Brunswick_Well Abandonment_20240318

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Trevor Mizelle 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
4629C wells abandoned:
Ap
proximate roximate volume of water remaining in wells 0.407575 (ral)
NC Well Contractor Certification Number PP g O�
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,Slate,i"lraance,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 ❑Neat Cement Grout S 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)
eMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 18.99 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Topsoil 7 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) Well pad was removed from ground. Casing was left
in ground with the top cut off. Hydrated bentonite
4.Date well(s)abandoned: 2/27/2024
was used to fill casing. Topsoil was added on top
5a.Well location: to bring opening to grade.
Glenn Parker Property
Facility/Owner Name Facility►D#(if applicable) 8.Certification:
7102 Ocean Hwy West, Sunset Beach, NC 28468 2/29/2024
Ph-ical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Brunswick
By signing this form. !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
and that a copy of this record has been provided to the well owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
ll field.one onl lat'l sufficient
(tfwe g is ) 9.Site diagram or additional well detail a 1.� �;+t^� �
You may use the back of this page to proide v '�dd�tidtrt ll sitef-&"ifor well
33.94684142261145 N -78.50255376332889 N
abandonment details. You may also attach ad iti�Kl pages if gcg�,sary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS LU14
Attach well construction records)tfararlahle. For multiple injection or non-water supply wells
ONLY with the same construction abandonment,you can submit one form. Ir1i3 7C;i Lf F e:fir'.^.9�kv': LIM
10a. For All Wells: Submit this form within bV1Ms3if&mp etion of well
6a.Well ID#• MW-2R abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 12 (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 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: 2.41 (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 Suouly&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): 2 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

a
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.N\cII(ontr:tctor Information: WELL ABANDONMENT DETAILS
Trevor Mizelle 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Ncl I 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
4629C wells abandoned:
7b.Approximate volume of water remaining in wells 0.393975 al
NC Well Contractor Certification Number PP g O' (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.U/C,(ounty,State, kanance,etc.)if known
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 ❑Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) El Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
❑lrri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7C For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 18.99 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage TOpS011 7 IbS
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/CoolingReturn) ❑Other(explain under 7 ) Well pad was removed from ground. Casing was left
in ground with the top cut off. Hydrated bentonite
4.Date well(s)abandoned: 2/27/2024 was used to fill casing. Topsoil was added on top
5a.Well location: to bring opening to grade.
Glenn Parker Property
Facility/Owner Name Facility ID#(if applicable) g.Certification:
7102 Ocean Hwy West. Sunset Beach, NC 28468 2/29/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Brunswick( 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
and that a copy of this record has been provided to the well 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:
33.94684142261145 N -78.50255376332889 `1 You may use the back of this page to provide i(eahal w,e�l site de,Eaj ,o will
abandonment details. You may also attach additional pages if nZrctessvdryr- L
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS MAN 1 8 1024
Attach well construction record(s)ifavatlable. 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 4hM' 9a c?''('dtBglCuc Jt �'yglell
6a.Well ID#' MW-7 abandonment to the following: utarQ 3G
Division of Water Resources,Information Processing Unit,
6b.Total well depth' 12 (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: 2.73 (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): 2 (ft.) abandoned.
6g.Screen length(if known): 10 (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:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Trevor Mizelle 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
4629C wells abandoned:
.Approximate volume of water s. 0.348075 (,,a].)
NC Well Contractor Certification Number 7b PP remaining in well()
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UB',County,State,Variance,etc.)ijknown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublic ❑Neat Cement Grout @ 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
❑lrri 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 ❑Groundwater Remediation Bentonite 18.99 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StorwaterDrainage TOPS011 101bS
rn
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
Well pad and casing was removed from ground.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
Hydrated bentonite was used to fill casing.
a.Date well(s)abandoned: 2/27/2024 Topsoil was added on top to bring opening to grade.
5a.Well location:
Glenn Parker Property
Facility/Owner Namc Facility ID#(ifapplicablc) 8.Certification:
7102 Ocean Hwy West, Sunset Beach, NC 28468 2/29/2024
Physical Addrt,,.City,and Zip Signature of Certified Well Contractor or Well Owner Date
Brunswick By signing this form, I hereby certify that the wells) 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 ft well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: t._. .
(ifwcll field,one i:u i,,,_is sufficient) 9.Site diagram or additional well details:
33.94684142261145 N -78.50255376332889 W You may use the back of this page to provide additiopal well s'tti@"'dilbs C� 111
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED
abandonment details. You may also attach additional ylif rjec 9� ry �•r
t►11`ti; < �`4
Attach wellconstructionrecord(s)favailable. For multiple injection or non-water supply w SUBMITTAL INSTRUCTIONSells
ONLY with the same construction abandonment,you can submit one form. }�s-Q��. I� �,,
10a. For All Wells: Submit this form within 30 daatori�tl rw4l
6a.Well ID#• MW-8 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 12 (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: 3.81 (I't) 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&lniection 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 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016