Buncombe_Well Abandonment_20240710

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.%>ell Contractor Information: WELL ABANDONMENT DETAILS
McMaster Holdings, Matt McMaster 7a.For Geoprobe/DPTorClosed4Loop 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
wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 56 (gal.)
FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: granular hypochlorite
2.Well Construction Permit#: 2024-00021
List all applicable well construction permits(i.e.VIC'.County,State.Variance,etc.)ijknown
7d.Amount of disinfectant used: half It)
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) iAesidential Water Supply(single) ❑Sand Cement Grout U Dry Clay
❑Industrial/Commercial ❑Rtsidetttial Water Supply(shared) VConcrete Grout ❑ Drill Cuttings
❑Irri ation ❑Specialty Grout VGravel
Non-Water Supply Well: ❑Bcntonite Slurry ❑Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundw•aterRemediation Concrete - 2 vds Gravel - 2 tons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Dry clay - 14 tons
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return ❑oth r(er,,irn, `) Disinfected well, took out pump and piping, filled
May 31, 2024 n hole with 1 ton of gravel. 14 tons of clay, and
a.Date well(s)abandoned: y IIJL 1 J ��� 1 more ton of gravel. Dug out approx 12 in wider than
Sa.Well location:
well hole and sealed with 2 yds concrete (in well house
McMaster Holdings, Matt McMaster
Facility/OwncrNamc Facility lD4(ifapplicablc) s.Certification: with concrete floor).
30 Westgate Pkwy#331, Asheville, NC 28806 L--� 11/asin
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner D
Buncombe 868784238900000 By signing this form,1 hereby certify that the well(s) was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(if well field,one lat/long is sufficient)
9.Site diagram or additional well details:
N 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)ifavailable.For multiple injection or non-water supply wells
ONLY with the same construcuorunbandcmment,you can submit oneform.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: approX 45 M.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For Infection Wells: In addition to sending the form to the address in l0a
6c.Borehole diameter:approx 3030 (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: approX 3 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6c.Outer casing length(if known): (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
6f.Inner casing/tubing length(if known): (ft.) abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

3
WELL ABANDONMENT RECORD C\ For liumilIscONlti
This form can be used for single or nitdtipk Wells ` /
\ I
1.Well Contractor Information: �`' V`t WELL ABANDONMENT DETAILS
Rich Lemire 7a.Numl►cr of wells bring abandoned: 1
Will('ontiractur Name rot well ow nr penanally abandomaS well an harhet pwit)1 For waftirlr oiler hear ,w row-inter vitiph -e11r ONLY wish ?be mar
rnrnnm rnwi.rhan:doirnnv i,rn,,m,ulvnrr wi.6rrpi
2593A
NC We11CoismdarCcnificalian Nnteticl 'b.Appro%inudr%plume tit wah7 rrrnaininR
SAEDACCO
FOR N ik I F'R SUPPI-Y WELLS ONLY:
Conip;ot%Name
7c. I)pc of drsinfectant used:CBLORINE
2.Will Coastwction Pernik M ,
(.ia sell rrlMa/wohlr we111ari its o.e-i wM..SirNr.!�rra n r lntratian,rtr.r i1 kn rrrr
7d. Amount of disinr%vtant uxtil:1 OZ
J.Well use(check:well usN:
Water Supply Well: 7e.Sealing materiak used nchcck all that apply 1:
❑Agncuimral ❑bhmicipaUPinblec M New Cement Groin ❑ Bcaonitc Chips of Pellets
❑(imthcrmal(HcanniVCoohng Supplyi ❑Rcsideraral WatcrSupph isingle) ❑ SandCemnit Grout ❑Dn Clay
❑lndustnaUCom rtcraal ❑Rmidcruial Water Supph (s.harod) ❑Cowme Grout ❑Drill Culmngs
DIFfigI111011 ❑Specialty Grcne ❑Gra%el
Non-Water Supph Nell: ❑Bervoinite Slum U Other lexplain under 7g)
29M01111onne ❑Ramon
Injection Well: X.For each nistriial selected above,proiide amount of materiaiv awed:
❑AquilefRccharge ❑GroundwzterRemeduanon Neat Cem. :941b ,Wtr:6gal. Sand Cem.:lb ,Wtr:gal.
❑Aquifer Storage and Reco%rn ❑Saluut% Bamer
Bentonite.:llb ,Wtr:gal.
❑Aquifer Test ❑Slomn%alrr Utatrwge .,
❑E\peruncmal Technology ❑Stibudewe Coratul 71t.Prmitle a brief demription of the abandonment proccdurr:
❑Geothemal(Closed Loopi UTracer
MIXED AND PUMPED TREMIE GROUTED FROM BOTTOM TO TOP.
OGtt%tlrmial(Neann 'Conlin Return) ❑Other( in under 7 )
A.Date well(Nlahandonrd! 5-16-2024
ta.Nell location:
FORMER BEACON MANUFACTURING FACTORY
Facility IDN(ifapplicabk) S•Ccnirication: LAM
� n O ifi�f3:]C3[btlr'rl r%f�ro�
202 Whitson Ave. Swannanoa, NC 28778 'hw -�//%i%1/�G� a1►VSC4511912024
Ph„kdl lddrev.C in.aid Zip Stamniirc of t .:trwd Wen(aracwiar w Wen o.Arer Dare
BUNCOMBE 14 erXporig this Dorm, I hameby cern/V that the w•ellrs) was(werei abwtikn ed or
Uamen f atel Ideatdwniiiin No iPIN i ae:vrdam-e with 15.4.'(AC 0A7.0100 or 2C 0.s00 R e•!f('tunttruehun.Verrulirrilr
and thou a cM,of this record hues been provided to the well owner.
Sh,Latitude and longip tic in dlylrcrw/minatrNrvcnndN ar decimal degree%:
Of ucil fold,one Lavlatia is sddricwwrl 9.Site diagram or additional well details:
You na% use the back of this page to proN ide additional well site details or%%ell
W ahatdonnieni details You tray Aw attach additional pages if nckxssan
CONSTRi'( i10% DEIAII.S OF NE:LLiSI BEIN(;ABANDONED SUBMiTTAL INSTRUCTIONS
.11toch n,ii- oler sapp(v -
%vik ONLY with rhe.%AmrewnrrerfprniJr kn ,rairrrt.iowcan ahmicote.krrnr 10m. For All WcLLs: Sul)tml this Corm within ?U da%s of completion of wYll
6a.Well ID/•M-26 ihandonnicnr to the following
Di%ision of Water Resouirc.%,Information Processing Unit.
6b.Total well depth' 17 —(ft.) 1617 Ntail Smice('enter,Raleigh.N('27699-1617
lob.For Inivrlion Wells: bt addition to sending the form to the address ni liia
6c,Borrhole diameter:2 (in,) abo%c. a6o submit one copy of this form widen 30 days of completion of%tell
abandonment to the toliowm4
Division ur Water Rewurces,l nd ergroved injection Control Progra s.
(A Water level hclim ground wrface: 8 Jft.l
1636 Mail Service('eater,Raleigh,N['2T699-16J6
10c.For Water Suouh& Injection Wells: in addition to sending the fomt to
6c.Outer caarnx length Iifknownc (h•1 the address(esi above. also submit one cop} of this form within 3o days of
completion of%%ill abandomtetu to the downy health depunmern of the counay
6f.Inner casing.+tubing Icn,.,tli iif knnwn): 7 where abandoned
Ih.l
6C.Slt•eea lengtb(d'know n is 10 (ft.l
Farm GW-30 North Carolun Degurlo ni of En,itonniem:nd Natural Resw ices-Dh isnon of Water Resootees Re,iced hii isi?nt It