Alamance_Well Abandonment_20230818 (2)

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathan D. Oldham, Jr. 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW!30 is needed. Indicate TOTAL NUMBER of
2889-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Pyramid Environmental & Engineering, P.C. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: NA
2.Well Construction Permit#:
List all applicable well construction permits(i.e.U/C,County,State, Variance,etc)ifkawn NA
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge RGroundwater Remediation Portland Cement lbs.
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite o lbs.
❑Experimental Technology El Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Slow pour Bentonite Pellets/Chips; Tremie Pipe
Portland Cement � � ��� �
4.Date well(s)abandoned:
1 nn�n
5a.Well location: a L LJ
Teague's Farm & Market NA iftwwon Pr;,capai-,q URI
Facility/Owner Name Facility ID#(if applicable) 8.Certification: 0 Q130G
8912 Pleasant Hill Church Road, Snow Camp, NC 27349 �/ '&
6-e
Physical Address,City,and Zip Signature of Certified Wellctor or Well Owner Date
Alamance 8757933722
By signing this form, I hereby certify that the wells) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of Bus record has been provided to the ivell owner.
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.876687593009216 N -79.47867456012426 You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the some construction/abandonment,you can submit oneJorm.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: AS-2, 3, 4, 5, &6 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 40 * 5 = 200 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 15.65 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 10c.For Water Supply&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casing/tubing length(if known): 35 (ft.) abandoned.
6g.Screen length(if known): 5 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

VV L' LL L»L'•1\1JVl\1r1L'1\ 1 1\L' l.V1WV IFor Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathan D. Oldham, Jr. 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
2889-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of watel remaining in well(s): (gal.)
Pyramid Environmental & Engineering, P.C. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: NA
2.Well Construction Permit#:
List all applicable well consiniction permits(i.e.UIC,County,State, Variance,etc.)if known NA
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout 11 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
eMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Portland Cement Ibs.
[]Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite IbS.
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Slow pour Bentonite Pellets/Chips; Tremie.Pipe
Portland Cement �
4.Date well(s)abandoned: Q
V MU
5a.Well location: AUG 1 ® 2023
Teague's Farm & Market NA
UnN
Facility/Owner Name Facility ID#(if applicable) 8.Certificatio �� �"�`��0 `'�
00
8912 Pleasant Hill Church Road, Snow Camp, NC 27349
Physical Address,City,and Zip Signature of Certified Well Contractor or ell Owner Date
Alamance 8757933722
By signing this form, I hereby certify that the tvell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.876687593009216 N -79.47867456012426 You may use the back of this page to provide additional well site details or well
abandonment details. You may also a ttachiadditional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable. For multiple injection ornon-watersupplywells
ONLY with the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this,forin within 30 days of completion of well
6a.Well ID#: VE-2 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 55 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 &5 (outer)(in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 15.85 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
Ge.Outer casing length(if known):
35 10c.For Water Supply&Iniection Wells: In addition to sending the form to the
(ft.)
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 50 (ft) abandoned.
6g.Screen length(if known): 5 (ft.) j
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

VV LLL L1D111�111 Vl\1V1L'l�l 1 R r,l.V R.0 I For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathan D. Oldham, Jr. 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
2889-A wells abandoned: �.
NC Well Contractor Certification Number 7b.Approximate volume of water
ate remaining in well(s): (gal.)
Pyramid Environmental & Engineering, P.C. FOR WATER SUPPLY WELLS ONLY:
Company Name NA
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e. UIC,County,State, Variance,etc.)if known NA
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublic e Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
eMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Portland Cement 1g® lbs.
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 9� lbs.
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Slow pour Bentonite Pellets/Chips; Tremie Pipe
Portland Cement �� ����
4.Date well(s)abandoned:
5a.Well location:
Teague's Farm & Market NA '1 ,,"Cn PrncA^*rq UN;
eV
Facility/Owner Name Facility ID#(if applicable) 8.Certification: DWO CKV
8912 Pleasant Hill Church Road, Snow Camp, NC 27349 /4g*l A 0 '" `;�K
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Alamance 8757933722
By signing this form, I hereby certify that the ivell(s) ivas (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well'details:
35.876687593009216 N -79.47867456012426 You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: VE-1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 45 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 15.55 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 10c.For Water Suualy&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 well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 40 abandoned.
6g.Screen length(if known): 5 (ft.)
I '
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources. Revised 2-22-2016

•♦Lii A1JL'A1 1%"V1\1�11Jl\ 1 1\L' V V1W I For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathan D. Oldham, Jr. 7a.For Geoprobe/DPT or Closed Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW'-30 is needed. Indicate TOTAL NUMBER of
2889-A wells abandoned:
I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Pyramid Environmental & Engineering, P.C. FOR WATER SUPPLY WELLS'ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#:
List all applicable well construction permits(i.e. U/C,County,State, Variance,etc.)if known NA
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public S Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Portland Cement ORD" IbS.
❑Aquifer Storage and Recovery []Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite ISO IbS.
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
[]Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Slow pour Bentonite Pellets/Chips; Tremie Pipe
Portland Cement "'
4.Date well(s)abandoned:
Ir , �
5a.Well location:
Teague's Farm & Market NA - ---►a Pm-v M
Facility/Owner Name Facility ID#(if applicable) 8.CertiflC ion: FQVa'Q 30G
8912 Pleasant Hill Church Road, Snow Camp, NC 27349x4jo 4491),n_ A g— —�3
Physical Address,City,and Zip Signature of Certified ell ontractor or Well Owner Date
Alamance 8757933722
By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the ivell owner.
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.876687593009216 N -79.47867456012426 `I You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment,you can submit onefornt.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-14 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 30 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 4 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 15.55 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft) 10c.For Water Supply&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 10 (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

•♦L+Z.L. L a A it\1/V/1\lTii'J.L\1 1\iJti V1WV I For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathan D. Oldham, Jr. 7a.For Geoprobe/DPT or ClosedTLoop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on hisflier property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
2889-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of waterl remaining in well(s): (gal.)
Pyramid Environmental & Engineering, P.C. FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc)iflonown NA
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
FlMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Portland Cement lbs.
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite sS IbS.
❑Experimental Technology ❑Subsidence Control 7g,provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Slow pour Bentonite Pellets/Chips; Tremie Pipe
Portland Cement ;; �.�, -aI Ar.r%
4.Date well(s)abandoned: ,
e �,• lrV L.
5a.Well location:
Teague's Farm & Market NA
Facility/Owner Name Facility ID#(if applicable) 8.Certification: pWOOOG
8912 Pleasant Hill Church Road, Snow Camp, NC 27349 ��� `✓� o g'
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Alamance 8757933722
By signing this form, I hereby certify that the tve11(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field,one lattlong is sufficient) 9.Site diagram or additional well details:
35.876687593009216 N -79.47867456012426 `l You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MWA 1, 12, & 13 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 * 3 = 105 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 15.05 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 10c.For Water Supply&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 10 (ft.) abandoned.
6g.Screen length(if known): 25
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

♦♦JLJAJJJ A1JA1\L V 1\lyxxi 1\ 1 1\L' V V1W For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathan D. Oldham, Jr. 7a.For Geoprobe/DPT or Closed7Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW'-30 is needed. Indicate TOTAL NUMBER of
2889-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water,remaining in well(s): (gal.)
Pyramid Environmental & Engineering, P.C. FOR WATER SUPPLY WELLS,ONLY:
Company Name NA
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e. UIC,County,State, Variance,etc)iflonown
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7L For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Portland Cement lbs.
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite ' lbs.
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geotherma](Heating/CoolingReturn) ❑Other(explain under 7g) Slow pour Bentonite Pellets/Chips; Tremie Pipe
Q' C� �7 � Portland Cement
4.Date well(s)abandoned: y �/ lam c u ""i VELr)
5a.Well location: AUG 1 8 2021
Teague's Farm & Market NA ll
8.Certificati E11�ie1t7""w},"/D' EOM t
Facility/Owner Name Facility ID#(if applicable) �(,{�?
8912 Pleasant Hill Church Road, Snow Camp, NC 27349 o g`�3
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Alamance 8757933722
By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance ivith 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one fat/long is sufficient) 9.Site diagram or additional well details:
35.876687593009216 N -79.47867456012426 `I You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable. For multiple injection or non-water supply wells
ONLY with the scone constuction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-10 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 27 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above, also'submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 15.55 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft) 10c.For Water Suooly&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 7 (ft.) abandoned.
i
6g.Screen length(if known): 20
i
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

rV L' LL 2yLL'il14IJV114Iyii U111 1 R D.I.Vitt/ I For Internal Use ONLY: I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathan D. Oldham, Jr. 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
2889-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Pyramid Environmental & Engineering, P.C. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: NA
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)iflarown NA
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public S Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount�of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Portland Cement gV lbs.
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Bentonite :2-6 lbs.
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Slow pour Bentonite Pellets/Chips; Tremie Pipe
Portland Cement
4.Date well(s)abandoned: 3 t % %.#Lw I IVC LJ
5a.Well location: AUG1 8 2023
Teague's Farm & Market NA I1h,%rinaUcin Pr^c�eil•,t9 U>k
Facility/Owner Name Facility ID#(if applicable) 8.Certi6ca'on: 0)f+'Q1J4t^n
8912 Pleasant Hill Church Road, Snow Camp, NC 273491. ��2�
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Alamance 8757933722
By signing this form, I hereby certify That the tivell(s) teas (tivere) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.876687593009216 N -79.47867456012426 `1 You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable. Formultiple injection ornon-watersupplywells
ONLY with the saute constntclion/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-1, 2, 3, 8, & 9 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 20 * 5 = 100 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 15.05 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known):
NA (ft.) 10c.For Water Suuoly&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 5 (ft.) abandoned.
6g.Screen length(if known): 15 (ft.)
i
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

♦t L'JJiJ ALAI\"TLY1\1T11J1\ A ltUt.%11W I For Internal Use ONLY: I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathan D. Oldham, Jr. 7a.For Geoprobe/DPT or Closed Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
2889-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water]remaining in well(s): (gal.)
Pyramid Environmental & Engineering, P.C. FOR WATER SUPPLY WELLS ONLY:
Company Name NA
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.U/C,County,Slate,Variance,etc)ifknown NA
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
FlMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
[]Aquifer Recharge ❑GroundwaterRemediation Portland Cement IbS.
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Bentonite �v IbS.
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer
7g.Provide a brief description oft'he abandonment procedure:
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Slow pour Bentonite Pllets/Chips; Tremie Pipe
Portland Cement .� �g—
4.Date well(s)abandoned:
5a.Well location: AUG ZVZ3
Teague's Farm & Market NA nfur r,"C,%�r:*anaa ,1
Facility/Owner Name Facility ID#(if applicable) 8.Certificatio : DIRt Q130G
8912 Pleasant Hill Church Road, Snow Camp, NC 27349Z�14W
Physical Address,City,and Zip tigKature of Certified Well Contractor or Well Owner Date
Alamance 8757933722
By signing this form, I hereby certify that the tvell(s) leas (tivere) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.01,00 or 2C.0200 Well Construction Standards
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the ivell owner.
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.876687593009216 N -79.47867456012426 N You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-4, 5, 6, & 7 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 25 *4 = 100 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 15.35 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
1
6e.Outer casing length(if known): NA (ft.) loc.For Water Supply&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
611 Inner casing/tubing length(if known): 10 (ft.) abandoned.
6g.Screen length(if known): 15 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016