Transylvania_Well Abandonment_20240903

WELL ABANDONMENT RECORD For Imarnal Use ONLY
This form can be used for single or multiple wills
1.Well Contractor Information: \V�lJ WELL ABANDONMENT DETAILS
Rich Lemire J 7rr.Number of wells being abandoned: 1
Wert Uouractor Nana for well oAraN persomlly abandoning well on)i1siber property) Forr.udiilrie itllecttcvt n► /KMJ-wvor stgt�dly wells O/VLY was the sane
consrnte'h.w+uhvrsionaaent.tam eon rnb em.e btr�t
2593A
NC WelContractor CeulliratioeMintier 7b.Approximate tribune ofwater•rcruain:lig rn ell(.1FONE sgat.)
FOR WATER SUPPLY WELLS ONLY:
SAEDACCO
Comecon Name 7e.Type of disinfectant used:
2.Well Corsttatction Permit I:
Last all applicable-well"max f:t.Cow*,Sage.!are nos,htfralOf Wc,)fjttturrt 7d.Amount of disinfectant used:
3.Will use(cheek well use):
Water Supply Well: 7c.Scaling materials used(Check all that apply):
0Agncnhural 0Municipal/Public (11 Neat Cement Grout 0 Bentonite Chips or Pellets
°Geothermal(HeatiaptCooling Supplyt ❑Rcsidcntial Water Supply(single) 0 Sadd Cement Grout 0 Dry Clay
❑hslustriaL'Consinerctat ❑Rcsidcuiud Water Supply!stoned) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Gard 0 Gravel
Non-Water Supply Well: 0 Bentonite Shirty C1 Other(explain under 7g)
®Monitoring ORes:ovety
Injection Wen: 7f,For encb material selected above.pros ide amount of materials used:
D Aquifer Recharge CGtonndw•rter Remedial ion Neat Com.:2821b ,Wtr:24ga1. Sand Cem.:lb ,Wtr:gal.
0 Aquifer Stowe and Recovery ❑Salinity carnet
❑Aquifer Test CStormwater Drattrtge
°E.eperimental Technology ❑Subsidence Control 7g.Pros ide a brief description of the abandonment procedure:
0GCOIherMal(Closed I.Oop) °Tracer
TREMIE GROUTED FROM BOTTOM TO TOP AND REMOVE ABOVE-GRADE 3'
°Geothermal(Heating/Cooling Return) 1:10 her(cxpbin under 7g) —
BELOW GROUND SURFACE.
1.Date woo(ss)ahandoned: 8-12-2024
Sa.Wto!nation:
Jf P 2024
WOODRUFF LANDFILL R.Certification:FacilN.°stria Name Parka 1331 nrigplirsbkl
500 Howell Rd. Brevard, NC 28712 .Q/Iht�s-4� )8/14/2024
Physical Adams.Cris,and Zip Signature of r�:turd Well Contactor or Well ON Mr Die
TRANSYLVANIA lit Awning b'u, bow, /hereby certify+thin the will{si was(were)abandoned as
Co out) Panel Identification NO.(PIN/ accordance waif I C I :\'CA( t)'f' !riot)or 2 ,O t)O 11"ell Construction Standards
and that a(Yaps!o1 INN record hi,1.in provided to the well owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
tit wen field,'011C L•ONn.ri suficsrtat 9.Site diagram or additional well details:
You may use the bad:of this page to pros ide 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 4 UBMITTAI.INSTRUCTIONS
;lttudt well curnireartor rrc.»',lha)tl avtal hk•. Fur muh;pee utledxm rs rxrn.x•ater wly.le
hells ONLY with the s me eund ianiut abiorik Brent,ta+n tLm anon,one ju nu 10a. For All Wells: Submit this form within 30 days of completion of well
6*.Welt IDl: -11 abandonment to the following:
Division of Water Resources.Information Processing Una.
1617Mail Service Center.Raleigh,NC 27699-16 1 7
rib:Total well depth: 24 (ft.)
tab.for Injection Went: In addition to sending the form to the address in 10a
Borehole diameter:2 (kW abandonment
also submit one copy of this form within 30 days of completion of well
fK.Borehole
abandonment to the following
Division of Water Resources,Underground Injection Control Program.
bd.Water level heron ground surface: (ft.) 1636 Mail Serice(enter,Raleigh.NC 27699-1636
10e.for Watel Sup»is& Injection Wells: In addition to sending the form to
6c..Outer casing kur.th(if know nr: (lt!.) the addresses) above. also submit one copse of this form within 3p days of
completion of well abandonment to the county health department of the county
where abandoned
Gf.biner asinwtubing icntrth(if Lamm): (ft.)
trig.Sawa length of known): (ft.)
Fonts GW-34 Noah Carotins Dtegen ea of Environment and Natural Resumes-Dis lion of Wow Resources Raised August 2013

WELL ABANDONMENT RECORD Fort arenn)Use ONLY.
This foam can be used for single or multiple wells
I.Well Contractor information: WELL ABANDONMENT DETAILS
Rich Lenire 7a.Number of wells being abandoned: 1
encior Nacre for well owner peaonafl abandoning well on his/her property) For multiple lrt)erriat .a rx.n-+.exec -s►rppl► ►ells.... ONLY yak the -some
G nstrw A1tI7-'+ahi>ndonmetit.Intr,tut a„luulr smtfwsn
2525 93A
WeltCorbagorCreifirationlYntnber 7b.Appntsirnatc solume of Hater remaining in w ell ls) ONE (gal.)
FOR N ATI.K SUPPLY WELLS ONLY:
SAEDACCO
Conpanl Name lc.'1 s pc of disinfectant used:
2.Well Construction Permit#r
1.1r t Of/,;ysptkrsble well to rmiis a e.( ah'.ire.t urhnri w;/ecu u.err.)fora
741.Amount of disinfectant used:—
3.Well use(cheek weg use):
Water Supply Well: 7e.Scaling materials used(cheek all that apply):
ClAgricuhural ObiunicipaLPublic m Nun Cement Grout 0 Bentonite Chips or Petters
OGcothemmal(Heating/Cooling Supply) Oltcsidential Water Supply(single) ❑ Sand Canso Grow 0 Dry Clay
OhrhrstriaL'Commcrcial ❑ResidesSiai Water Supply(snood) 0 Conctefe Grout 0 Drill Cuttings
Oirrigation 0 Specialty Grout 0 Gravel
Nnn-Water Supply Well: 0 Bentonite Shay 17 Other(es-plain wider 7g)
IMManitonng OReCoven
injection Well: 7f.Yor each autrrial selected abosc.plus ide amount of materials used:
❑Aquifer Recharge ❑Gtoundwaterken►ediation Neat Cam.:1881b ,Wtr:12gal. Sand Cam.:lb ,Wtr:gal.
DAquifer Storage and Reco my DSalinay Barer 0 Aquifer Test °Storrmsmdei Drainoge --
°Eaperimenlal Technology OSubsidetrcc Control 7g.Pro irk a brief description of the abandonment proccdu re:
OGeothenmtal(Closed Loop) °Tracer
TREMIE GROUTED FROM BOTTOM TO TCP.
OGeothetnmal(Heating/CoolingRcoins) OOdicr(explain uncles 7s) —
4.Date wdl(s)abandoned: 8-12-2 0 2 4
Sa Well k,catiun: CP '' 3 2024
WOODRUFF LANDFILL
Faritar/Owner Moor l'.,.,110.mar(rtappbcabk)
R.Certification:
'
500 Howell Rd. Brevard, NC 28712 ° ,,.e/1'sst.r..t� 8/14/2024
PM sic:(1 Address.City,aamd Zip Stgrvaure of ::deed toed CotaracMr oir Well(Meer Dale —
TRANSYLVANIA DV swung this Joan, 1 hereby certify that the *wilts)was(worst-ohetidwted ur
tA,uoa. Pared identmoujeti No.(PiN) accntYltuxa with I s.I.%'CAC O r• t)iOfl or 2(.0200 Well Co,rtnwhon Stmidords
and this a carat rh1.record Ir., h.-en provided to the well owner
Sb.Latitude and longitude in degrees/minutes/scmnds or decimal degrees:
(1f wail felrt this la(,brsg to 5110K/etY; 9.Site diagram or additional well details:
You may use the bad of this grage to provide additional well site details or well
N W abandonment details. You elm also attach additional pages if necessaly.
CONSTRUCTION DETAILS OF WELDS)BEING AHAND9NED �iuBMITTAL INSTRUCTIONS
,lthmtt well cnrnuuction recurdia)if osolldik.. For multiple injection or osm.waier apph'
14 eat ONLY with the aurae cv>tnructliM abondotmeal.low can mtN tit uhrA m IOa. For MI Wells: Submit tins form within 30 days of completion at well
6a.Well[i!6 P6-7s abandonnacnl In the following-
Dirisinn of Water K mill recs.Information Processing Unit.
1617 Mail Scrs ice Center.Raleigh.NC.27699-1617
6b Total w elI depth: 10 (ft.)
t(W.Fnrintectloa Web: 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.
Disislou of Water Resources,Underground Inky/ion Control Program.
lid.Water tcsel helms ground surface: (ft.) 1636 Mail Service('enter,Raleigh.NC 27699-1636
10e.for Water$unnls'& lnicetson Wells: In addition to sending the form to
be.Outer casing length Iif lumen): (D.) the addresses) above, also submit one cops of this form within 30 days of
completion of well abandonment to the county heahh department of the county
where abandoned
(d.Innercasing/tubing length(ifIcatima):.10 (IL)
(.�.Screen length(if knots n1:10 (f.)
Sono(:01.:t North Catotua Department of Emiren:nen:and Natural Rcsoirces-Dh kinn of Water Rtsoruccs Revised August 2011

WELL ABANDONMENT RECORD i-or Internet UtcONLY:
This fonn can be used for single or multiple netts
I.Well Contractor Information: WELL ABANDON MEN'f DETAILS
Rich Lemire 7a.Number of wells king abandoned: 1
(ortmewr Now(or will cosI i us-mount))alsandenbis wen on Miller property) ' movie f*O.., ,w nowstater *apple wells ONLY with the sort,
ourft noa-ad++iu«rancor.writ-or whitest one form
2593A
NC WCiI('nrnnAtlr Ccnlfiatl;oA Number7b.Apprnv imate stibnistibnite.l of water remaining in ee11104ONE (gal.)
FOR WATER SUPPLY WELLS ONLY:
SAEDACCO
Cowan)Name 7e.Type of disinfectant used:
2.Well Cautractian Permit d
tar.r oil apptirubk well"nook ti.e.f:awMv,Seale.l'ariewa>lryacwnus.;em.trfkitorrt 7d. tmountofdisinfYtanttoed:
3.Welt use(ebeclswell use):
Water Supply Well: 7c.Sealing material+used(check all that apply):
❑Agricultural oMunicipaliPublic ®Nem(cnrcnr Gnarl a Bcntonite Chips or Pellets
°Geothermal(Heating'Cooting Supply) ❑Residential Water Supply(tangle) ❑Sand CCmetd Grout ❑ Dry Clay
Dltduurial!Commcrcial ❑Rcsidenial Water Supply:(shunod) ❑Concrete Giout 0 Drill Cuttings
°Rogation ❑Specialty Grout CI Grs el
Non-Water Supply Well: ❑Bentonite Shiny 1)Other(explain under 7g)
ESIMonttoring ❑Recovery
injection Well: 7f.For each material selected ahncc.,pram ide amount of materials used:
DAquikrRecharge ❑GroundraterRentediation Neat Cem. :3761b ,Wtr:24ca1. Sand Cem. :lb ,Wtr:gal.
OAgaifer Storage and Recoset OSalimity Balmier
❑Aquifer Test ❑Stormwater Drainage
DEsperinien tal Technology ❑Sebsidence Control 7g.Prm ide a brief description of the abandonment procedure:
OGeothemtal(Closed loop) DTracer
C7Gettthcrtttal(Hs"tti TREMIE GROUTED FROM BOTTOM TO TOP; 45' ALSO REMOVED COMPLETE
m1g/Cooting Return) DOther(csplain muter 7g)
WELL.
4,Date well(%)abandoned: 8-13-2024
Sat. location: '} 4` 7074
WOODRUFF LANDFILL
S.Certifications
e'y
Facit /Ott acr Name F s no.ID4(ifapplitable)
500 Howell Rd. Brevard, NC 28712 V\c ',.�/irtt.-(.. 8/14/2024
Physical Address.Cm.and Zip Stpult rc otr ::ified Writ Connecter ar Wen°wner Date
TRANSYLVANIA r!t'.ogling thri friar. 1 hereby certify that the well{.r) war twerei dsam avaed in
<.,li t. I.0 l hlerwfic don No.(PiN) accordance with 15A NCAC 02t'.nl00 or 2C;(P1)0 Well Conrtrucht u 57cvulards
and mar a eptw,,fthis reared has warm provided to thriven owner.
!sh.Latitude and longitude in tkitrces/minuteslsceonds or decimal degrees:
id-unit field one raglan$ 9.Site diagram or additional well details:
You may use the back of this page to provide additional well sue details or well
N 3ti' abatdonmetu details You may Mao attach additional pages if mecums:.
CONSTRUCTION DETAILS OF W1:1,IASh BEING ABANDONED 5tJBMI TAl.iNSTRUCTIONI
Altrrtlt will cunsiniel nt rctunlrat rl ussalable. i nr,.wlti le utfectxm ru rxsa•wat0'imppA'
w ells ONLY With the s+nrr EVA-V(tuet1mM a It amiotaa stet a.)ee can sathtatt fate firm. Ina. For Ali Wclh: Submit this form within 30 days of co ion of wall
6a Weil Ii l:P6-7D abandonment In the following-
Dit rune of Water Rcwurues.Information Processing Utdt,
oh. total H oil depth 4 5 (ft.) 1617 Mail Scrs ice(enter.Rakigh.NC 27699-1617
10b.for Infection Well*: In addition to sending the form to the address in 10a
be.Borehole tliamctcr:2 Din.h above.also submit one copy of this form within 30 days of completion of well
abandonment to the following-
Division of Water Resources,I oder:Toned Injection Control Program.
ed.water le%el below ground surface: (ft.) 1636 Mail Seance Ccntcr,Raleigh.NC 27699-1636
6t.Outer easing length(if iuutrwrn): 10 ( � 10c.Per Water Saonh & lniect on Wells;: In addition to sending the form to
the addtess(es) above, also submit one copy of this form within 10 days of
completion of well abandonn►ent to the county health depanatent of the county
where abandoned.
6f.Inner casing%tulong length(if known): 35 {R.)
6f,Screen length of Loin n):10 (ft)
Form►OW.i,• Non)*Catohm Department of Entironn►eni aid Natural Resources-Dh elon of Watcrftsoum-s Reined Aup at 2013

WELL ABANDONMENT RECORD Fortrprrn'i1LcCrv11`
This form can be used for single or multiple wells
I.Well Contractor Information: WELL ABANDONMENT DF.TAII ti
Rich Lemire 7n.Number of wells being abandoned: 1
1\veil Contractor Hanle(or well emir(petsonap)'abandoning Pell on Wier property) For nrodunle fnjernon or rno water swirly wit ONLY with. stir eoee
conorrectionnknnionmen.tad con nitwit one fe n,
2593A
NC t1'cit Cnremktor Cenifiwtien Number 7b.Approximate*idiot of water remalning in ss cti(s) ONE (gal.)
SAEDACCO FOR WATER SUPPLY WELLS ONLY:
Crmpun,Nance 7e.Type of disinfectant used:
2.Weil Construction Pik a:r
Las.dl ryptk-able-well"moire,i.e.Coehty.Se rorkaace Injection.ek•.)fibrin**
7d Amount of disinfectant used:_
3.Welt nse(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
Agricultural I:Municipal/Pubtic 01 Neat Cement Oraut 0 Barconite Chips or Pellets
QGeolhemrvl(NcanttgiCoobng Supply) QRcsidcnsial Water Supply(angle) ❑ Sand Cement Grout °Diy Clay
QMdnstrial/Commercial ❑Residential Water Supply(shared) Q Concreic Grout 0 Drill Cuttings
°Irritation 0 Specialty Grout 0 Gtaael
Non-Water Supply Well: 0 Bentonite Shiny 0 Other(explain Rieder 7g)
®Monitoring QRecovety
injection Well: 7f.For each material selected alxosc.provide anumnt of mite 9abused:
❑AquifeRecharge QGroludwoterRemediation Neat Cem.:3761b ,Wtr:24ga1. Sand Cem.:lb ,Wtr:gal.
°Aquifer Steamy and Rowney QSalinity Flamer
°Aquifer Test OStonowuter Drainage --
❑Experinscntat Technology °Subsidence Control 7 .Provide a brief description of the abandonment procedure:
°Geothermal(Closed Loop) °Tracer
TREMIE GROUTED FROM BOTTOM TO TOP; 45' ALSO REMOVED ALL
°Geothermal(hinuinglCooliiw Return) °Other(explain under 7g)
CASING ABOVE ROCK AT 20' BELOW SURFACE.
4.Date w'ent%)abandoned: 8-13-2024 - -
Sa.Well location: {�
WOODRUFF LANDFILL �Er 2024
Facility/Oarr v.1,1Y r.r.,n,t,Ins tappbeabtr) S.Certification:
ts
500 Howell Rd. Brevard, NC 28712 1 C/:•�/+c�..ts [o ,B/1j/2074
Pbosical A6dm•.,.( n ii Zip Si�ture oft :died Wrtl Cotwat:toror Wel1()wer Dote
TRANSYLVANIA Bt..nro a r,tlrr,Jean, 1 hereby coltfy that the weiline was(were)abandoned to
Parcel Ihts,fKruon No.(PIN) accordance with ISA.b1C-4r't):t' t)100 or 24'-.0200 Weil(onstrucriun Sleon rds
and that a cog%ofthr.e rev or ,;:',t, rn provided to the well owner.
5h.Latitude and longitude in degrees/minutestsecendsor decimal degrees:
ofwell(rid,one larbntg ns sutli:;0.nt l 9.Site diagram or additional well details:
You may the he back of this page to provide additional%ell she details or well
V abandonment detaib You may also attach additional pages if tteeessal.
CONSTRUCTION DETAILS OF WE1,I.1S)BEING ABANDONED a LBMI Tr11.INSTRUCTIONS
Afteth urn emarrrnantn rrurr,fisr S)asmt).,J,k Fier multiple rnjearcm av nm water.uppiy
»etLs ONLY with the some comnrvcnwrrtwnobrra,rmr.JOn own AMMO,One"OM loa. For All Wells: Submit this form within 30 days of completion of well
6a Well IDN:NW-13 abandonment to the farm ing-
Dis'tsioa of Water Resources,Information Praceasing Unit,
1617 Mail Service(:enter.Raleigh,NC 27699-1617
6b.Total well depth: 45 (ft.)
10b,for IntecNgs WdJg: In addition to sending the tome to the address in 10a
above.also submit one copy of this form within 30 days of completion of well
be.Borehole diameter:2
()n,) abandonment to the following.
6d.Water level below ground surface: ( ) Division of Water Resources,Underground Injection Control Proems.
1636 Mail Sersiec('enter,Raleigh.NC 27699-1636
6e.Oattxeasine Icn�th if FBI: 20 ) 10c.for Water Suonlr& Inicction Wells: In addition to sending the form to
the addtess(es) above, also submit one copy of this form within WI days of
completion of well abandonment to the comity health department of the county
6f,lnntleasinwtuhin:,length(If known): {ft.) where abandoned.
6f Screen length of loon nk (ft.)
Form GW 30 North Carolina Derani`sl of Environment and Naomi Resumes-D)sisan of WWI Rt*arid s Reassed Aupia 2013

WELL ABANDONMENT RECORD For lamed Use ONLY'
This form.an be used for single or multiple welts
I.Well Contractor!nfortaation: WELL ABANDONMENT DETAILS
Rich Lemire 7a.Number of went being abandoned: 1
Well Contra-tor Name Mr*sell ou amorally abandoning nett an hisilla pit/tab) for mwtttple lnfeenan ,r nun-water -supply wells ONLY wrrh the tante
co ns/rwasontthaahounent.wits tan swiwelt one fates
2593A
NC Welt Cost UorCcnifw�tioeNumber 7b.Approshn sub
mit ss atwitter (gal.)
taAEDAcco FOR WATER SUPPLY WELLS ONLY:
Company Nana 7e.Type of disinfectant used:
2.Well Consti tetlon Permit a:
t.nl,rdl atnplktsi'k well/worm o.e.Cooney Sink.I:trluncr„brjeti>nrt:ek:)Jfknown
7d.Amount of disinfectant used:
3.Well use(cheek well use1:
Water Supply Well: 7e.Sealing materials used(check all that apply):
QAgricultural DMuncifed/Public di Net!Cement Grow 13 Bentonite Chips or Pellets
Derreothcrmai(Hcating'Cooling Supply) 0Residential Water Supply(single) ❑ Sand Cement Gene 0 City Clay
❑IndustriaUCommcrciai ❑Residential Water Supply(shared) ❑ Conaele Grout 0 Drill Cuttings
Dlrngation D Specialty Grout 0 Gravel
Non-Water Supply Weil: 0 Bentonite Shiny U Other(explain maker 7g)
xMonitomeg OR/Jemmy
injection Well: 7f.For each material selected ribose.puss ids amount of materials used:
❑AquiferRecharge OGioundwaterRentediatton Neat Cem. :3761b ,Wtr:24ga1. Sand Cem. :lb ,Wtr:gal.
DAqutfer Stotagc and Recosery OSnlmity Barrier
❑Aquifer Test DStonnsutcr Drainage --
0ExperimentalTechnology DSubsideneCCanttol 7g.Pro%ide a brief description of the abandonment procedure:
OGeolbermal(Closed Loop) °Tracer
OGeothermal(1{eaung(Cooha Return) IOther(explain under 7g) TREMIE GROUTED FROM BOTTOM TO TOP; 33' REMOVED COMPLETE
Y. •
WELL. '
3.Dote srdl(a)abantbptd: 8-13-2024
S F P S'
1 2024
Si,Well location:
WOODRUFF LANDFILL S.Certification:
FoeilM/Ou ter Name Facility-Kw Cd ipp le)
500 Howell Rd. Srevard, NC 28712 `��`- .,..•Q/r+.t�t� 8/14/2024
PMtital AdJress.Cite.and Zip Stgrusore of" :died Well Commctor or Wed Owner Da*
TRANSYLVANIA By.agwng tine firm*, f hereby cern&Ate she swills) was(wet abamioned ur
Pond Idotairicauon No.(PIN) accordance(rich I¶t:\nut:0 r- ',too or 2C.0200 irsit Construction ion SUnndurrIs
arrd that a cvyn'i ;+cis retard lr:,.�,,•.n provided la doe iaell°wore
Sb.Iatitude and longitude in degrees/minutes/seconds or decimal degrees:
of well field one hoong t5 sdfir:serzt) 9,Site diagram or additional well details:
You may use the bail of this page to provide additional wen she details or well
N. W abandomneutt details. You may also attach additional pages if neceSsary.
CONSTRUCTION DETAILS OF WELDS)BEiNG ABANDONED $IUBMITTAi.INSTRUCTIONS
A/tetlr well cwn+trrivi<wt monks){/,ruslahh. be-mw/opts ogectum e-nun•water.smpply
well)ONLY stab the sante a nturtentwabbandwiment,wis taw submit one form* t0a. For All Wells: Submit this form within 30 days of completion of well
6a Well IDe:P6-4 abandonment to the following
Division of Water Resources.Information Proeesdng Unit.
In,)
1617 Mail Smite Center.Raleigh.NC 27699-1617
6b.Total Neff depth: 33
!Ob.For Inieedoa Welja: In addition to sending the form w the address in t0a
abo*c. also submit one copy of this form within 30 days of cot►q►letion of well
bc.Borehole di:un:ter;2 (in.) abandonment to the following.
Disision of Water Resources,Underground Injection Control Program.
b(1.Water lesel burns ground w rfacc: Ifs.) 1636 Mail Sees ice Center,Raleigh.NC'27699-1636
10e.for Water Sunni & inkction Went: in addition to sending the form to
6e.Outer casing length(it known): ( ) the nddress(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 cassnoltubing length(if known):23 Lk) where abandoned
68.Screen length(if Limn to:10
Form OW-30 North Carolina IAyatutt n of Environment and Natural Resources-Dis ton of Water Resources Reused Auerst 2013

•
WELL ABANDONMENT RECORD i-urtntt:rntilUscONLY:
This form can be used for single or multiple stelis
1.Well Contractor Information: W'F:Lt.ABANDONMENT DETAILS
Rich Lemire 7a.Number of wells being abandoned: 1
N'�lI('oriracirn h,,ll t°'fCIIOCa7PenamiHly:ab0140111S sell on hirte'her progeny) w m'iulrft lg1ertion aatt-wirer Gam�.p��ly was ONLY nab the sa�rie
cW ttettenvecahathl[WM ..what onn mtl .}��a,W, e rtr1e
2593A
NC Wet Contractor GettifrcatieaMambo 7b.Approximate volume of watts-rermaining in'e ell(s)140NE (gal.)
FOR WATER SUPPLY WELLS ONLY:
SAEDACCO
Cana:any Name 7c.Type of disinfectant used:
2.Weil Coratnictian Permit tl:
i.uj all applicable well;termite ic.e.Coolly,Ste$.rariewor.Iiyeale*.,ekk.}Poona 7d.Amount of disinfectant used:
3.Well use(cheek well use):
Water Supple Weil: 7c.Sealing materials used(check all that apph):
CIAgfiCuhural CIMunictpaLPublic 11 Neat Cement Grout CJ Bentonite Chips or Pellets
C3Gcothcmul(Heating/Cooling Supply) Dltcsidennal Water Supply(sing/*) ❑ Saud Cement Gran 0 Dry Clay
Cltrduairial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
Olrrigation ❑Specialty Groin 0 Gravel
Non-Water Supply'Well: Cl Bentonite Shiny 0 Other(explain under 7g)
i10Monitoiing ❑Recovety
Injection Well: 7f.For each material selected above.provide amount of materials used:
❑Aquifer Recharge OGrounduater Reinedimion Neat Cem. :3761b ,Wtr:24ga1. Sand Cent.:lb ,Wtr:gal.
❑Aquifer Storage and Recover OSalinity Barrier
❑Aquifer Test ❑Stounwater Drainage
oExpeiintertalTechrobgy ❑Sabsidctre Control 7g.Provide a brief description of the abandonment procedure:
cGeothenitai(Closed Loop) DTracer
TREMIE GROUTED FROM BOTTOM TO TOP; 38' PULLED COMPLETE WELL.
OGeotliernial(if calm ngCoolmg Return) ClOtter(explain unttr 7);l
4.Date wef(s)abandoned: 8-13-2024 •,a.`. ,
sae Well location: S E P 9 4.i 2024
WOODRUFF LANDFILL8.CttYhlica11an1:
Faciinvow err Mont: Fiches 1D4(itneel i iblc)
500 Howell Rd. Brevard, NC 28712 8/14/2024
Pay Scat Address.CM.tad Zip Siiutme ode. :stied Well Coiurusnr or Well Owner Date
TRANSYLVANIA By signing this firm, I herby cer*that the wellial was twerel abandoned us
(MIA) Pareel Ideferi'tiion No(PIN) aeconfianwe watt i5A NCIC 0 r' WOO or 2C,02200 WW1 Construction Sl'andstrdc
and that a cam,of three record h., hre•i provided la the teen owner.
5b.Latitude and longitude in ekgrresfmnt uteslxcnndc or decimal degrees:
(if well frig oft:sot long to vilh.t..a; 9.Site diagram or additional Nell details:
You may use the bats of this page to provide addtiOnal sell site details or well
N W abandonment details. You may also attach additional pages if neceasaiy.
CONSTRUCTION DETAILS OF WELIAS)BEING ABANDONED $Ul11%1ITTAL INSTRUCTIONS
dart*well cwvraarictirst reevrdtsn If atialal,k. Me mnlopk ayechate rev arm-Baum supply
writs ONLY with the Rune canthwetivlttbandownent.jar can Silturtt one pm_ 10a. For All Wei Submit this form %tithin 30 days of completion of well
6a Well @p•P6-3 abandonment to the following-
Division of Water Resources,Infornwtam Processing Wait.
db Total well depth: 3 8 (It.) 1617 Mail Service Center.Raleigh.NC 27699-1617
lOb.For latecttoa Wells: In addition to sending the form to the address in Ida
6c.Borehole diameter.2 On.) abandonment
also submit one cops of this form within 30 days of completion of sell
abandonment to the following.
tell Witter krd below grouted surface: Division of Water Resources,Underground Injection Control Program.
1636 Mail Service('enter,Raleigh.N('27699-1636
10c. For Water Sunnis'& ink'ctlon Wells: in addition to sending the form to
6e.Outer casing length(if larewn): 0 (ft.) the addresses) above, also submit one coy of this form within 30 days of
completion of well abandonment to the county,' health department of the county
6t;Innereasing/tubing lea ltb(Uia ewe): 2 8 tit.) wherebandoned
6g.Sates length(it ImowasX 1° (ft.)
funs GW 10 North Carotins Dilemmeil of Estirooatcnt and Natural Rcsoiates-Di%atom of Water er Rcsowacs Revised August 20(3

WELL ABANDONMENT RECORD For Internal Use ONLT
This form can be used for shale or multiple wells
1.Well Contractor Information: WELL AB NDONMENT DETAILS
Rich Lemire 7a.Number of wells being abandoned: 1
t1 ^t u!AMC kV Nance aorwtUoenspasonaU)sMndmrumwell on hitthtrptoprn)l 1 fir satinets* tnoecrun or sew-voter soar* wells ONLY milt ;, ,
toporteaseirolhesdoo rout c.,rt cost*door me.tioe
2593A
76.Appnrtinsatc%ulunae of water remaining in,well(s1FONE (gai.t
�('Well Corhaeter Certification Number
FOR WATER SI:PPII.I ►►FLIS ONLY:
SAEDACCO
Company Name ic.T:i pe of disinfectant used:_-
2.Well Construction Permit k:,
La LSI ul plicablr rmtt"roots r;e.Gwent'.Awe,rotriattest,injethos,eke!fft'Moro 7d.Arnonut of disinfectant used:
3.Welt use(cheek well use):
Water Supper Well: 7e.Sealing materials used(cheek all that apply):
ElAgricultural °Municipal/Public ® Neat Cement Grout Q Bentonite Chips of Pellets
O(icothermal(HcatingiCoohng Supply t °Reside tial Water Supply(Single) O Sand Cement Gnat C7 On C'kty
DtndustrialIComauserc,ia) ❑Residertiat Water Supply(slimed) 0 Concrete Grout ❑Drill Cuttings
Obligation O Specialty Grout 0 Gravel
Non-Water Supply Well: U Bertonite Sleety 0 Other(explain under 7g)
aliMututoring OReco tety
Injection WrU: 7f.For each material selected otiose.preside amount of materials used:
❑Aquifer Recharge °GroundwaterReniedutton Neat Cem.:2881b ,Wtr:18ga1. Sand Cem.:lb ,Wtr:gal.
❑Aquifer Storage and Recovery OSalinity Barrier --
°Aquifer Test OStonnwater th:irrage
°Experimental Toehnoiogy °Subsidence Control 7g.Preside a brief description of the abandonment procedure:
OGeotherund(Closed Loop) OTracer
CIGeothemtal(Heating/CoolingReturn) °Other(explain utder7gi TREMIE GROUTED FROM BOTTOM TO TOP; 28' PULLED COMPLETE WELL.
4,Date wells)abandoned: 8-14-2 024
So.WA location:
WOODRUFF )
WOODRUFF LANDFILL 8.Crttilication: If,:
FoeilinfOaoer Nana frailty ION t if upptxabkt i.
500 Howell Rd. Hrevard, NC 28712 01 G , di..t.- 8/14/2024
Phy si::,I Address.CM,and Zip Snoutwe Arc._: tdd Wd Contractor or Well Ow-rer Ihrre
TRANSYLVANIA By saginng this forth i hereby cntttf that the u r11:tt it t r+rrei abantlemed as
t'uuot) Parcel kkatatkatieu No.(PiN) ac<onlota°e with ISA 1, it'02(7.0100or2C",(100if'ell Construction Standards
and thirt a copy of"tlrr.r ttrd hay been provide/to the-well owner.
Sh.Latitude and longitude in degree./minutesfseconds or decimal degrees:
if well field.one krt;lnrrg is siSxscn i 9.Site diagram or additional well details:
You tray'use the bad pae prov additinal well site details or well
N W abandontrett detail. Youof maythis alsog attach addideitionalo pages if.mectrssaiy.
CONSTRUCTION DETAILS OP WELUSI BEING ABANDONED ;i}BMITTAi.INSTRUCTIONS
Moth well comb-action reccrofim)if available.":Fear eurlrtpte aytdan:fAr rmon.Wale'apphv
setts ONLY with the same Voss nscnott abort onstt'rot.os ca'i mitosis isw fmmat 10a. For AU Wells: Submit this forth within 30 days of completion of well
6a.Welt ID.:P6-5 abandonment to the following:
Division of Water Resources.Information Processing kTult.
6b Total well depth: 2 e (II) 1617 Mail Service Center.Rakich,NC 27699-1617
10b.for Weeders Wd: In addition to sealing the form to the address in 10a
6c.BomMrlr diameter,2 �) above.also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources,Underground injection Control Program.
64.N titer level below ground ul thee:- (ft.) 1636 Mail Sees-ice Center,Raleigh.N('27699-1636
IDe.For Water Sunnis& Inieetlon Wells: In addition to sending the form to
6e.Oster ca sing length Iif►:newts: Ift•) the addrecs(es) above. also submit one cops of this form within 30 days of
completion of well abandonment to the county health dcpanneta of the county
tit..fR s ing/tulting length(if itaawn);-18 (ft.)
where abandoned
6E.Settee kugt6(if known):io (ft)
FormGW-)(a North Camino DepatutszntofEmironnent and Neural Resources-Dim ism of Water Rcsoura-s Rey tied August NW

WELL ABANDONMENT RECORD '
Rif llrterruni Use ONLY'
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Rich Lemire 7a.Number of wells being ahandoeed: 1
Well Contractor Name(or well ow ner personath abandoning well on Wier property) F,v rumple etlletrrrur t~ nor-wars supply well. ONLY with the same
o nsoweouwahise*omenr,sue taut sulwur cure film
Well 7b.Approximate stibnite of water remaining in a tilt sl#TONE tgat.)
Ni Well Contractor Certification Number
SAEDACCO FOR WATER SUPPLY WELL`ONLY:
Coogan Nan w 7e.Type of disinfectant used:
2.Well Construction Permit 0:, ,
•
1 all q,p6cable well^entity iev.(wank Slat?,l irtance.lr eel ihai,ele.l if totee 7d Amount of disinfectant used:_
3.Welt use(check well use)
Water Supply Well: 7e.Sealing materials used(cheek all that iipplr):
°Agricuhural plvtuniciperl;Pmrblic 61 Neat retool'Grout 0 Bentonite Chips or Petters
°Geoihcmul tHcatIng/Cooting Supply) °Residential Water Supply(single) 0 Sand Cement Grout ° tin Ckn
L1lridusteallCommercial °Residential Water Supply(shared) ❑Concrete Grout ❑Mill Cuttings
❑trtigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: I7 Bentonite Slimy 0 Other(explain under 7g)
®Monitoring °Recovery
Injection Well: 7f.For cacti material selected ahiot.prrrside anment of materials used:
°Aquifer Recharge °GtoundwaterRerediation Neat Cem.:941b ,Wtr:12gsl. Sand Cem. :lb ,Wtr:gal.
°Aquifer Storage and Recovery ❑Salinity Barer
°Aquifer Test ❑Stormnatcr Drainage --
°Experimentai Technology ❑Subsidence Control 7g.Pnnirk a brief dcseriptinn of the abandonment precederr:
DGeothermal(Closed Loop) °Tracer
OCreoftmetntellHecuingrCoolitRBRelurru p(Jdser(e�7slainur►Acr'.)1 TREMIE GROUTED FROM BOTTOM TO TOP; 18'PULLED COMPLETE WELL.
4.Date well(s)abandoned: 8-14-2 0 2 4
Sa.Well kreath,n: •3 E P 2824
WOODRUFF LANDFILL
S.CertUkatiaq:
FaKI)rh(h+r�,'r V;u,x 1..,01 tt Ilit iII applv.iblc.
500 Howell Rd. Brevard, NC 28712 ' r'^� tl1 ,.Q/Mt..-tom 8/14/2024
Plissieal Address.Cts.and Zip Si W,wc ii r :rlrcd Well Conuai,uur nr Well Owner Date
TRANSYLVANIA liv-ogmag lltrs front, 1 hereby eertr/y that the meths) was leery)abandoned in
Parcel ldcout'icad oe No.(PIN) aceOhionce willl It 4:\'C,IC OX .0/0o or 2C,0200 i1:'ell i'anafr ei an Standards
and that a ern o f this record has been provided to the well owner.
Sh.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
tit well field,otrc tautow n sufficient) 9.Site diagram or additional sea details:
You may use the back of this page to provide additional well site details ot well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELI.(S!BEING ABANDONED $UBM!T1AL INSTRUCTIONS
:loth well tvO,ieNcO nt recorclia,et.j eitd,ie. Liar ma/614e trrjeanrn,r nun-wetter espial,,
n:y1.Y with the snore twunucowc gi ae*.n+oreat./ur c,im tathmu cvrr Joni 10a. For All Wells: Submit this form within 30 days of completion of well
6a Well WO:P6-2 abandonment to the following-
Division of Water Resources.Information Processing Unit,
1617 Mail Service Center.Raleigh,NC 27699-1617
oh.Total well depth: 18 (ft.)
leb.For Intention Wd j: In addition to sending the form to the addtess in 10a
abme.also submit one copy of this form within 30 days of completion of well
oc.Borehole diameter:2 (in.) abandonment to the following-
Disisioa of Water Resources,Underground injection Control Program,
del.Water Iced blow ground surf ct Ot) 1636 Mail Settler Center,Raleigh,NC 27699-1636
10e.For Water Sunnis& Infection Well}: In addition to sending the form to
6c.Ol4ereasing length of low*n): (t't.) the addressees) above. also submit one cops of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned
6f.Inner casin+itlei mini;Ion+u li of hem%II): 8
614..Scrern length(if knot%n):10 (ft.)
Form s GW-. Non).Carolina Dcuutaxel of Environment and Natural Res cones-Division of Water Resources Het sed Aupast 2011