Edgecombe_Well Abandonment_20240423 (2)

WELL ABANDONMENT RECORD Fcrlcdctuall7soONLY:. i
Ibis form can be used for single or multiple Ivells
i
1.Well Contractor Infoeniation: W1:LL ABANDONMENT DETAIt_q I-
i
Brian Ewing 7a.Number of wells being ahandouc& 1
Nell'COdcadorN9niC(q%%t ubu rpclsanatt}alrandoflingwdl.anI&II&prutic fly) Fur m1f[uplc vver)far or. iniP-tiwwar '1slrprb. wens. 'ONLY wtd! rlw. stwe'.
NMti f,wo civ? 1+N11If tNlc'OR71.
4240-B p
NC1Ycll GbnttaaorCoitifianioli Nnnicr '' ?Ir.Apprnximatc volume ofvFntce retn:tiriin�in n'eli(a}: - (filet.)
SAEDACCO FOR WATER SUPPLY WELLS ONLY;
Gln�unj Natnc 7c.Type fir disinfectant used:
2.Well Coustruction Permit a:. ._
Lt Xdl"MAIvhl,r willM-L,(Le.c-,rlt;4a:1e. 7d.A ount of disittfCctAnt'lLSi 1:
3:Welt uac(eLccii rill use):
Water SuppBv Welt• 76.Scaling materiids.owd(thee[,all that apply):
pAgrfcultumI pMtintcip9UPtiblic'. CI Ncat Ccnicut Grout d Bcntonitc Chips orPcllcts.
MGcothcrmit(HcatinvJCbolino Supply} pltcsidontiat W'ntcr Sillnpis(,inglc) d Saud Cenlou Grout ❑Dty Clav
❑hujiistriallCommcicial ORcsidentiat%Vnter Supply.(Ouurd) d Concrete Gtut O Dril1 Curtin's
dltti lion ❑Spec:iatCyGrout. d Gravel
Non-Water5upplyWell- d BentouiteSlurn• ❑Other(esplaiaunder7g)
Monitoring_ pRecoven
Injection NVcll: 7G For each.l iarcri it selected'above,pnoAdc amoittit of.materials ttsed:
OAquifcrRecharge OGroundnalerItente"'On Neat Cem.:471b ,Wti:3ga1. Sand Cem.:lb ,Wtr:gal.
DAquifer Storage god Reroven, OS dinity Barrier .
❑Aquifer Tc-A dStbnmatcr Dutitiage.
dElrtintetnul Technotogv OSubsidence Comm(- .7g Prniide a brief dcscriptian of thc;altLndnnrnent ptY►ciglun:
dGeoihennal(Closed Loop) . ClTmcet
TREMIE GROUT FROM THE BOTTOM TO THE SURFACE
®Geothemtal(Hea(igQ'Coolin Retum) Mthet(ex- lain under 7g)
•. F­do cd: 3-28-24 . . i. .._._ ;•-•li�..i ,�•!w,.,}
4.Daiewelt(s).aban n
Sa'W�ll wratinn: .. AP R.2 2 G[4
Former Edgecombe Genco Plant
Paeilit}IOvenarNarirc Facilit.`•IDA(ifoppliwbie) 8.Cet1iQ6doil: ifi vi' •=ti' ; ?;-f"�f ' i?''�
• I. Lf1Vks4J� _.
6358 Battleboro Rd.; Battleboro,.NC 27809 B da rt_.E1d11�n 4/3/2024
Physical Addles,City.and Zip- sigmlnre orcenirn"d W01t(:oturactar.,r-r.'.tl Oivtvr Dille
Edgecombe County )3v sag»!ng 11ai_s forma.I hbvby certify rhal the.arell f)was prere)uhamfoned in .
Cauuiy I'etcel IdamiftcadauNo•(PiNj ficcvrdduce with 1SA CAC'02t;.0100.or 2C.0200 TFW-Cvrisd»tcuort Stantkircls
and f rid v CopJ'bf11ds retard kas bevy provid&fo fife well 6imer.-
sk'tacitude'and longitude;in degtsePftninumslscmnd5'ordccimal degrees:
(ifwt!11 rwK 0114 bulollai}gjllllliClrl) 9.Site diagram or addltiauAwell details:
You tuay Iuellk back-of this page ta.proyide additional uvU sits.details or well
N . NV. .a6ariflotmtetu details..You tuay also altoEli additional pages if necessary.
CONATRUMION DF.TAi1 S OF WELUS)BEING ABANDONED SURNt7TAT.FNMUCTIONS-
rtr=1ejp1ei)Y,-rf!quvrmj
n•uvirs supFd}'
ux11sUNLY with
dx smilez�ursurecfiorr'rzrimrfhrer.+i�ru,taucurrarbmliwrefrirm 10w For All Welk- Submit-IhLs fnriu withal►30 daY5.of completion of well
Ga.WellID :TMW-2 abandonment to tho:failotving;
Division of WateeRcsourccs,Infor•mation•Procctsi§ing Unit,
18 fGI7 Di:ri1 Scriicc Gentler;Italei{;h,PiC 276ry9-1417
6b.Totalmell depth: (ff.)
10b.B00tilection Wells: _In addition to sending the fornt"to the addtess hu l0a -
6c.Borehole diameter.l pu.j above.uLso subodt one copy of this Ifonn vvidtut 30 days of completion of 1itll
abundonntern to the fella}v.itig":
fad.WatCr Icvelbciov� untl surface: (ft.) Division of Water Rcsourecs Underground Injection Couttvl-Progratn,
1696 Niail.)twice Ccintcr`,Italcigh,nC 27G99-Ifi36
p
Outer casing 1 (if ivnvrn): (f�) 10c.Fnr\V itcr Slmnlr'.ii.iniectino Welts; In addition id sending the form to
Gc
g cnptli( the address(es) akpve. also submit bue copy of this forhi within 30 days of
comptcdoti'of vv-cil abandonment to�ii�.county ImIth deplimncid of the county
Gf.Inner easiniVitibb ig kogth(if Imm..vn), ( ) whcro abaodoncd•. '
6g.Screen length(if Uoly n):10 (ft)
Foim GWV.30. North Camllm Ucpsrin>em afPalvironutrnl and Narumt Rcsou2cs-Dls ision of VlatcrRrs urns Revised AQusl 20 B

,
KNELL ABANDONNEEN.T RECORD rorbrlerntlUscONLY:
This form cao Ue usc�i for singlz or mu]Gp[c tir�Its 'I �.
1.Well Contractor Information: )YV LL ARAN110"IFNT DCTAILd
Brian Ewing . 7a.Number ofedls being abandoned.
?
NYelfCoulraetorNaoie.ortvillovrr aanall iL�amtotdv^vvetl.orrhiellrrr r For rtuiaph- .f+y.ctrae: d ,rrara-iitiravI 'such wells Dti`lY wtd+ +lie. swucx
( >k s: o N ml cYxurrrrc%r,xi,hm6airrhriiraia�rf,ir�ucrwe,rib+irlfrurefurer,
4240—B
i. .
NC NVOI Cbn6;ac1orQA1 i=8 a Ninrbet
71r.Anptnzimatc rolume u.f vsat��nYmnininig in iNell(s};_ (gai•)
SAEDACCO FOR WATER.SUPPLYNVELLS'ONLY:
Coa>QaapNamc 7c.Typeofdisinfectan uxed:
2.}Yell Construction Permit 9-, r
LLrlalleppllaL4lPk�l7/nrlrtiLr(LatGwreh',Stara,d'rulnuce;Ljeavarr„arcd1Jttrtrwu 7d.zlmotmtofdlainfecimit"used:
3..WeII use(ch"cckn•cll use}: ,
WaterSupplc Weil: 70.Sealing materials mW 0hecis all`chat applrr):
❑�1gr@cultitral ❑hltiniciptUPtrhlic M Neat Cement Grout ! . 0 Dcraooitc chips orpcllcts
I70cotlicnntl(H60ie Cooling Sttppt}} ORcsiJetmal Water Sti' (single} ' ❑Saud COIL.1d Grout ' 'q Dry Clay .
❑htdristniallComntctcW pltcsidential Water Supply-t*twd). ❑.ConcrcteGrout ❑Drill"Cuttinyt
❑Ttti •tiott' � ❑Spectialty�Grout ,❑Grovel
Nan-Water5upplr\Vcil: ❑*ntoniteSlurry ❑Other(explain under 7g)
29manitodrtg. ❑Recoven'.
Injection!Yell: X For each tuatcrl;l sciceted'abaye;'prav�dc atnottrit of.tit iteiials nscd:
❑Aggife!ftfiaqge ElGtoundnalcr.Rentediation Neat Cem.:471b. ,Wtr:3gal. ' Sand Cem.:lb ,Wtr:gal.
DAquifer Statage and Recioven' !]Salinity Datder j
❑AiIiAki Tesi OStomnNnterDntiiiagc
❑Evperintetitnl Tc�ltuoto t7Subsldettce Cotdml ?g,Provide a brief d6cripdan of the abandonment procedum
❑Geothemtat(Closed Loop) ❑Tracer
TREMIE GROUT FROM THE BOTTOM TO THE-SURFACE
17Gmthenual dieatina Caalin Return) OOther(ex- lain under 7g)
4.Datcwell(s)abandoncd: 3-28-24 APR 2 .2024
_ i'r�iti Yi�ti�(v "7S-r��i+�/J.`''�)✓Y`� -
Former.Edgecombe Genco Plant { L}v°4'Gi313
Facilit?_r�ri•ncrNamc ra;ilit:•LDbCfapplicablc4 -• R•CRcrtllicalioit: �j�� '
6358.Battleboro•Rd., Battleboro,.NC 27809 L�ri; n_ E_�i i 4/3/2024
Physical'Addwm.City,mid Zip 5igtgiereorCeititud Wen Cn,utiidtG�r.';tl O%vmr Dme -
Edgecombe County 13y+ai8rrl1Jq lhis for•irr; 1 herlzby cerrifr-4hat the yelljs)was(were)ahemdoued in .
Cauaty Parec1 lii;fll("icallnu Na(Pi�ij truati Irtilce it i!h 15A:1;C�tC 02C.010Q.tir 2C.0200 Kell Garisrnicfiurl SlrirttkrrYls
• � � aad rhar.it copy oJtlris rrcard lras be'e+i provirlerf to rlre'u•e11 on•»er.'
Sb.I:adhrdeand longitude in ttegrceslminutcStscOndsordccinuil-degreesi
(itnenCard,ow.laol n3ic 4.Site diagram oradditionalwelldetails:
You ma}use the ba&of this page'to provide additional well site details_or well
N W .abimdoinileottletaft.•You may also attacbndditional pages if necessar;`-.
CONSTRirCTI(lN DETAtt i 6V WELUSN BEING A®ANDONED SUBN117TAT.iNSTRUCTiONS
' :Ilrrrth rreU,cvlisrrnrrirrrr riivnlfs)1J'o�nllr�7a. for urnlnple ur�wi ur iauri.uxrrir.rLpj,1J' '
»r!GfJ 0-11idi'dwsmiigcwurrckrro,r%ahmulauinentir�uinrrmrbirui ore waic 104k.Par-All"Wcllc Submit thus form uithin 30 da}'s of completion of tivell
.6g.Nell ID#,TMW-3 abartdontncm to the fullowinG:
Dii•isidn of Rater Resources,Informitiou Proeev4ng Unit, '
lg. 1617 ALnil SeiMcc'Ccn' Ralei{;ti,itC27t99-Ifi17
Gb.Total vvcll depth: MA
106. -or-Tin lectlon%V01s: In addition to sending the form io the address In IN
Gc.Borehole diameter:l (iu.)
above;also submit one copi oC thislfoinn.vtillrut 30 days of crnnp[etiou of!►ell
abiddountent id the follo.whig:
Oil.Water levcl.bcPow grouritl surface Division of Water•Resources;Under ground i i jectlon Coultol Prbgratn,
1636 Mail Scnicc'Ccgtci,Ralcitili,NC-.2769-j 1636
Outer ca3in length(if laott n): (ft) loc.Tnr Water Surinh•IS.Tilleetrori Wells: Jn addition to.sending the formio
Gc
g, �( the•address(es).above. also submit.one cop}• of this form within 30 days of
complctiori of wrll abatulaitorent to�lhr roomy health dcpp"nmerd of the coutgy
6E Inner eminjUbbing to ngh(if ldnoWn) (D) where itrrndoncd,.
Gg.Screen lenptit(if lin011u):10 00
Tom GN-30 NonhCarothnDemiu raofEnvironmentau9NafumiRcsawres—DivisionofWaierResoums RevisMAuFusl3Dl3

i
• I
WELL ABANDONMENT RECORD Fatlii1murlOqg'ONLY:
This,form can be used for single or multiple t`'e11s I j
1.Well Contracwr Information: }YELL ABAND5N6ILNT DETAIL-S! I
Brian Ewing 7a.Numbir6firetlshcingaabandan : i
OYcIt'CoeuarlorNaene(or�tiillorcrsrpaonlllyal►�nimdn;�ivll.onliiall>irpiupcny) far rtidaplc- ofLeurmr or wjm-%i Y. krp�h- wells _ONLY well) Ilk. .xamw
c•irutrtrcoar.la6ra'rY6•tirni.�rrt,lvo Y§rn,rrluirit ais jFirrn;
4240-B
14C'}Yc1lCkrniraanrCcrtittcaliouNnri#,a 7Ir.Anprnximat6milumeof water rera ininginwell(s): (gnLl
SAEDACCO FOR WATER SUPPLY WELLS ONLY:
Convatq•Name 7c Type of disiarc'ctant med.:
2:We11 Construction Pernilt 0:
LEd1 dl efipltaubl,welll"' Is(zo.cwjnh,St te,1'arlrum:L feet nr;.etc l lJkmwn 7d.r11n0un[of d151nfCefunt nsetl:
3.�Vcll use(�Ledcn'cll uuj..
Water.Supply Welk 7u.Scalh ig materials used(chccliall that apply):'
pAgricultitmt' ghttinicip dlFtd?lic M Ncat Ccmcat.Gmut la Hcrdoriitc Chap§or N'.Ilcts
ackollmmal.(HcatinglCooling Siipply) OltesideWal WatcrSnpply(single) ❑Sand Cetnenl Gmut ❑.Dry•Clay
❑hidristrialfconrnrcrcial ❑Rcsidcnti,'tl Watcr Soppl},(shmd),. ❑ContrcleGrout O Dtill Cuttidlo
❑1nN tiara p SpecialtyGraut -'❑Gravel
!Yap-Water 5ugpty Well: CI Bentpuke Slurry 0 Giher(ex-plainunder 7g)
�Mauitorine I711ccoven,
Injection Well; 7f,For each anmhtAt of tit.•iteirials trsed:
❑AquifgRcct>agge I7GtotriuiunerPenledirition Neat Cem.:471b ,Wtr:3gal. Sand Cem:Elb ,Wtr.gal:
13AquirerStomge ar►d Recoven' OSaltnttp farrier'
` C]Aquife'rTast pStonmyatarDnttiiage -
❑kwiIinterualTechnotagv OSubsiderxoConiml.
7g.rro►•ide a lirief-d6cr'ipttan of the al►:kndonment piiiec lum
ClGeolherirnt(Closed Loop) Mraeer
. FROM.THE GROUT FROMTHE BOTTOM-TO THE SURFACE
Hea Moothenual( rin Coolie Return) • C301her(ex lain under 7>;)
a.Dafc;n'cl[(s).abandancd: 3-28-24 rr ADD 92&A y
Sa.Wc0lucafion: -
Former Edgecombe Genco Plant aMaL iiz.� P :z: z" ;� vi•'?
Facilit}�lOn race Narrnc Failiti•1r7J1 Ctappl4wblc) $•CCflif[rnlNoir: y�/� � G•
6358 Battleboro Rd., Battleboro, NC 27809 Brian• _ Ewing,n• 4/3/2024
Phpsical'Addresss,City.'andZip SigAyhucorCeuinkA+ vefl'Cnruractar:rryv.1tChvtalr. Date
i
Edgecombe County fay.slgnlr{g This fmmr; I herby certify that Ylre rre11(s)N'i:s(I re im am of ed ire
Couaiy Parcel ld_-,Ail'b�i11ni1 No.(Pnij 'neturdance with'114_VA 01C .0l fla.ur 2C:OZ00 Nfiell a- imbvdion SYrinr&ritls
md Arat a cop3,ofthis record has heap provided fo flee hell otrrrer.,
Sb.I ntihrtic an8 longittidc Nrr dcgrCcslmNnutes/5ccbndsbr dccintal°degrees:
(ltdell caul,are larllong isUritiKier>t) 9.Site diagram or additional well demIts:.
You iitap>ne the bacJ:of this.page io.provide.adlitiona!titti li site details'or'isell `
.abaudoiunertt&Wts..You may also aituch additional pages if Ikicxssaty..
CONSTRIVrION.DETAIIS ON W>LUS)BEING ABANDONED SURb177TAL tNSTRtTCTFOVS•
tflrrtlr.Nz11 cviavrrncllcrr nfturd(s)if.21,W/dife- For mulhple itrjecticvldr min•nnrir sgplp '
arils ONLY wjtli dre svni�nuuovcnan'ah.uuMirrne�ir,i+,u itiur arLmil,are fence• 10a.'Nor Ali-W&% Submit this farm Within 30 days.oUconiplctiow of roell
6a �VeIfID£t•TMW-4 abandoommt to the folloitiing:
Divinipn of WnterRes6nrcC'$_,Information-Proces-iing Unit,
18 1G171114i1 Seniec Center;Raleigti,NC.27G99-1617
Gh.Total well depth: (Ct.)
lob.For.Tnieclinn WcI1F: III adstitiou to sending the fornt to the address[iti0a
6c,Borehole diameter:l fin,) whoa.also snbndt and Copy of llris',faiiii%%thin 30 days of comptelion of bell
abnndonnmid to the follmNiug: i.
fd,Water Itevcl.bctno ground surfitce (ft.) Divislonof Water Rrsonries,Untler'ground hije�•tton.Coulrat-Pr6gram,
I636!!fail Scnicc Ccritcr,Ralci;h;NC 23699-1 G3G
I
Gc Outer c tsin length if imp�v): ( .) 10C Bnr W iter StrrirrIv 8c Iniectinri MH%: To addition to si:nding the fort!!to
fi ',( the addresses) above. also submit 10e copy of this.form within 30 days of
completion of well abandoun:ent to jthe eoiuny h►nith department of the county
vvl►crc abandoned,- '
6C Inner easinlftuhinglcnj;th(iftmawa)i
i
6F.Screen length(Nf huottn):10 (fe)
Fom G1V-10 NOnh C'arotlm DepJnn►cm ofEmironmeni mad Natural Rmwmcs-Dh islon of Warcrimo -a RrvE;Ld Ak%m 2013
i
i .
i

I
A
WELL ABANDONMENT RECORD . Fvr lnl�rnal osc tmLy:
This"form can be used for single or aluliiple wells
1:1 Well Contractor Information: RYLL ABANDONMENT DErAlt,'
Brian Ewing 7a.vuniberofwillsheingal►andaneds
«'cIt'CoutcaclorNanic{ort«Uutce`Yp:rsns>aUy_atiasrtdt�g«cll.oniiivlrrpralhnyl. Firniulople. GJeetiae or rwn-mll. "aup{Jj. "wails "ONLY wlrlr fLw .swua
. - c�rurnrcriixi,'rrbolerhNurn*ru,�vry ccur nrMrilr'ar���brwG.
4240-B
71►.Approximate volume of*at&remaining w trell(s): (g rl.}
NG Wdl EanlradorCultificatfoiiNnnibci . . .
SAEDACCO FOR WATER.SUPPLY WFLI.S ONLY.
Ccrngmq Name 7c.TyYle of,disinrcctant usnl:
2:'*Veil Construction Permit 0:,
Id37u11 ep rlliuLlo ur111xrmirr(Lt CuerrtR;Sttta,YurJnrrce:fi�cr7irur..elcj ffklmun . 7d:Amount of d1s1nFdctslut uSMt"
3.Well"i(chc&Well use):
Water Supply Well:" 7c.Seating matetialstiscd(chcch all tli it apply):
pA,ericnititraT :"phltinicipiliPttblio. CI Ncat.CcnacutGtout Q Bdntooitc'Chips or Nilels
C]Gcathcmutl(Ncatinn��ooliuo Supply) f]ltcsidoauinl Water"Supply(single) '❑'Sand fientrru Grout ❑Dry CLty
❑htdiistriallCotitmcrcial ❑Residential Water Suppb,(slinr>d) ❑ConrintaGraut ❑Drill CulUngs
❑hri lion 17 Spedalty,Grout 17 Gravel
itou--Water Supply Well: -- - - p Bentotute Slua O"Other(exp)ainunder 7g)
99mouiloring._. ❑Recovery
Injection Welt: ±f,For each piaterial scicctcil'aboFr,pro�idc amauutdf.rifateHals n'scd: '
i
❑Aquiferitechaige ❑Grattiidttuerltemedluian" Neat Cem.:471b. ,Wtr:3gal. Sand Cem.:lb",Wtr:gal.
I7Aonifer Slomge and Rettrvery liSaliidty Dartier -
❑Aquifer Test ❑SlonmcaterDmiiiage
.0E\rerintental Technotogv dSubsidetr a Coartml. 79,Provide a lidef description of the An pnocc,dure: "
Moothennal(Closed Loop) ❑Tracer
TREMIE.GROUT FROM THE BOTTOM TO THE SURFACE
17Geothcnn al(HeiitingiCooti Retum) ClOthei(ea laity under 7g)
4.Dafctfc11Wabandoncd:3-28-24 APR 2 S 2021-
50..Wclllocation:
Former.Edgecombe Genco Plant
8.CeniQratioit: L't'a�����
raeilrry•/QnnerNutae Facillti•ll)1rtiFappliwbic) . ,
G358 Battleboro.Rd., Battleboro, NC 27809 -Br'.��_ E1r /�11 4/3/2029
Physical Address:City.mid Zip Sigmlo VUr Cco Wvd VV'etl(U,urt urr:,r r',rl(ltris:r Dille
Edgecombe County By signing Ibis form.f hereby certify that the ire11(s)was(Inver)abartdoned;irr
Coauir Parcel lo:ntlt"kWait No.WINj ac-cunthme With 1 .MCWC 02C A100-or 2C.0 00 well Consfiurfran Swalkirds '
and that a cope ofdli ris record has been provided to 11re troll owner."
5b,,Latitude and tong tulle in dcga+ccsltnimutcalscconds ordccim;tl'dcgrccs: I
(if'asell rwlI ow tiultong i.s stf.ri rci>i) 9.Site diagram or additioaatwell details:
_ You may u 6llie bach of 116pa.&I6:pr6videAditiornal.titcll site derails of�4 e11
a ban.doinkient-&WIs..You may also attaelrudditimial p*s if neeessan•--
CONSTRIiC_rim-4 nrTAl1.-4 nF WCLugi BEING ABANDONVD" " . EMN1`17iTAT.INSTRUCTIONS
:tlludr v`rll curr�7rtielinn n!ivnl(s)lj'orwlhs!!d. Fin multiply r>tlectiwe'tir r�a•viulrr s,�ppQ � '
i v!k ONLY with the aernsxrunauriion'i2hOtrCkUl7irefal.i uu imn subuift are funa..
lQa:'Fnr All W&Lc Submit 11ris form%%!thin 30 daVs of wanpletion•of%vcll "
6iC Weil ID§iTMW-5 abandonment to the rollolting:
Division of WaterResimrccs InformationTroceming Unit,.
18 I617 Alit S&,Acc Center;Ralciph,Kc.27699-1617
66.Total tseR depth: (I t.}
10b,rgr inlecilon Wells: In addition to sending the form to thi aidiess W 10a "
6c.Borehole diameter:i (iu.} abovc:also subutit one copy of this form within 30 days of completion of hill
abandonment to the fallowhi-
(ft.)
D1,0slon of Water Rcsouties;Underground hijection Coutrol•Prtigratu,
611.Watcr level.bclon Around surface:
1636 lllril Scr%icc CenQer,Italei-,h,1CC 27699-1636
6c Oukcrcnsinrlcn th(iflwtan): _ (fL.) loc.Enr Water Somlly fi inicetfai Welts: Inaddition`to sending(be form to
the addres(es) above. also subnut,;btte copy of this,form lvitbin 30 days of
comptctioti-of well abandmuneut to itte count}•health.deparunerd of(he county
6f.Inner caiin�wf m1ling length(if fmau n): (R) tnccrc alnndancd,.
t
6g,Screen length(if knottn):10
I 'i
Fatm GtiV-30. Nonh CamWn Depsnnxm ofEmironmem ms1 Natural Rcsoakes-Ulvtslan of I hierltcsoum:s Revised August 2013
t ,
i
{
i