WQ0043421_Well Abandonment Record(s) (GW-30)_20231206

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Letter of Transmittal
Date: November 10, 2023
Project No: 213887A phase 430
From: Gary Simcox
To: Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
Attn: Information Processing Unit
Copy to: From:
S&ME Inc.
8646 West Market St. Suite 105
Greensboro, NC 27409
Subject: Abandonment records for Shinnville Road/Nest Communities monitoring wells.
Transmitted via United States Postal Service
First Class X Overnight Hand Other
Mail Express Delivery
Remarks:
1

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Gary Simcox
Well Contractor Name (or well owner personally abandoning well on his/her property)
2944-B
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitorine ❑Recovery
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned. 1 0/30/23
5a. Well location:
Nest Communities
Facility/Owner Name Facility ID# (if applicable)
640 Shinnville Road, Mooresville, NC
Physical Address, City, and Zip
Iredell
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
350 39' 02.68" N 800 48' 05.99" W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: MW-2
6b. Total well depth: 43.3 (ft.)
6c. Borehole diameter: 2 (in.)
6d. Water level below ground surface: Dry
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout S Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
❑ Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
65 Ibs
7g. Provide a brief description of the abandonment procedure:
Removed concrete pad and protective cover.
Filled well casing with bentonite chips to surface.
Hydrated bentonite.
8. Certification:
11 /10/23
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For 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,
1636 Mail Service Center, Raleigh, NC 27699-1636
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
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Gary Simcox
Well Contractor Name (or well owner personally abandoning well on his/her property)
2944-B
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitorine ❑Recovery
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned. 1 0/30/23
5a. Well location:
Nest Communities
Facility/Owner Name Facility ID# (if applicable)
640 Shinnville Road, Mooresville, NC
Physical Address, City, and Zip
Iredell
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
350 39' 01.49" N 800 48' 08.72" W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: MW-3
6b. Total well depth: 43.2 (ft.)
6c. Borehole diameter: 2 (in.)
6d. Water level below ground surface: 42.19 ft.)
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): '2 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout S Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
❑ Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
65 Ibs
7g. Provide a brief description of the abandonment procedure:
Removed concrete pad and protective cover.
Filled well casing with bentonite chips to surface.
Hydrated bentonite.
8. Certification:
11 /10/23
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For 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,
1636 Mail Service Center, Raleigh, NC 27699-1636
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
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Gary Simcox
Well Contractor Name (or well owner personally abandoning well on his/her property)
2944-B
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitorine ❑Recovery
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned. 1 0/30/23
5a. Well location:
Nest Communities
Facility/Owner Name Facility ID# (if applicable)
640 Shinnville Road, Mooresville, NC
Physical Address, City, and Zip
Iredell
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
350 38' 58.52" N 800 47' 46.88" W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: MW-7
6b. Total well depth: 52.5 (ft.)
6c. Borehole diameter: 2 (in.)
6d. Water level below ground surface: Dry
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout S Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
❑ Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
75 Ibs
7g. Provide a brief description of the abandonment procedure:
Removed concrete pad and protective cover.
Filled well casing with bentonite chips to surface.
Hydrated bentonite.
8. Certification:
11 /10/23
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For 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,
1636 Mail Service Center, Raleigh, NC 27699-1636
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
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Gary Simcox
Well Contractor Name (or well owner personally abandoning well on his/her property)
2944-B
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitorine ❑Recovery
El Aquifer Recharge
❑Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
El Other (explain under 7g)
4. Date well(s) abandoned. 1 0/30/23
5a. Well location:
Nest Communities
Facility/Owner Name Facility ID# (if applicable)
640 Shinnville Road, Mooresville, NC
Physical Address, City, and Zip
Iredell
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
350 39' 01.47" N 800 48' 04.81 " W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: MW-1 0
6b. Total well depth: 42.6 (ft.)
6c. Borehole diameter: 2 (in.)
6d. Water level below ground surface: 32.91
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned: 7b. Approximate volume of water remaining in well(s): 1 .5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout S Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
❑ Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
65 Ibs
7g. Provide a brief description of the abandonment procedure:
Removed concrete pad and protective cover.
Filled well casing with bentonite chips to surface.
Hydrated bentonite.
8. Certification:
11 /10/23
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For 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,
1636 Mail Service Center, Raleigh, NC 27699-1636
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
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

December 1, 2023
NCDEQ, Division of Water Resources
Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC, 27699-1617
Attention: Mr. Zachary J. Mega, Environmental Engineer III
Transmitted by email to: [e-mail]
Reference: Notice of Improper Well Abandonment
Shinn Village WWTF Permit No. WQ0043421
Shinn Village WWTF, Iredell County, North Carolina
S&ME Project No. 213887A
Dear Mr. Mega:
On behalf of Shinnville Farms Development Partners, LLC, S&ME, Inc. (S&ME) submits this letter to document the
unintended improper well abandonment of monitoring well MW-4 associated with Permit No. WQ0043421. S&ME
was contracted by Shinnville Farms Development Partners, LLC to abandon monitoring wells MW-2, MW-3, MW-4,
MW-7, and MW-10 at the above reference site. On October 30, 2023, S&ME properly abandoned the listed
monitoring wells, except for well MW-4. S&ME's certified well driller was not able to locate well MW-4 for
abandonment. Based on site observations, it appeared that the well was demolished during site grading activities
associated with the construction of the new WWTF. Accordingly, well MW-4 was inadvertently improperly
abandoned by others. This letter was prepared to document this finding for Permit No. WQ0043421.
Closure
If you have any questions regarding this request, please contact the undersigned.
Sincerely,
S&ME, Inc.
Edmund Q.B. Henriques, L.G.
Principal Geologist
[e-mail]
Copy: David Hughes, Shinnville Farms Development Partners, Manager [e-mail]
Thomas Perdue, MacConnell & Associates, PC, [e-mail]
S&ME, Inc. 18646 W Market St, Ste 105 1 Greensboro, NC 27409 1 p 336.288.7180 1 www.smeinc.com