Cabarrus_Well Abandonment_20240507

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: • ' WELL ABANDONMENT DETAILS • - -
John W. Huneycutt I 1 1
y .• •.. 7a.Number of wells being abandoned:
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.
2465-A • ' -
•NC Well Contractor Cerfificaiiou Number' 7b.Approximate volume of water remaining in well(s): N/A (gal.)
i' i
Derry's Well Drilling, Inc. i FOR WATER SUPPLY WELLS ONLY:
Company Name 7e.:Typeof disinfectant used: Granular
2.We Construction Permit#: WE 2022-00032 (#2) • - .• ,
List all applicable wellpermits(le.Co '—' . - • -- • '
ppunty,State,Variance,Injection etc.)ifknown 7d.Amuunfof disinfectant used: j1/2 lb.-
-3.Well use(check well use): ' - I.
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout • ❑Bentonite chips or Pellets
0 Geothermal(Heating/Cooling Supply) ElResidential Water Supply(single); - 0 1Sand Cement Grout 0 Dry Clay
❑lndustrial/Commercial DResidential Water Supply(shared) ❑•Concrete Grout 0 Drill Cuttings
❑Irrigation , ' ❑Specialty Grout i 0 Gravel
Non-Water Supply Well: . -El 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 ❑GroundwaterRemediation 75 lbs-Bentonite Slurry -
❑Aquifer Storage and Recovery ❑Salinity Barrier .
,
❑Aquifer Test ❑Stormwater Drainage '
i
❑Experimental Technology ❑Subsidence Control - 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Well was pumped with,bentonite slurry through
OGeothermal(Heating/Cooling Return) 0 Other(explain under 7g)
a 1"tremie pipe extending down illt2 iveg from bott r•-,.
•
12/14/22 ` 7.. :�.
4.Date well(s)abandoned: to the top. �.. - -• - - :- A /� r -; f
.•MAY-CP •i `t •
5a.Well location: 1, .
MA Homes of Charlotte LLC Itv��� ti.r'rs_ i lx�t
Facility/Owner Name Facility Mit(if applicab •
le)
8.• Certifieatinn: `/ ��+ L�l�
2630 Jim Johnson Rd, Concord 28027 Gf� 7 , 12/31/22
Physical Address,City,and Zipj Sigma• of Certified Well Contractor or, 11 Owner Date
YIY,
i
Cabarrus . 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 1at/Iong is sufficient) - 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 abandonment details. You may also attach additional pages if necessary.
i
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED •SUBMITTAL INSTRUCTIONS I,
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
• abandonment to the following: ,,'
6a.Well MN: I
•
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 65 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
i'
lob.For Infection Wells: In addition to sending the form to the address in 10a
2 - above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) ,abandonment to the following: I'
• ) i
N/A - Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
l0c.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) • whereabandoned. �'
• i,
6g.Screen length(if known): (ft.) I;.
Form GW-30 North Carolina Department of Environment and Natural Resources—.Division of Water Resources Revised August 2013
i'
I'

2" Well Diameter
# 9 -Well Diagram .
( 1 No Casing
Removed
•
•
.
•
Casing Depth
Unknown'
0' to 65' Pumped
with Bentonite
•
•
..
65' —Total Well Depth

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
•
1.Well Contractor Information: ' WELL ABANDONMENT DETAILS I " -, - ••
John W. Huneycutt 7a.Number of wells being abandon)di 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water i supply "wells--ONLY-with •the- same
construction/abandonment,you can submit'one form
2465-A +
7b.Approximate volume of water remaining in well(s): N/A (gal.)
NC Well Contractor Certification Number - i• ,
Derry's Well Drilling, Inc. : FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: Granular
2.Well Construction Permit#: WE 2022-00032 (#3) ;
List all applicable well permits(i.e.County,Stale,Variance,Injection,etc.)if►nown 7d.Amount of disinfectant used: 1/2 lb. - •
3.Well use(check well use):
Water Supply Well: - 7e.Sealing materials used(check all that apply):.-
❑Agricultural OMunicipal/Public 0 Neat Cement Grout . -❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) !Residential Water Supply(single): 0 Sand Cement Grout El Dry Clay
❑lndustrial/Commercial ❑Residential Water,Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation • O.Specialty Grout El Gravel
Non-Water Supply Well: . •El-Bentonite Slurry ! 0 Other(explain under 7g)
❑Monitoring ❑Recovery '
Injection Well: •7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation •75 lbs-Bentonite Slurry/
❑Aquifer Storage and Recovery. ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage ,
•
❑Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer Well was pumped with,bentonite slurry through
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
a 1"tremie pipe extending dovtirisitito(vi �l"'ft�m'1gttom
• 12/14/22 - '
4•Date well(s)abandoned: to the top'. - - ' - '
MAY;c�..a 2514
5a.Well location:
km Homes of Charlotte LLC lr"Q;"~ri•' -,,1 i-ccowi Ugta
043
Facility/Owner Name Facility ID//(if applicable) 8•Certifieatjo Dlr`vC rr�3
2630 Jim Johnson Rd, Concord 28027 W 7/ 12/31/22
Physical Address,City,and Zip Sigma of Certified Well Contractor or 4411 Owner Date
Cabarrus . By signing'this form,1 hereby certify that the well(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with ISA 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 lnt/long is sufficient) 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 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 DM: - abandonment to the following: 1.
•
' Division of Water Resources,Information Processing Unit,
65 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft)
• •10b.For Iniection Wells: In addition to sending the form to the address in l0a
above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: 2 (in.) abandonment to the following: 1 ,
i
N/A Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft) - 1636 Mail Service Center,Raleigh,NC 27699-1636
10c.For Water Sunnly&injection Wells: In addition to sending the form to
6e.Outer casing length(if)mown): (R•) 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. ,
6E Inner casing/tubing length(if known): (ft) ,
6g.Screen length(if known): (ft) - - - - - - -
• j i -
Form GW-30 North Carolina Department of Environment end Natural Resources'—Division of Water Resources Revised August 2013
i 1

#9—Well Diagram 2" Well Diameter
No Casing
Removed
....................
Casing Depth
Unknown .
. . :::::::::::::::::::::::::::::::::::: . - - .
0' to 65' Pumped
with Bentonite
.
65' —Total Well Depth

'
WELL ABANDONMENT RECORD For Internal Use ONLY: i ,
This form can be used for single or multiple wells Ii
1.Well Contractor Information: WELL ABANDONMENT DETAILS
John W. Huneycutt , ,. 7a.Number of wells being abando led: 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
2465-A -.
• 7b.Approximate volume of water remaining in well(s): 126 (gal.)
NC Well Contractor Certification Number • !
Derry's Well Drilling, Inc. • FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.,Type of disinfectant used: Granular
2.Well Construction Permit iI: WE 2022-00032 (#1) ;
List all applicable well permits(1.e.County,State,Variance,Injection,etc.)iflmmvn 7d:Amount of disinfectant used: '1'/2 lb:- -- -- --
3.Well use(check well use): - .
Water Supply Well: 7e.Sealing materials used(check ail that apply):
❑Agricultural ❑Municipal/Public ❑'Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) IZResidential Water Supply(single) . 0 Sand Cement Grout [rJ Dry Clay
•
❑lndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout 0 Drill Cuttings
❑Irrigation ❑Specialty Grout I 0 Gravel
Non-Water Supply Well: 'RI Bentonite.Slrirry 0 Other(explain under 7g)
❑Monitoring ❑Recovery '
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 350 lbs- Bentonite Slurry
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer Well was pumped with bentonite slurry through
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
• a 1"tremie pipe extending down into well from bottom,
•
12/14/22
4.Date wells abandoned: to the top: - •-• .
r
5a Well location: \\c t, "�'-i W.:�y
M/I Homes of Charlotte LLC MAY C. 7 2024
Facility/Owner Name Facility ID,/(if applicable) 8.Certification: `/
2630 Jim Johnson Rd, Concord 28027 a). Y4' ,filr.f,r4'l1''2/3_*=/2231
Physical Address,City,and Zip Sign of Certified Well Contractor or 11 Owner DVij i Coil
Yri• P
Cabarrus By signing this form,I hereby certify that the wel1(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:
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
abandonment'to the following: i
6a.Well IDII: ,
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 11 0 ((t) 1617 Mail Service Center,Raleigh,NC 27699-1617
1
10b.For infection Wells: In addition to sending the form to the address in 10a
above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: 6 (in.) i'
abandonment to the following: `
26 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) ' 1636 Mail Service Center,Raleigh,NC 27699-1636
I,
l0c.For Water Supply&Injection Wells: In addition to sending the form to
6e.Outer casing length(if known): (B) , 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.
6E Inner casing/tubing length(if known): (f_)
6g.Screen length(if known): (%)
•
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Resources Revised August 2013
I

# 9—Well Diagram 6" Well Diameter
. .. . No Casing
Removed
Casing Depth
Unknown - -
0' to 110' Pumped
with. Bentonite
z
3
110' —Total Well Depth

i
i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS '
John W. Huneycutt . 7a.Number ofwells being abandoned:I ed: 1
Well Contractor Name(or well owner personally abandoning well on His/her property) For multiple injection or non-watett supply""'wells ONLY With the same
conetruction/abandonment,you can submit one form
2465-A ',.,..,..:: ,.:. : I
NC Well Contracmr Certification Number 7b.Approximate volume of water eemaining in well(s): 0 (gal.)
Derry's Well Drilling, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name, - -• . -- - . lc.Type of disinfectant used: Granular
2.Well Construction'Permif 8: •''Ci HA-WE-2023-00160
List all applicable well permits(ie.County,State,Variance,Injection,etc.)ifknown , 7d.Amount of disinfectant med.:.1/2 lb-
3.Well use(check well use):
Water Supply Well: . ,7e:Sealing materials used(check all that apply): '
❑Agricultural ❑Municipal/Public 'El Neat Cement Grout :., . ❑Bentonite Chips or Pellets
0 Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single), A❑Sand Cement Grout 0 Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) ,❑Concrete Grout ❑Drill Cuttings
❑Irrigation . ❑Specialty Grout ❑Gravel
Non-Water Supply Well: l Bentonite Slurry ❑Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: • 7S For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation . 50 lbs- Neat Cement
:aquifer Storage and Recovery ❑Salinity Barrier • . 50 lbs-bentonite Slurry.
❑Aquifer Test ❑Stormwater Drainage .
I
❑Experimental Technology ❑Subsidence Control ' 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer • Well was:pumped with.bentonite slurry through
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
a.1"tremie pipe extending:down initp aivetl:from'bQtOrn.: .
12/20/23 `:-,.:: '.4.- -
4.Date wells)abandoned: .'to the top. -,,_.. .._ __ .._. ,... +
Sa.Well location: MAY d. i 'Li1C4
SM Smith&Sons Inc. �;-r
trfcl lr,=i: r,r. ,.:.>tirAgi? U-e.i
Facility/Owner Name Facility ID#(if applicable) 8.Certification: crr s'
0o
4800 Mooresville Rd., Kannapolis 28081 a). Yr 12/31/23
Physical Address,City,and Zip Sigii f Certified Well Contractor ell Owner Date
Cabarrus • By 66signing this form,I hereby terrify 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: i
(if well field,one lat/long is sufficient) 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 .abandonment details. You may alsdattach additional pages if necessary.
CONSTRUCTION DETAILS OF ELLS)BEING ABANDONED - SUBMITTAL INSTRUCTIONS I
W
Attach well construction records)if mailable. For multiple injection or non-water supply .
wells ONLY with the same construclion/abandonmenb you can submit one form. 10a. For All Wells: Submit this!form within 30 days of completion of well
6a.Well IIT!/: " abandonment to the following: I
Division of Water Resources,Information Processing Unit,
1617 Matz Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
lob.For Injection Wells: In addition to sending the form to the address in 10a
above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: 2 (in.) abandonment to the following: i ;
N/A Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) • ' ' :1636 Mail Service Center,Raleigh,NC 27699-1636
10c.For Water Saanly&Iniectio'n 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
6E Inner casing/tubing length(if known): (ft) where abandoned. I,
6g.Screen length(if known): (ft.) . _
Form GW-30 North Carolina Department of Environment nnit Natural Resources-Division of Water Resources Revised August 2013

# 9—Well Diagram _ 2" Well Diameter
( 1 No Casing •
Removed
4 gFIIIed with
Casing Depth - . ement
. . . .
Unknown . . ,�/� -
• 3' to 44' Pumped ►
:with Bentonite .
•
•
44'—Total Well Depth