Currituck_Well Abandonment_20231228 (4)

WELL ABANDONMENT RECORD For Internal Use ONLY:
i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Michael Young 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
2370A wells abandoned: I�
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Fishburne Drilling Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(r.e.UIC County,State Variance,etc.)ifknawn
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'; �., ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout, �� 3 Bra,C�y
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout C ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout DC C 2 r 8 2023Gravel
Non-Water Supply Well: ❑Bentonite Slun*lfr)ffr"jen aroc. 0 O (explain under 7g)
RMonitoring ❑Recovery P�k'Qf
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation water 37 gallons Bentonite 20 pounds
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage cement 47 pounds
❑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) Mixed grout, lowered tremie pipe to the bottom
of the well, pumped grout thru trremie piupe to the bottom
4.Date well(s)abandoned: 11-27-2023 of the well to the surface, removed tremie pipe
5a.Well location: topped off grout, removed well cover, cement patch
Academi
Facility/Owner Name Facility ID#(if applicable) 8.Certifl
850 Puddin Ridge Rd. Moyock, NC. ce, 12-13-02023
Physical Address,City,and Zip Signature of Certified ell Contractor or ell Owner Date
Currituck By signing this form, I hereby c fy 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 well owner.
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well;details:
36.461789 N -76.202749 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 WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS !
Attach well construction record(s)ifavailable.Formultiple injection or non-watersupply wells
ONLY with the same curestructionlabandonment,you can submit one form.
10a. For All Wells: Submit this'form within 30 days of completion of well
6a.Well ID#• M W-2 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 10 (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 8 (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: (N Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 276994636
6e.Outer casing length(if known): (ft-) 10c.For Water Sunuly&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 cotinty health department of the county where
6f.Inner casing/tubing length(if known): 2.5 (ft.) abandoned.
6g.Screen length(if known): 7.5 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

I
WELL ABANDONMENT RECORD For Internal Use ONLY: j
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Michael Young 7a.For Geoprobe/DPT or Closed-LI op 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
2370A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Fishburne Drilling Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name
7a Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well constructionpermits(i.e.UIC,County,State,Variance,etc.)iflmown
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 Grog "c I1,9entonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout rry lay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout QE A 8' 20� Drill Cuttings
❑hri ation ❑ Specialty Grout 4 Gravel
Non-Water Supply Well: ❑Bentonite SlOOfomueil Prt:t,9p er'(explain under 7g)
eMonitoring ❑Recovery io�a
Injection Well: X For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation water 37 gallons Bentonite 20 pounds
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage cement 47 pounds
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
[]Geothermal(Closed Loop) []Tracer Mixed grout, lowered tremie pipe to the bottom
❑Geothermal(Heating/Cooling Retum) ❑Other(explain under 7g)
of the well, pumped grout thru trremie piupe to the bottom
4.Date well(s)abandoned: 11-27-2023 of the well to the surface, removed tremie pipe
5a.Well location: topped'off grout, removed well cover, cement patch
Academi
Facility/Owner Name Facility ID#(if applicable) 8.Certification r
850 Puddin Ridge Rd. Moyock, NC. 12-13-02023
Physical Address,City,and Zip Signature of Certified Well Contractor or We wner Date
Currituck By signing this form, I hereby ce fy t at the well(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C. 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:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.461745 N -76.202666 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 WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction records)ifavailable.Formultiple injection or non-watersupply wells
ONLY with the same construction/abandonment,you can submit oneform.
10a. For All Wells: Submit this,form within 30 days of completion of well
6a.Well ID#• D M W-1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 25 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Inieetion 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:
I
6d.Water level below ground surface: (fw) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (fL)18 10c.For Water Supply&Inieetion 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): 20 (ft) abandoned.
6g.Screen length Cif known): 5 00
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Michael Young 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 130 is needed. Indicate TOTAL NUMBER of
2370A - wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water;remaining in well(s): (gal.)
Fishburne Drilling Inc. FOR WATER SUPPLY WELLS;ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit M
List all applicable well construction permits(r.e.UIC,County,State,Variance,etc.)ifknown
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 Ce: cut^ _ ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cemep 'out % /E D Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Groutn ❑Drill Cuttings
❑Irri ation ❑ SpecialtyGrouNEC 2 8 2023 ❑Gravel
Non-Water Supply Well: ❑Bentonite 1 - ❑Other(explain under 7g)
eMonitoring ❑Recovery Jen Procas"11RX
Injection Well: 7f.For each materia SGQ� e,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation water 37 gallons Bentonite 20 pounds
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage
cement 47 pounds
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/CoolingReturn) ❑Other(explain under 7g) Mixed grout, lowered tremie pipe to the bottom
of the well, pumped grout,thru trremie piupe to the bottom
4.Date well(s)abandoned: 11-27-2023 of the well to the surface, removed tremie pipe
5a.Well location: topped off grout, removed well cover, cement patch
Academi
Facility/Owner Name Facility ID#(if applicable) 8.Certitica
850 Puddin Ridge Rd. Moyock, NC. 12-13-02023
Physical Address,City,and Zip Signature of Certified Well Contra:�rify
Well Owner Date
Currituck By signing this form,I hereb that the well(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15.4 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:
(ifwell field,one lattlong is sufficient) 9.Site diagram or additional well details:
36.461745 N -76.202666 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 WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)tfavailable.For multiple injection or non-watersupply wells
ONLY with the same constructionlabandonment you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#• M W-1 abandonment to the-following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 10 (%) 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• 8 (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: (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (fL) 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): 2•5 (ft.) abandoned.
6g.Screen length(if known): 7`5 (%)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

I
WELL ABANDONMENT RECORD For Internal Use ONLY: !
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Michael Young 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-3i0 is needed. Indicate TOTAL NUMBER of
2370A wells abandoned:
i
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Fishburne Drilling Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(4e.UIC,County,State,Variance,etc.)iflmown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaVPublic a Neat Cement Grout ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Ce Grm a 'q Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Gro?Ut3--�Cl Drill Cuttings
❑hri ation ❑ Specialty Gro'b g 2U23 ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
RMonitoring ❑Recovery c•gB r7S ng ul&
Injection Well: 7f.For eaclit ena 1 c a uve,provide amount of materials used:
[]Aquifer Recharge ❑GroundwaterRemediation water 37 gallons Bentonite 20 pounds
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
cement 47 pounds
❑Experimental Technology ❑Subsidence Control 7g•Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/CoolingReturn) ❑Other(explain under 7g) Mixed grout, lowered tremie pipe to the bottom
of the well, pumped grout thru trremie piupe to the bottom
a.Date well(s)abandoned: 1 1-27-2023 of the well to the surface, removed tremie pipe
5a.Well location: topped off grout, removed'well cover, cement patch
Academi
Facility/Owner Name Facility ID#(if applicable) S.Certification: .
850 Puddin Ridge Rd. Moyock, NC. 12-13-02023
Physical Address,City,and Zip Signature of Certified Well Contractor or We er Date
Currituck B signing this form,I hereby c , th the wells was were abandoned in
y � g 1' y ,fy, l J ( )
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C. 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:
(ifwell field,one latllong is sufficient) 9.Site diagram or additional well details:.
36.461551 N —76.202522 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 WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable.Formultiple injection or non-watersupply 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#• M V p`p'—7 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 10 00 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• 8 (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 (ft,) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (fL) 10c.For Water Supply&Infection Wells: In addition to sending the form to the
addresses)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): 2.5 (ft.) abandoned.
6g.Screen length(if known): 7.5 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

Q � ..i1 ►
r � �
/r !j
r+ P
r'r
�•�
IF
44
N A` W
O
O
e' Ln
i1M`v` ., _..
l '

m a6pi�l uiPPnd.
n �
m - - -
iT
��
do c.
C�
ov
Ln
cn
?iV
Cn
M�
Sk
C
7 1

�� ..
a � e
r
.01
AML
aF
Q.
LEGEND
® Previous Temporary Monitoring Well Associated with Impacts
aProposed "Shallow"Monitoring Well Location
Proposed "Deep" Monitoring Well Location
• Pro
;r FIGURE 2
= PROPOSED MONITORING WELL LOCATION MAP
SOURCE:
GOOGLE EARTH Ram Pad Area
IMAGE TAKEN MAY 2, 2018 ACADEMI Training Facility
SCALE AS SHOWN ABOVE 850 Puddin Ridge Road
Moyock,Camden County, North Carolina
TM
ECS Project No.49:8246-E

v
' I�� ,
lk, Aar
I(t r p
1
i
o�.
✓. t
•1d,
r
.-a 7
r^

V '
CU
m Ab •
gy e •
Ir
,,. ll
�g
}
1'
i
h
c
c
}

� i 4
MW-2 +
*h MW_3 I
RPTW-4
MW-1
RPTW-3
x
DMW-1
M W-5
\t
' II,
rF-
1,000-gal AST ='
W^�A.
fw
RPTW-2 ,
d
LEGEND
Previous Temporary Monitoring Wells Associated with Impacts
• Current"Shallow"Monitoring Well Locations
OCurrent"Deep"Monitoring Well Location
Proposed"shallow"Monitoring Well Locations
FIGURE 4
PREVIOUS AND PROPOSED RAM PAD
SOURCE: MONITORING WELL LOCATION MAP
GOOGLE EARTH / 1 Ram Pad Area
IMAGE TAKEN MAY 2,2018 ACADEMI Training Facility
SCALE AS SHOWN ABOVE 850 Puddm Ridge Road
_ Moyock,Camden County,North Carolina
'TM ECS Project No.49:8246-F