Brunswick_Well Abandonment_20231113 (6)

WELL-ABANDONMENT, RECORD Fat lmcmnlUq;ONO%,
This faitn.rahW u ed,kv single or mulliptew-'alls'
1.Well Cantric6r tirotmation: FLLABAND ONRIEN6'imirA1GS
Stefan Smith. 7a,Number o(wells being abandaitl.1 1
tVelCCoutractorrana�(ortc�tlotvicr rSoii�lly:il:ain4grilneaetlonlitsil xvyp ticoaYl For inlrlirple Myertar to; "rwrJ-nelierl �rpp� aell3 ONLY Wth r1� .srurfe.
. cav�xfrnctriNi'rv+arrdnuirrJr�,t,1rlUctiui sratvrlrt lure frrnrL
3576A,
NC WO Comtai iarG:tiifi2nliou NtinLaci A.Approximate t'alame of watts re laitdtkg in bell( <l
SAEDACCo FOR.-NV►TER.SUPPLY Wi u-50NIII,Y:.
Coti�tatt}'.hams' 7c.Type 6fAsWketaltQ tiled.-None '
�.ilfialtCousttuctiun Pcrarlt t(:
LW al vj{{"f ile uep,rx. ff. C�wrrht SICra;4'urJiYrrt.11yea?iUle,.a1c J gj krmu'fr Wp,.; Utttlt Uf dLtillltcctstltt ttst4i:•
3:�Ir'dL'u•_r(di�d:n'i•Il ufie}s - } -
bVsuer Supply,Well: v.Sealiitg ntatedals:tised(chcc[;all tlt;tt annly)�
O ftedcal4tr l le t Of Mlets
Cl Ueothem at(Hcptinnicoolina Supply} 171tcsidettiinl Watcr Supply(singlo) P-Sitnd Cetttent Gltiut D'Dq
OhJdustriallComtncicia) ORrsidential Water Supply-(shared). D Gonerete'Grout !; ❑ DrilKittUit
❑irii tioo b Specialt}brunt �;Grnrel
Kurt-Water Su_ltply�yca. - C1 6ettfoaite Slttitp D Otl><r(explain antler 7gj.
i lmonitorine 131tecoverl' ! .
injcFvan Well. 7f For each tuatmial seected ahavet,pratide antouni'ormiaterials Used:
�r�i(uiferltecharQe Cicia, nlnlierRente_diWon Neat Cem..:941b ,Wtr:7gal. - Sand Cem.:lb ,Wtr:gal.
DAyttife Sto_taieaid_Reciweiv DSalinify©anter:
Wtr:gal.
❑Agnifet Test. DStointtt'ater ll'ntinagy Bentonite.:31b ,---.----
DE gritn2dhtl Cacltuologti DStibsidet>Le CalNrtf) ?g,Frn�;dc a hricf d ccrinEiati of thc':t1►Oatlunmcat prt cWun:
OGgedwa nl(Closed Loopt M.D.acer
Pulled entire well and pressure grouted bore using Portland
OGeothemiat(Hca(in 'iCootiif Rctutu)_ _00(herl_es lain under 7n_y
cement and bentonite groutI
J.°DatcWet!(s}.aliandrincd; 1.0-17-23
_NU
Sa.Well tucattnn: V 1 = 073
ExxonMobil
Cucilitj�'On�ttirNnit?c Fa;illtylDN(iE'Spplicalilcl t�.,,,,,a„•,,,3
1515 River Road SE.Leland, 28479 10/26/2023
Phi'sical'Address.City,and Zip pale
Brunswick . f�v cr uing llrls/vrnt, f havhy+cerdo,' of the ireN{sf was(trere)r bandonad.in
(outlay' Marcel Idcntirteiilnnxo'.(PIN) 66ccrirhiucc with'1SR l4CAC b C;(i,!t or'2C.0200 MW16 diakllun 5fduAttcls
-and!Part v ebpa,af'tlrisresurd Jras baeit.L r-6W*Jrta tlto.ii"eN otrser.-
••Sh.-1_•ttitadc aad lnngitutta in dcgecr,�latintttrd�Jsccnnds nr ttscim;tl c[sgrccs: - ;.,
(ifdell£slut! r�lx.t Jdloug:ts 4�fflcfet>A? 9.Site diagram or addittonal wcH details:
Y©u tuayttsa tls~uacfi'of sluts pag8 to:{iru��ide.�additipiut[is�u site.detdils or�t�ell
34.181720 . . * 77,988742 ,
h %V :a6auddimteludetails; xioutuvyalsoaltacltuctilitiomtl'pagLs;ifiteCi�San.
CONCTRIM LONE TA►IIV4OFR+ELiA11 1ONe ABANDONED. S[iBM1f1iTT1t.IIVSTRLTQ"FTONS
:lttQrh tfirP�trrrstrirt'tkrn rraiur!(sJ Jj'miuilnbFe, ,17�r irtytnple irrteuuie.ril�'rwn-vwrer;rufpM .
nxttiOYCt',rlrfrZow ertnrt!trrrcttrs?rlenu riGarreharrridral,j�n c :a 3ii +rrtJ�irre iGlnrr 10a. FatAll Wflc: Stthtnit'tl> to nittdn 30 daV sof eduiFlctian of Hell
6ti Well @#•MW4 abatidoatncut wthe fallowing: ;
131visinn of Water Re sources,tnfontuidon Prdiq..sinvrnit,.
14.38 1G1'riil S&%ice Center Raldgh,NC 27699-1617
6U:Total well deptU: (ft.} 171)
10b.Fnr fnlcet&ttt_ti'ells; In hdditiou-to setiditig Uie fora to the a9dt'dss fit 10a
6e.•Bomltole diantetw. so submit otie copy of this form'i0fi it 30 days a' cone'let(oo of rrall
iiu. abaadoutncut to thC,falh]tti'ing: j
j
Gil.Watcrlc«l'.hctOty�tritttttt'sttrlaccd 4 (ft.} mistott of\Wmtcr Resources,Updet nitiftd lnlectlon Coiittvl Program, .
b• W4 Mail Scrtiicc d~cntrr,Ralci„tr,RC 27699-1G3G
GG fluter casin It tfflman n):: 4:3 (ft) !t)c Fn «`:}ter, mnh.,Cr 6r Minn R'u.11a: fit addition to sending the fonu-to
g: ( the addwss(e,) above, also subunit one copy of this fbmt within 30 day of
comptctionvof lull aband6umant to the16unty health dcpartnieid of(he couNp
6f.!Hoer utsim•„Jtabin;;tcngth(if lanown): (ft.)
wltctc abando*d, t
6g:Scram length(if latomt n):10 00
Fart GW-50 NOM1, atollm Dctnnnxm of eadronrncnt at-d Nautuat L csotgres-Dlvlsloatof 1VatcrRijuurte s MEW August 2013

� i
WELLABANDONMENT RECORD Fat Intatmitix ONLY
:.
' Thi�,foint can be used:foQ singEo or:tnuliip[ rs�lls: � '
• I
1.We'll.O_antractar lneormapictr �NELt.,ABANDONhIFNT I)FTAILS
Stefan Smith let YatniterafncUsbiidy;aitirndonld:iI
lt'e1t'CotirictorNau*6rwzlloaciei`IS91 t',d1b>AIa aeu.on1,94r.;0 .n For irarltiple rrileelf0m 6r im uett . �tr,� - velb ONLY will) He wave
1� S' �e p ix Y I l�
a vVaYr�rrcnix,,�n5ritalrxtruer r,1r,rt cevr sr;lvitrr WORM,
3576A
NC\VcltConUa2larC.httificnlionNritrber 7b.Appnisiivatcrnlameafrrnttrae iniieginiiell{
SAEDACCO FOR:�Yr1TE:RSUPPI.Y`�'GGI S`tDND:iI'::
C4nVanyNarnc. 7c•Type6f t Worie6itt used:None;,
2;Mit'Consttuctlon Permit t#:. 1
I tsf ir11 d vpfitv9li nrH lanrt rr ri..,C.(Zs.See m;ai•Jar e,byee im;ate l y firnjtvrt
7d:,lmount oCtllslnfcctant ttsexl:
3:Wdl asr(check W L41 uNO.
Mater SappW Well: Vie.Sealing rietitcoial�:tiscd(chccl:all Elr;tt a�plY?:
L7Agticultrttat I]h4tmiciptlli't�blie. W Neat Cenicai.G*m'it M l3CMonitethiiis6fNllets
ElGeotkmat(HcatinWtooUng$uppky) 17R2csid6t4nt Water Supp4-(sin rlaj a Sid.Cetitt,nt Gmut n biy Clay
❑Induitrial/Commcicial, ElRrsidetttial Waucr Sttppl}(slttund) Cl Cbncixte Grout �' E3 6611 Curtin
T7hri flan O Specialty Grunt O Gravel
ironWa ter SoVPty-NYC R: - C1 EtentouiteSNEry I. 0 Otlier(e.`)iltiin under 7g)
1&Mntiilndirg I7Rc�at�rn '
iajGction�YcU; 7f For each tuatctial idecUd abovci prmridc amoaat-ottuaterials'used:
❑Aijaifer:RtctiarF;c ❑Gtotmdty;tlerRenletiiatiott Neat' Cem.:94lb ,Wtr:7gal'. Sand Cem.:lb ,Wtr:gal.
t]Agleifcr Starii>;e'arxF.Rccbren I7Saliitity©artier.
Bentonite.:31b ,Wtr:gal.
D'Agetifet Test- I7Slonu}rater�'tuiaaga; -- - _ — _ - _
DE reri iintstog, L7S►ilisitletb e Coitlnil 77 Proiide a brief description of'tltc abandnnnrcat pitii&�dar:.
Motliaunat(Closcd:l:oop) MTmcer 1.
Pulled entire well and Pressure grouted bore using Portland
t7Ceothc-nwt<ftca6ow'CoolinaRc(um) OOth AEN( laittuodec7r) _
cement and bentonite grout,
1.'Oatase•clf(sj.nlraniltinccl; 10-17-23
Sa.Well tucation:
ExxonMobil
t3.Ct rtiRedtiaa: i L° a':;`�'.31s
Fu<iiiij/t7tvt>vr Nait>c - Fa:ility lDAl(it;tppRi;.,tiio) ,
1815 River Road SE Leland, 28479 -•_�. 10/26/2023
Fkysical-M&rss City,andti me C.edit3edWat(OntrrXnrurfVCff.tl.crr Uwe
Brunswick Hy:signing IW fgrur, i lrcawby cerdfyy fhnl Om u•allp?) wax(tare).ahandoned in
COW)' Nrcel (PIN) 6CCu ltil ii ivillr i$e€ w�lG O?C,arQ.a,'Ur at'.O.aIJ Rrc1l CorksliaicliUrr Shirtiktfrfs
arserilrrrt.acgpj c+fltrisrecvrc3lrtxsbcett.pmt zeclloYka:ti+edlourles
Sk[attitude and Inkltude I►t clMcolhiiaaieAcconds ot•,dccitila ¢ebmcca: 1.
(df.vcn ratA,otx kiUlo+ta is tttieicp) 9.Sito diagram or'additionat Writ detAts:
You cua}•.use tlk.back of this page tu'{iron tde•additional hell site:details or well
34.181726 �* 77..988558 {{+. :aliittdottuterttdetaila. V;06tt6 also attai:ltaitditioualpagcs"iftkc li}'_"
coNC'PRItC'i 6k OETAl1.S OF WELLlS)'BEINGG A®AiNDONED
SuRnlrrTAr,ilvs't-rzLra�elovs
:kfr-rsmelltry stritckidrirmritsl-tral ilwrFe. •heiramiltlpleiteryluie,er,M.jn;uwhr.aulplr
+1, 001MLYntU'tnce Ittar: Far All-Wells: Sttbtriil dti5 form tiithin 30 days of completion of well
61L LYcit(v#..MW5 abtindoamcnf to the fall�rvirtg;
Disusian,pf Water Rmonrc i,(nformation-Pi teeming Unit,
(ft:y
1617 A(ail Seisicc Centel;Raleigh.Nt 27G99-1G17
61t:Total iv ell depth: 14
dflb.i�nr inlcYtiatt WcIIs: In addition-to cettdittg tip(otnt io ttte addt�ss•in.FOa.
6c 6atYltolediantcter:2 abam atsa sub it one'colmof this foam midiit'3tl days of tantpteiion of well
(u:} abatidoniftcat to Rite falldrr•i
tt0.�Yatcr tcrr�l:bcton•Srti►ttrieG surfat:c 4 (ft.) i?h�1sU1n of�Vaitcr li�iltic�ec4,[Indcr);round iiijectlou Cotite+�I Ptrogram, .
Ici34 mail Scntiicc t~caier;Ralci„b, X.27699-1636
Gc.flatcr.raiing ieb(ifflairttrrYt); 4 . (f3 j IOc,rue tVarer •i t 1h aC In straa BM: In addition ttiadin the fomt_to
the addresses) above. also sabalii one copy of this flint Within, 30 days of
campletiari'of tvctl abaitslaruncent m(tic county hLirlth department of the comno
'6f.[utter casifi rvh al)tnalottcd,
alnrbutn„ftyry�tii(it_Lara}y"n):
6k Scr&n length((fknott ):10
Fotnt M1.10 Nonli Carotim Depannl:ul df Etu•irotmtcnt and Natal ltcso=cs-Division of Water k6a=+s Revised Angusa 20 t3
I

WELL-ADANDONMENT RECORD For.ltrlc 0l3scONLY",
ltics;tprnt.can�eused:fitsinatzortuultip[ rF�[[s"
1.Wctt.Cantraciv' rInformatiow Wt LLARANDt)1VhIENFDETA6r5
Stefan Smith 7a,Number t►f�vclls bciu);ubundotletOs 1
11'clCCatitattorNmnM(ortt.![owtxr{iCrtoriall�:ilt5iatanWotiiaU.on9d511ritprulcnyl �N fiVW,(ple. hiferttar iu� r&rrt-imer` siynj+lj' ue& ONILY W1b t,'.e sturre
• E4N1yrMctAW14, :VN�tr Wk,?if,tYJNGSIR�StilNrll�cJrefirn6
3576A.
7b.A tt►xi;nate t'itittine of rrottr I ntuining i0�1ell
(s. •
NC\Veil Conlractorl:cnifii4ilinu Niinabci pp. I {. .. .1 (h;tL)
SAEDACco FOR.WATFiRSUPPi,Y� ELE.SONIIY..
Con$±attyNattrc - - f
7c.Tj'pe 6fdisinfititaiii t6,B;None .
2:Wick Construction Permit fd:, P
11sr i l rrji lKvB!¢it elllarmlfs�.i,C—A,S1a1e:Mrjdree.luJeNlnr,.rtc J,tJ6'ert�u{� 7 -Am6aut of distafeciaut used:
3:Wdi use.(chgctn'�91 use}: -. 'i
Water Suppl:AVetl: 7•c.:Scaling tilatc(ials:ust d(eicel,-'all,Ghat apply):
l7A�tic»IhrrtE t]14iitnicip.tlAPttblic Ud Nc ti Ccnlci(t Grout Q Hctuonitc Chips or Pellets
C1Crcnth ln�l(H¢a(ii►GICo�?bnr;'$upply} l7ltosidmial Water Suppl}.(single) '. 13 Sand Ccntcin Grout I; 13 my Clay•
❑luduSlriallConimcreial EIRWdentiat Water Supply(s!>aml)• E3 ConrceteGront ❑ DrillC\tltin�s
❑hd tioo -13 SpeciirttyGrouf :17 Ci:n'el
itaa AYatrr Sulrpiy%VCII: i, CI Other(explain under 7g)
�Mdniforiite: t7Ri�ot'en'
to jcetictn X For each tuarerlal selected abovoc prntide antountoCtuatciials used:
❑AquiferRccftaQa DCitiiuttdi}aterRented'wtion Neat Cem..:941b ,Wtr:7gal. !; Sand Cem.:1b ,Wtr:gal:
Oaquifer Storitge,i d Rerovrn, t7Suhnt(p Darner I .
Bentohite.:31b ,Wtr:gal.
I7AgniferTrs! t7Slomncitter©nsin:igc. .
17@y>rtiati'ultil TaclCuo[o i DSti 4de-we.Coninil ?h;Proiidc"a brief desCr Otion of dkiliandonment pniccdur
C3Gwedwrinal(Closcd,Loop) rjTracer
0Gcother►t l 11 tHtnEinl CooliDgRcturn) 00(tterle:s Iainuuder.7E}
Pulled entire well and pressure grouted bore using Portland
cement,and•bentonite grout':,
3.'patci`di0.:61►andrincd; 10-17-23 ep f;..., .o
Sa.Well Watlon: i N n V
ExsoiiMobil
FactlitjlQnncrlVaiec FacilflvlDY(t6ppliGiblc) 8.Certilicigah". is`. UrA .
1515 River Road SE-Leland, 28479 _ 7_
I' 10/26/2023
F1tvsical Addfcs,City;acid Zip 5 ---b..COMWV4110c ii rlor or Well 01+rr:r l7 ue
fil+,vigntng Phts fgrtrr, I hal-My cerhfy•llrat llae u'e11{'aJ erac(here}rrhturdar>er!in
Cautiij' I rccl WcalitayijlnrrTfo•(11N) tralr I i'A e1��IG(1a ,dlda,ur 3C.6200(Irelf�viiti7i�C1(urr Starrikrr4rs
agdllratacapl�o•ff1ti;rcc rdI=been,p,m, ewd-fa
Sh.Utitti4c and igngitude in dc*a1in[n({ttwl3cegnds nr dbcisiud degrees:
(it ttcll fibt 1,prd t trllnng tsoytlticicrtt) 9.Situ diagram or addidonal well desalts:
You.may,lise ti c:bkk of dris page to,pro(ido.'additional%id site.derails•or NMI
.34.181395. .. N .77.9.88662 tiY. ..tlanud0 ine►itdeto[Is. 1'oiiuto5':t[so ullcltatjdiiiot,af gesiflkussarl'_
CON§fi RUCTION bl TAILti(iN WiKU-M U?ilN"(-ADANIIibNIFD- SUlillti iTAi.iNSTRITQ r lOi`IS.
:tllaeh i4P 6ow-nkYfpn rtnurdlo If aiWw'hL„Rvd mvltlple it jecrioll rir7miniimur aulplp
rie11.cO1�LYiiJfLrlwsvrir<racitrntiiioinrrGareslur,rrl�naRjenclro:c hwirsurefuran f0t:For All h4cl1c• Stt6mit tlr fatrir within 30 da}s ofcatnplction of u-ell
-dlt, yell®N MWii mba❑doamcatt to•thGfollowing;
Dk siou of Water!Resources,Information PrOwainl;Unit,
GU:TYten!ecel!delttlr. 12 (�.1.
tGl7 hlriil Scn�ce Ccnfei,Ilalei�■fi,IQC 2;699-I6t7
10b.-:or intc'ct(an-Wcllr: hi addi(ion:to odittg(IIe'fornt•'ro the address[it 103
fee Rur+eltole diameter.2 (n;y above.also subnilt one ebpy of[his fo-I l;witleiit 34 di{}'s.of cotnptetion,of.well
ubaulloumett(td We.falldivirtg-:
AL Water fcvd'.bctrin 4 I}lvisZoa of lVmtcr Rcclitirrc�;Ifirder�rvund LtijectiagCotittvl Progr lru.
grnuritl strrfaca; (ft:) i63Cn MwI Scevirx lrcntee,'iWaghl NC x3699-1i63e
6c,outer casing lcagth-gIMotru). 9 (ft,) IQc rnr Warr S!m t'..0 iniccNnn l`e1GA_ In addigon ld sending the fomr to
tite.'addWSSOS) above. also-subn_tit bue copy of this.ibmt withiii 30 days of
completion Pf well aband n mcnt to the tcoinuy heafth departniniit of the county
where abatxlo�icd,
Gf.Inner cayinr;JttebiaR Cut}■tii(if laiusYn):
Gg.Screw Icu(th(If(oiou n):10
Farm G%W-10 net't ed Aagutr 201_t
I
Y.