart within 30•days of completion of well
loos Welt LD :TMW-2 abandonment to the following;
Division of Water Resuurcu,Information Processing Unit;
38 '1617 Mail Service'Cenccr,.Raleigh.NC 27699-1617
6h.Total well depth: ((It.)
1011.For Inlec•tion %ells: In addition to sending the fort to the address in 10a •
6e.BorEholediantctca:I OM} -above.also submit.otte copy of this-form within 30 days of cumpletioo of well
abandonment to the fallowing:
6d.Water[cFcl.borotn gtotrncl surface:- {ft.) D(vislou of Water Resources;Underground Injection Control Preigram,
1636 Mail Service Center,Raleigh,NC 27699-1636
• IOe.Far W jiter Snnnly A4 iniectirin Welly: In addition to sending the font to
6e.Outer casing length.(if known): . (ft.) the address(es) above. also submit one copy of this font Within 10 days of
completion of well abandonment to lime calmly health department of the county
(if.inner casing/tubing length(if(mawn): 28 (ft.) yvhcrc abandotted,
6g.Screen length(if knots n):10 (ft.)
Form OW-30 Noah Carollra Depanirent ofEn,iromncnt anti Natural fiesou:ccs-Division of Water IRdouttms Revised August'2013

WELL ABANDONMENT RECORD Far Irderna UscONLY:
Tliis form cam be used.for single or ntultipte n'eUs
I.Wet[Contractor Information: WELL ABANDONMENT DETAILS
Brian Ewing - 7a.Number of wells being abanl uued:.1
Welleonracier Kam:.Kirk lloai�f pc ra1talb:alyatulog p niat:tl.o Es's ilrc7 propcfiy l For wirfnple Weak(' li or non-water sum). welds .ONLY teeth He a song+
masrnrctar•wbondnr ,near,pill cwr.+vFtnit n firai,
4240-B
NC Well Contractor Ccniftc:rliau Nnn bcr 7b.Approximate Volume of water remaining in�i•cti(s): (gaL)
SAEDACCO Inc • • FOR WATER SUPPLY WELLS ONLY; t
Company Nairn. 7e. fyite of disinfectant'tied:
2:Well Construction Permit#:, , .
Liir r Ii i.sp?hti&le iiel/p.rnticr(i..Cvruth,Str.,M.i irimece.lirfecdfate.,ifiU 1f known /d.Amount of.disinfectant used:
3.Well use(thee:.well use):
Water Supply Well: 7.e.Sealing materials used(cheer;all that apply):
❑ASticniturtl ❑htitnicip.il13ublic , lid Nett Cenictii Gout CI Bentonite Chips or Pellets.
❑Crnl1tcrm;tl(Regan/CaolingSupply) 0itcsident1a1Water Supply(single) ❑ Sand Cereal Gtnut 0 Diy Clay'
Dhtdusirial/t omniercial ❑Residential Water Supply^(shared) ❑Concrete Grout El Drill Callings
❑irrigation • .0 Specialty Grout • LI Gravel .
Nero-Water Supply Welt: . Ci Bentonite Slurry • Ci oilier(explain under 7g)
®Mua loriate. ❑ita:over)
injection We.tt: 71.For each material selected above,provide antonntof.materials used:
❑Aquifer Rcr:[targc ❑Groutith ater Rentediation Neat Cem.•471b- ,Wtr•3ga1. Sand_Cem.•lb ,Wtr•gal.
❑Aquifer Stontge attl Re oven' OSalinity Barrier•
-❑Aquifer Test. ❑StonnwaterDraltiage
DExpeiintenlal Technology ❑SUbsldeIr a Control • 7g.Provide a brief description'Attie abandonment procedure:-
flGeotlternal(Closed Loop) • C1Tracer
TREMI GROUT FROM BOTTOM TO SURFACE
CJGeothenital(lieittinptCoolina Return)' .ElOtlter(explain under 7g)
4.Date well(s).abandoned: 6723-23 . �"i ,
5a.Weil/oration: JI [ 9, A 2023
Auto Truck Transport USA
racilitrtQrrticrNmrvc Pa ittlplDs(ifapnli blst 8..Certifleation: IMGriti^i.it•tt 7rn.esook'r�Urii
CSr•`01Bt?r:
320_Bear Poplar.Rd. _Bran E'%Ai_f + 6/29/2023
Physical Address.Cits.•aird Zip Si_rri1lnrc al'ca;iiiriCd Will Ccttirronr fir.d all O n r thrlg•
Rowan . - - . - • fftr srmrlog t/tt4 form,../Iremby certify-that the wells) u'aS mere)abandoned lit
Co fluty Parcel 1dctg1fa a1ini1No.(PIN) ttc.coro/aJtc•tr with 1.A.1CiIC Ott.,010tl or 2(7.0200.Tf 8/l:Couslntctiori Sk,uchtrds
• and that'a copy of/his record hos been provicded.fo the ri•ell ciwiier.
Sb:Latitude and longitude in.tlegree tmintite'dseconds.or&elfi;!l dcgrccsi
0r).6;11 rater,ors hitt101a 1$a rft;ticrx) 9.Site diagram or-additional well details:
You May use the back of this page to provide additional nett site details or well
• N • . . . W abandonment details: You may also attach additional pat:s if necessary.
CONSTRItCTION.DETAIL.0 OF WELDS)BEING:ABANDONED SUBAiTTTAi.iNSTRUTCTiONS
11rodt troll coartracgd rpcvrilfs)ii.n•irrildrk. For nrtrhtple in.li ii.yr or rxin•nvter suppir'
wltc ONLY:with itfi the Altaic cv,rsir.vaio r'ar urreibunr Ku.i,tu ran sub.utit Ware fume 10a.Tor All Wells: Submit this film within 30-days of completion of well
6a.Well IDih
TMW-3 abandonment to that-allowing:
•
Division of Water Resourtc,Information-Prucessfng Unit,
lib.Total well depth: 38 CIO
Mail Service Center,.Raleigh.NC 27699-1617
• 10h.for Inlection Wells:-In addition to sending the fortn.to the aidress in.inn
Gc:Elatehole dlantetetr:l above,also subntit.one Copy of farm within-30•days•of completion of well
(in.) :Ibtitulonuteul to the followin
g:
lid.Water tc�cl.bcfn�ground atti ice: (ft.) .D[vistottof Water Resourecs,iluderground itiject[ou Control Program.
1636 Broil Scores Center,Raleigh,NC 2769) 1636
Gc Outer casing length Oilman-Rh (ft.) lOc,For Water Swink'&infection Welts: In addition to sending the form to
the•addtess(es) above. also submit.one copy of this form within 30 days of
completion of well abandonment to the county hrnttk•dcpariment of the county
where abctridoncd,
6f.Inner easing/tubing Length(if Down):28 (ft.)
6g.Screen length(if knoua):10 1ft.)
I
1
Form GW-30 North Carolina f?cpana>rm of Ensirannacot art]Natural Rcseu cos-Dh•ision of Watcrtt&utces Revised August 2013.