Haywood_Well Abandonment_20240306

ia
WELL ABANDONMENT RECORD 0$ For"mental Use ONLY:
Ild foam can lie used for-single or ntultipte wells • •
- — /\
1.Well Contractor Information: \ WELL ABANDONMENT BETA It S i
Scott Bunt, Jr . \"\\ Tit.Ntunber of wells being abandoned:•l
We]ICor1rador Name(or stelloteneipenanally-abafdanht well onitilferprapcny) For n+alnpk. nyeethur or ani.unftr !,apply wells' ONLY tent the .some •
cmurnrcn.>n cbuilabamenr inn cu+railmilt a,ejt rut,
4561-A ! -
BEAM Connector Celt ltiotioti Nualrcr
• 7h.Approximate%nhune of water retraining in evcll(s)0 (PO
FOR WATFR.SUP_PLYWELLSONLY: _ _
SAEDACCO -� _�L£i�
_
Gummy Name' I '
7c.Type udislnfi�ctant Used:
2.Well Construction Permit 0:, , : . M AR 0 ii 2024
Lest crll,apptlieuld¢teelNeed s(ie.Cunnrr Siam,ranonet;.lir;entinu.,ek4 tf anvo 7d.Aittount of disinfectant'used: '
3.Well use(ehcekwelluse): In•ortr'airea i ;. :cry UFA
• WaterSupply Well; • 70.Scaling muterdals•uscd(clicek all tb,•tt apply): • DANGr3. . .
• fAgrieultivat dMunicip llEtiblic- III Neat-Cement Gtnat ❑Bentonite Chips or Pellets..
ClOtothertnal(Heating/Cooling Supply) I:Residentiaal Water-Supply(single) -CISand•Centt nt Grout El Dry Clay
❑LtdostrialIComnLercial °Residential\Vatcr•Supply:(shitttd) El Cauerete Grout El Drill Cntlings ,
Dbrigation • ❑Spiecialty Grout ❑Gravel •
Ron-WaterSupply\Velt: U BentoniteShiny El Other(explain tinder 7g)
F9Monitoring. • . • ElRecoveiy
Injection'Well: 71.For each Material selected above,provide amount of titiiterials rued:
DAgniferRecharge UGroundwaterRentediation Neat Cem.:471b ,Wtr:3ga1., • Sand Cem.:1b ,Wtr:gal.
' . !'Aquifer Sromge and Recovery ['Salinity Battier
❑Aquifer7cst l7Slomnca[erDnthiagt Bentonite.:5%lb ,Wtr:27ga1.: type 2.portlarid Amount:
DExperiutetual Techuotot_y DSubsIdette Comsat 7g.Provide a brief description Of the abandonment procedure: •
LDGeotltennal(Closed Loop) • PJTracer • I
drilled and used.drop screen to collect water sample trimie
®Geothermal(leaung'Cooling Return) . DOther(eaplain under 7g)
grout boring after water sample was collected
4.Date wetl(s).ab:uuloncd: 1-29-24
Sa.Well-location:
Pactiv Evergreen Canton Mill -
FacilityiOtvrnrNome Facility Ill))(ifappli able) $•Certification: '
34'•Park St. Canton, NC 28716 . we1Jt � . , • 2/4/2024
Physical Address.City.and Zip s:Attuoor ca ille l Well CA)tangtor or Well Owner line
Haywood 13y signing MOfi71irr; I hereby certify that the wells)rrirc(were)abandoned in
Cow*. •Ptrteel Id:rgittcit)ptt No.(PINj accv►dancc With 1.5A 3CAC 02C.01 CO.ur 2C.0200 Well Construction Standards.
• and Ike a copy ofthis record l:as been provided to ire well owner.
Sit,Latitude and longgfudein degeeslminntes(seconds or decimal degrees:
Owen Card,one Iat/Inttg It Imificicta) 9.Site diagram or additional well details:
You may use the back of Wis.page to provide additional uehl site details or well
N W .abattdoinnent details. You may also attach additional pages if nectssaty.
CONsTRIICTION DETAILS OF WELL(S)BEING ABANDONED `UBMl7"TAI.INSTRUCTIONS
:Nerd(ndl corisinietiort erivrtlts)if atrultrfe. For multiple byectinn or rmrn•utu er supply -
unite ONLY wlUh the slaw cunstrwetwrr'a arrelormtrrat.for inn sand(cure rmc 10a.For All Wells Submit this torus within 30 days of completion of well
6a Wcu IDn:SB-5 abandonment to the following:
•
•
Division of Water Resourc►s,•Information-Proceasing Unit,
32 I617 Mail Service'Center,Ralcigli,NC 27699-1617
6b.Total well depth: • 00
10h.For in ieellott Wells: In addition to sending the form to the addiesi In•1Oa
6e.Borehole dlautctcr.6 (in y -above.also'subunit one.Copy of this'loon within 30 days of completion of well •
abandonment tr1 the following:
Division of WaterResoucceS,Underground Injection Control Prdgratn,
fed,4V tree lta>'cl.bclow Browner surface: 12 (fr.) 1636 Mail Service Center,-Raleigh.NC 27699-1636
Ge outer,casing icu (tf Imnr a): (ft.) 10c.phr�Yater.fir ipIv inijt I\ Ili: In addition to.sending the form to
the addresses) above,•also submit lone copy of-this foam Within 31)days of
wd comptctioti•of l abandonment to thecounty health depanntctd of t c county
61.Inner'easingitubing length(if[mown): (ft.) where abandoned,
•
6g.Screen length(if known): (ft.)
Foam GW-10 Nonh Carotitn Damnnenni ofEmironment aid Natural Resources-Division of Water RCS urns Revised August 2013

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WELL ABANDONMENT RECORD For imerntlUmONLY: f
This form can be used for single or multiple walls
{
I.Well Contractor Inforinationr WELL ABANDONMENT DETAILS i
•
Scott Bunt, Jr 7a,Number of'nclI being abandonL: 1
WeltContractorNauie-(or%teUou.nopcaanallyatbmMnlnouellanlisitisrprapcny) For inuft,ple trauma Or MIA-Srd(Qr; ntppdp wails ONLY with the sauna
hJrlifnifCfkNlei?btU dNirlitnlf) Clv Cd,f RAW(ellefilrilf.
4561-A. 1 1
• 70.Apprn)dmatc volume of Water renuining in' ell(i)0 . (gaL)
NCWell CornmelorColificalieii Militia E i _
SAEDACCO FOR WATER SUPPLY WELTS ONLY: `` L: i I-2 D.
Company Name >
7aTrpe"ul'di,infi�ctuntUsed:
2:Well Construction Permit 4:, , �VIf1K U U 102A
List nil ipial)l ible well permitr(i.e.['airily,pale;i'iradrxe,Drjech'wr„elo.)jtxown
Id.Amount of disinfectaint used: Info:TP.3(4 E a ?""' s4rol Ufdt .
3:Well use(eheeltivell use): . GY•ri.iY CIC.i• •
- Water Supply Wen: 7e.Scaling materialstised(cbcck all that apply):-
17Agricnitural t ihittnicipaI:Pttblic. 1111 Neat.Cement Grout El Bentonite Chips orPellets
• ClCt othcrmat(noting/Cooling Supply) •❑Residential Water Simply(single) . Cl Sand Cement Groot . ❑thy Clay
❑hedustriallCowntcrcial Ottcsideuti l Water Supply.-(shwa!) Cl Couctt:tt:•Grotu . ❑Drill Cuttings
.0Inimition . . l]Specialty Grout , . . .t7 Gravel
-Non-Water Supply Welt: ' 0 Bentonite Shiny - Cl Other(explain under 7g)
ITIMordlorine. . ORecovety. ' '
Injection WO: - • . 7f.For each ltiate:Jai selected above,provide amanot of-materials lined:
❑AqulferRecharge -l7GroundwaterRentedliaion Neat Cem.:471b ,Wtr:3ga1.. Sand Cem.:lb ,Wtr:gal.
OAquifer Stonige and Recovery .CISa tinily Bonier
•0AquiferTest • l7SlonnwaterDrnhwge
Bentonite.:5%lb ,Wtr:30ga1. . type 2 portland Amount:
❑E,cperinteutal Teehnatoev 0Subsideuce Control 7g.Printde a brief description of the abandonment procedure:
ClGeotheitnal(Closed Loop) l7Tracer
used drop screen to collect water sample trimie grout boring
t7Geothemial(Heating/Caolina Return) DOthcrtexplain under 7a) -
after water sample was collected
4.Dafc veeU(s).atlandoned: 1730724 '
5a.•Wel location:
Pactiv Evergreen Canton Mill
Facility/Owo r Natno Facility 11)s(ifupplicabwc) 0,-,Certification;
34 •Park St.. Canton, NC 28716 • li: L—;aj� ' 8/4/2024•
Physical Addnss,City.and Zip• :xt!nn ol'r'c•;tirsvt Well'Cent-roar or Well(honer Dale
Haywood By signing this Arm,1 hereby certify thin the well(s)eras(irk)abandoned in
County Parcel Idcntitieatina No.(PNj riczsnlm)re will:15.,1 a\CCIC 02C,0100 or 2C.0200 Well.0)n/ruction Stanrktrcls
'and Inuit a copyofthis record hm•bec?i provider!to ire well Dinner.
Sb.•Iauiludc and lbngituttein dcgrmstrula ttes/sccnnds ordccim;ll'degrccs:
(Iffrell card,one Iat/ eeetti)lang is 2..Site diagram or additional well detiilt
• You may use the back of this page to.p'rovide additional well site details:or well
N • W -ab uidoiuuentt details. You may also atlnCll additional poses if tiect nary
C()NTKiICTION IETAII..S()il WELl tS)RHINO ABANDONED CURMiTTAi.INSTRUCTIONS ; ' .
math 1141 cvni'Irndiaua s'.vrdtls)If wag/able. For sradoyle infection'or•r4in-wdltrsapp!v
wells ONLY with i/s svntg4vimtmcnon'wfwittihn*rl).main ern sahmlt asii'm.
• 10u.For All!Wells:- Submit•this forte within 30 days of completion•of wall
6a.Weil IDdas-4 • 'abandonment to the iollovving: '
Division of Water Resoure s,Information Processing Unit,
6b.Total well depth: 37 (n,) 1617 Mail:Service Center,Raleigh,NC 27699-1617
lob.For iiiie llon Wells: •Lt addition to sending the form,to the address is Ica
6c.Raaehale diameter:6 • (in:) above.'Aso submit one copy of this'form within 30 days of'completion of well
abiindomnem to MC following:
Division of Water Resources;Uudergrvwnd Injection Control Program.
ail.Water level bclovv ground surface:12 (ft.} 1636 Mail Service Center,-Raleigh,NC 27699-1636
1.
Gn:Qutcr easing length(if Impnvj; (ft.) Inc.-For Water Surinly-.5:iofeetrmi Wells: In addition to-sending the form to
the.5ddress(es) above. also submit forme copy of this form within 30 days of
completion of well abandonment to1 the-county'health department of the county
6f.Inner easing/tubing length(if!mown): (ft.)
Aline abandoned,
6g.Screen.length(if laiown): (ft.)
Farm GW-30 North Carolina Pepstniem afEnvironnicnt and N:aural Rcsoicres-Division of WaterRcs ilk's Revised Augast 2013

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WELL ABANDONMENT RECORD For Imanial Use ONLY: 4 .
This,foam can be used far.single or Multiple yells I
I.Well Contractor information: WELL ABANDONMENT IIETAICS •
•
Scott Hunt, Jr 7a.Number offwi�lls being abanditnld:ll
Wc1L'CoarractorNante or.weitOtreY aancill atiamiontrtgucl!ontdsfltsr rpery 1 cn For tuulap,>a afecttrur or rv�n-itwtir supply 'wells. ONLY wsh f!f some
{ P y rnaernrciinw bando toumr,VW cme saabnidt r110rnt.
4561-A
NG tYc11 ConaraaorCcnifi idoti Nmi(ncr lit•Approximate rolunte of water remaining in isell(s)9 -. (gat.)
i '
SAEDACCO, LLC I OR WA I 1 R-SI1Ft'I.Y WELLS ONLY: �:,�< :...LL' � `=- : E D
Company Name le.Type Of disinfectant used:
• MILK 0 si 1024
2.Well ConitniMEmr Permit 4
Ltd pll rtpp/kobitt well prnt-kr(it!Cwtth:St t1o.•Varia Variance.Itreriinwetc)If known
7d.Ateount of disinfectant-used: la(not n..:i.f7 , . :,
3.Well use(elrecliwe1l use): • CV+Qi°Otif
Water Supplti•Well: - 7e.Sealing rate ials:tascd(checle all',that apply):
' DAgriciittttr l• DMttnicipal/Pttblic' ID.bleat Cement Grout '' 0 Ben tonite Chip§ort'cllets
0 eothcnn,7l(HeotingICooling Supply) . ❑ltzidential Water.Sirpply(single) ❑Sai d-Cernenl Grout ❑Diy Clay
❑htdastrial/Comnrcrcial ❑Residential Water Supply-(sl in d) ❑Conetete,Grotit •CI Diill Cuttings
❑Irrix thou • .• . CI SpecialLy'Grout 'CI Gravel .
Non-Water Supply Welt: ❑Bentouite Slurry 0 Other(explain under 7g)
Phiouitoring. ❑Recovery. . '
Injection Well: 7f.For each material selected above,provide amount ot materials used:
❑AquiferRecliarge ❑dniondh'ialerReatediaion Neat Cem.:471b. ;Wtr:3ga1., • Sand Cem.:lb ,Wtr:gal.
[]Aquifer Storage and Recovery OSalinity Barrier
❑AgniferTest ❑SlonansaterDmhiage - Bentonite.:5%1b ,Wtr:24ga1. type 2 portland Amount:
❑ExperintenttilTechnology CiSubsidenceControl
7g.-Frnv[dc a brief dcscrIptlou of the abandonment prt►cedun»
OGeolhernnl(Closed Loop) ❑Tracer
• removed pipe and trimie grout bore hole .
.❑Geothermal(fie=itingCoolinstReturn} DOthor(explain under 7g) . . •
•
d.Date weR(s).abandoned:271 24—_-_-
Sa.Wen-ocation: '
Pactiv Evergreen Canton Mill.
Facility/13mm Name Facility link rrapplicebtc} 8.Certllicitlieir: •
34 .Park St. Canton, NC 28716 jJ4' 2/4/2024
Physical Addre .City,and Zip ���WWWc�.Iir;c or tiZti'rid Well Contractor or ell1 Omer. Dale
Haywood • By signing this farm, I hereby certify-that the treE(s)If'as ncere)abandoned he
C`:tuna1s Parcel IdeiUllieatinallo.(PIN) aeconlmace ulth I t.:\C IC 02C.0140.or2C.4200 Well Cant r rctron Slrir:daids
and ttrit,,a copy Oftlris record has beet;providedio the well owner.
Sb•,Latitude and longitude In degrees/minutes/seconds or decintai degrees: • ;,
(Iftrell new,Date Lotion is otfficiets) 9.Site diagram or additional well details:
• You may use the back of this page to provide additional well site details.or well
N W .abaudoimteut details..You may also attach additional pages if necessary.
CONMTRITCr'IQ)N DETAILS(1F WELL(S)BEIN(:ABANDONED • •8T)RMiTTAT,iNSTRuC T ONs .
:Math tirll.cofeetruetnm rrinrdfs)If oarelwfe. For multiple arrctieut or rstn-nv r sapplr • - •
u,e11sONLY'with dta swttecvtisorxtwtr'iihmrdoxraent.fort eau Atbmil wteJ7tnrc 10a,"For All Wells: Submit•tilts fart within 30 days of completion of well
bat WenID :SB-2 abandonment to the following; 1
D['ision of WaterDesou'res,Infermation-Froccctiing Unit,
) 1617 Mail Scivice'Centcr,Raleigh,NC 276994617
6b.Total well depth: 30. 01
10b.For-Tleellan Wells: In addition
n to sending the form to the address to 1011
6c.Borehole diameter:2 (in.} •above,Oiso•submit one:copy of this fo'nn within 30 days of completion of Well
:tbutadonnteril to the fallowing: 1 '
I
lid.Water level below 12 Division of Water Resources,tfndergrtiutnd Injection Control Fragratn,
ground surface: (ft.) I636 Mail Service Center,Raleigh,NC 27699-1636
6e Outer casing lcnti h(if!clown): VWloc.For W prcn Sunnis,*infection Wells: Ln addition to sending the form to
tire•addresses) above:also submit hope copy of this loran within 30 days of
completion of well abandaiunent Co;the county health deptirricnt of the county
where abandoned,
6f.Inner easing/tubing tength(if known):25 • (ft.) .
6g.Screen length(If known):30 (ft.)
Fora GW-3t1 Nanh Canrlhn Drinrtau:m ofEnvlronnnmt ant Natural Resources-Division of PinterBcsaun cs -Revised August 20l3

1
WELL ABANDONMENT RECORD For Internal Use ONLY: I'
'INS form Oil be used for single or nitillipte wells
I
1.Weil Contractor Information: lyELL ABANDONMENT DETAILS '
Scott Hunt Jr.. . •7a.Nutnberof Dells being abnndimed:j1
1Yelleoronetertanne(or well My=personally abanctdnhigucllon•!ustlierpiupcny) Fir rriuh)pk Infeetlai wP non-train ,sup* aclls ONLY Leah rile some
constrecitirnobairthrirrmcRrr.ION cme,rnhttur wiefirmr,
4561-A . J
7b.Approilmate wrlumc of sratu•rentitining in st•elI(s): . (gal)
NCWeil euniiaaoromittcatioirNurib i i _
SAEDACCO FOR WATERSUPPLY WELLS ONLY: i` " 1 /'"
Comany Name le.Type of disinfectant used: ' ' .
• MAR 0 ti 2024 .
2.Well Construction Permit d
act all oppltt+t k well yermibe(i.e.Co**pine.!araerce:Iejrrirn,. te)tfRtmwn • yd.Amount of diStnFCCt:tnt useik frh`Oi r7?ntiF t A�
.. --..Ra Basta*
3.Wri1use(thccicsrclluae): river g
Water.Supph Well: 7.e.Sealing materials:used(sheets all that apply): :
pAgriculturrl_ - 't]Munictpal/Public• f7 Neat•Content•Grout • Oil l3etuonitc Chips or Pellets•
fGeotitcrmal(HcatinelCooling Supply} pRcsidential Water Supply(single) ❑Sartd Certtent Gmut ❑Day CLry+
OhtdtisiriaVComnt0ci3I.• EIRcsidential Water Supply.(shared), ❑Concrete Grout .f]Drill C nllimg
❑irtiption•• . l]Specialty Grout • 0 Crtsel
Non-Water Supply Well; • ®Bentanite Shiny ❑Other(explain under 7g)
AMotiflorine. . . . . . D13ecoveiy . - ' • • •
. Injection-Well: - - .7f.For each material selected above,proside amount of.Materials used:
1.
❑Anil ferRecltarge OGruundnalei Rentedianion . i '
[]Aquifer Storage aizi Recovery OSalhdty Barrier .
•OAtluifer Test CJStomn}°ater Drainage
Bentonite.:501b ,Wtr:gal.,
DEatperintetilal Technology pSubsidetica Cottitul 7g.Przaide a brief description of the abandonment procedure:
DGeothennal(Closed Loop) IMacer '
Pulled 1" temp well and abandoned borehole-w/ hydrated
.CIGeothermal(HeatinalCooling Return) ®Other(explain under 7g) • .
bentonite chips ; •
1/31/24 I
4.DafcWclf(s).ahundoncd: -_--
S:t.Well loention: •
Pactiv Evergreen Canton Mill
PeeilityiahY.nor Noise Facility 1)0(ifapplrablc) IL Cei liRcatlun;
34 ,Park St.. Canton, NC 28716 wk.././e.
. . . 2/20/2024
Physical Address,City.and Zip ✓)y+:o:ttrre erf`i�:J'vcr114ell Confront ont ur Wei!Otvt>:r Dam
Haywood 13y signing this fiarin,I hereby cnt4f/PI/tat the wen(s)was(were)abandoned in
County Parcel pc:silk:160u No.(PIN) accordance will?I t I:\CHIC o ,0100 or 2C..0200 Well.Cosisiratc!ion Standardx
and that a copy of this record has becii provided to itte well owner. •
Sb,Latitude and Iongituale in degreeslminutestscconds or dccintai"dcgrees: . - I
Orwell t'reW,one ladling is nidleisi) 9.Site diagram or additional Well details:
• You may-usethe-back of this page to provide additional Troll site d:fails:or well
A- W °abandoimte t detai.ls..You may also attach additional pages if necessary_.
fONSTRIICTION DETAILS OF WELLS)BEING ABANDONED $UBMITTAT.INSTRUCTIONS
Math troll coarrrnelidu racvrdfs)I)'UVOJ Fish it. Par milnple itjectirur'or lira-miar sulplp 1 .
issii'ONLrnilir&.5vntqcurstnctioniAtirekmiacau.iuucan,errbmitwreAnt. 10a.',For All Welts: Submit this lbiiu Within 30 days of.conipletion.of well .
is VcItID :T -1 'abandonment to the following:
Division of WaterRecurirecs,Information. -Proce sing Unit,
25 1617 Mail Seizice•Ceiiter;Raleigh,NC 27699-1617
6b.Total:eil depth: TO
10b.Fur Inlectlon Wellk: In addition to sending the faun to the address Eu It a •
Gc.Borehole dLunctcr:1 (in.) above,also Subunit one copy of this'fotni within 30 days of completion'of Well
abiuuiomnein to the follawirig:
•
• Division of Willer Resources,Underground Injection contrid Pregram,
fad,Water levet.bclow ground surface: (ft.) 1636 Mail Sense Center, 'Iitalcltb,NC 2iGrJJ-l636
Ge Outer casing 1cn�tlr(if lamp n}: (t�) 10c.'Fnr Waiter Ssrinlo-&infection Wells: In addition to.sending the form to
.the.address(es),above, also submit one copy•of this font[within 30 days of
completion-of ss-ell abandonment to the cSiwy health deportment of the county
6f.Inner easing length(if known);20 (ft.,) where abandoned, I
I
i
6g.Screen length(if knossn):5•: .(ft.)
1
Foist GW-30 North Carolina Department ofEnvironment and Natural Resources-Division of Water Resowa.s •Revised August 20 LS