Wake_Well Abandonment_20240401

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Lawrence D. Opper 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-wales supply wells ONLY with the same
construction/abandonment,you can submit one form.
3322-A � I
7b.Approximate volume of water remaining in well(s): 0 (gal.)
NC Well Contractor Certification Number
Regional Probing Services FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: 65!% Ca(CI0)2
2.Well Construction Permit#:
List all applicable well construction permits(i.e.Counry,State,Variance,etc.)if known • 7d.Amount of disinfectant used: 7 oZ
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
0 Agricultural 0 Municipal/Public 0 Neat Cement Grout ! 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) lResidential Water Supply(single) l Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial OResidential Water Supply(shared) ❑ Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 1 0 Gravel
Non-Water Supply Well: - - - — --0 Bentonite Slurry - - 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Grout: 3.75 cu yds.
DAquifer Storage and Recovery ❑Salinity Barrier i;
O Aquifer Test ❑Stormwater Drainage
❑Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the'abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Piping was removed prior to abandonment. Disinfected
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
with Ca(CIO)2. Dewatered and filled well with grout. Removed top casing.
4.Date well(s)abandoned: 3/11/2023
•
5a.Well location: , `" = - ' 1:
Js
Mahmood El-Qadi `
Ap.
Facility/Owner Name Facility ID#(if applicable) g•Certification: A-PR a Lo 24
5901 NC Hwy 55, Fuquay-Varina Lawrence Oppe
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner G+ti% G.,u,,Dia ✓
Wake By signing this form, I 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lot/long is sufficient) 9.Site diagram or additional well details:
35.596143 78.758560 You may use the back of this page to provide additional well site details or well
Nr W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. 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:within 30 days of completion of well
6a.Well Ill# Supply Well(WSW-13) abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 15 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
IOb.For Injection Wells: In additionIto sending the form to the address in I0a
6c.Borehole diameter: well I.D.=24(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: 5 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Injection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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.
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

it
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells I
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Lawrence D. Opper 7a.Number of wells being abando ed: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water, supply wells ONLY with the same
construction/abandonment,you can submujone form.
3322-A
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 0 (gal.)
Regional Probing Services FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: 65 % Ca(C10)2
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc.)if known 7d.Amount of disinfectant used: 6 OZ
3.Well use(check well use): 1
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublic ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) EResidential Water Supply(single) El Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Grout: 1.25 cu yds.
❑Aquifer Storage and Recovery 0 Salinity Barrier -
❑Aquifer Test ❑StormwaterDrainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:l
❑Geothermal(Closed Loop) ❑Tracer Piping was removed prior to'abandonment. Disinfected
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g) ,
with Ca(CIO)2. Dewatered andifilled well with grout. Excavated
3/11/2023
4.Date well(s)abandoned: and removed top casing. Backfilled and'gradedsut"Face.
5a.Well location: i,.'''' �-i . a_ 1
Bruce and Barbara Turrentine �4.�� /17 ,' I 2024
Facility/Owner Name Facility ID#(if applicable) 8.Certification: , l
• ='-;. ;tea l
1830 Eakes Street, Fuquay-Varina Lawrence Opper�'• "' �s t '- ,,.y'"�•=,3/:1:9/42Q24
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner u Date
Wake Wake By signing this form, I hereby certikthat 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/longsufficient)�is 9.Site diagram or additional well details:
35.596620 N 78.756872 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)if available. 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 within 30 days of completion of well
6a.Well ID#: Supply Well(WSW-14) abandonment to the following:
i
Division of Water Quality;Information Processing Unit,
6b.Total well depth: 15 (ft.) 1617 Mail Service Center;Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
well I.D.=20 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: 6 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I '1
10c.For Water Supply&Injection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one.copy of this form within 30 days of
completion of well abandonment to the bounty health department of the county
where abandoned.
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

i
. WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAIL'S
Lawrence D. Opper 1 . 1
PP 7a.Number of wells being abandoned.
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-watr I supply wells ONLY with the same
construction/abandonment,you can submit one form.
3322-A
NC Well Contractor Certification Number - 7b.Approximate volume of water remaining in well(s): 0 (gal.)
1I
Regional Probing Services FOR WATER SUPPLY WELLS ONLY: •
Company Name 7c.Type of disinfectant used: 65 %i Ca(C10)2
2.Well Construction Permit#: GW-117207-2024
•
List all applicable well construction permits(i.e.County,State,Variance,etc.)If known 7d.Amount of disinfectant used: 6 oz
•
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check allfthat apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 1 0 Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) 1lResidential Water Supply(single) P1 Sand Cement Grout ' 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout 0 Drill Cuttings
❑Irrigation . 0 Specialty Grout 1 0 Gravel
Non-Water Supply Well: ❑ Bentonite Slurry i 0 Other(explain under 7g)
❑Monitoring - ❑Recovery.
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Grout: 1.25 cu yds.
❑Aquifer Storage and Recovery ❑Salinity Barrier I
❑Aquifer Test 0 Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer !
Piping was removed prior to abandonment. Disinfected
OGeothermal(Heating/Cooling Return) 0 Other(explain under 7g)
with Ca(CIO)2. Dewatered and filled well with grout. Excavated
4.Date well(s)abandoned: 3/1 1/ZOZ3 and removed top casing. Backfilled land graded surface.
5a.Well location: II-7' , -..•
Bruce and Barbara Turrentine t ,t I" 't-- G Ite •��'
r7.--.
7i
8.Certification: ` , ; 11�R
Facility/Owner Name FacilitylD#(ifapplicable) • �w J 1 �,•G24
1830 Eakes Street, Fuquay-Varina Lawrence Opper� -,- - . 3/19/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Ow ,,..^.,;(' 'Matt' !s
r
• Wake 0677222028 By signing this form, I hereby certify that the well(s)was (were)abandoned in
County Parcel Identification No.(PIN) accordance with I5A NCAC 02C.0100 orj 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: f
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.596620 78.756872 You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attacli additional pages if necessary.
- _- i
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available: 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 within 30 days of completion of well
6a.Well ID#: Supply Well(WSW-14) abandonment to the following:
I
Division of Water Quality,Information Processing Unit,
6b.Total well depth 15 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
•
10b.For Iniection Wells: In addition Ito sending the form to the address in 10a
well I.D.=20 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: _• (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
I :
10c.For Water Supply&Injection Wells: In addition to sending the form to
1. 6e.Outer casing length(if known): (ft.) 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
6E Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)r.
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality 1 • Revised March 2013

WELL ABANDONMENT RECORD For Intemal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Lawrence D. Opper 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water. supply wells ONLY with the same
construction/abandonment,you can submit one form.
3322-A
7b.Approximate volume of water remaining in well(s): 9 - (gal.)
NC Well Contractor Certification Number 1 ,
Regional Probing Services FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: 65 % Ca(CI0)2
2.Well Construction Permit#: GW-120149-2024 1
List all applicable well construction permits(i.e.County,State,Variance,etc.)if known 7d.Amount of disinfectant used: 7,oz
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial 0 Residential Water Supply(shared) ❑ Concrete Grout 0 Drill Cuttings
❑Irrigation ❑ Specialty Grout 1 ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry I 0 Other(explain under 7g)
❑Monitoring ❑Recovery 1 -
Injection Well: .7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge 0 Groundwater Remediation Grout: 3.75 cu yds.
I.
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Piping was removed prior to labandonment. Disinfected
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
with Ca(CIO)2. Dewatered and filled well with grout. Removed top casing.
4.Date well(s)abandoned: 3/11/2023
5a.Well location: 1 .i.L L.0"a.:is fit` 3: L
Mahmood El-Qadi i APR 0 1 2024
Facility/Owner Name Facility lD#(if applicable) 8•Certifieation:
5901 NC Hwy 55, Fuquay-Varina Lawrence Opper,/ ° a «m ?r f97 t ei
fur t
Physical Address,City,and Zip Signature of Certified Well Contractor or Well'Owner Date
Wake 0677117847
By signing this form, I hereby cert 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. •
5b.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:
35.596143 78.758560 You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. 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 within 30 days of completion of well
6a.Well ID#: Supply Well(WSW-13) abandonment to the following:
Division of Water Quality,Information Processing Unit,
1617 Mail Service Center;Raleigh,NC 27699-1617
6b.Total well depth: 15 (ft.)
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: well I.D.=24(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: 5 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,.Raleigh,NC 27699-1636
10c.For Water Supply&Injection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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
6f.Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources-.Division of Water Quality Revised March 2013