Granville_Well Abandonment_20241001

YY L'LL ___._ABANDONMENT.____ RECORD
JForinlcnml Usc ONLY:
i.Wellettraclor Information:
WELL ABANDONMENT DETAILS
a,.*?' 0 0
7a.For GcoprT or Closed-Loop Geothermal Wells having the same
Well Contractor Umna(or I ow,crpersonally abandoning well on hisgtcrpropcny) well construction/depth,Only)fGW-30 is needed. Indicate TOTAL NUMBER of
16 r—A wells abandoned:NC Well Contractor Certification Number 711.Approximate volume of tvaler remaining in well(s): gdV/, (gal.)
N.W. Poole Well & Pump Co. FOR WATER SUPPLY(YELLS ONLY:
Company Name •
7c.Type of disinfectant used: HTH
2.Well Construction Permit#:
/.Lon all applicable Iracatrtrnetian pumas(i.e.U/C Cannot.Stara•Parlance,ate.)if known 1/2 lb.
7d.Amount of disinfectant ustd: •
3.Well use(check well use):
Water Supply Well: 7c.Scaling mater•1als,uscd•(cheek all tha a l :
l7Agriculutral t, (tP))
❑Municipal/public 0 Neat Cement brpuh_•
OGeothcnnal(Heating/CoolingSupply) -••'•...� `v' t-.,_�entonitc Chips or Pellets
pp y) iesidcntial Water Supply(single) ❑Sand Cement Gro
❑Industrial/Comntcrcinl rid J 1 2024 0 Dry Clay •
ORcsidcnlial Water Supply(shared) O Concrete Grout �r l/
°Irrigation0 Drill Cuttings
Nun-Water , ,SpecialtyG(pu: A:.., »... ',ravel
-•�
°Monitoring 0 Bcntonitc Slurry "i i;c LZ•iy 0 Other(explain under 7g)
°Recovery
Injection Well:
7f.For each material selected above,provide amount of materials used:
0/Aquifer Recharge OGroundwater Remcdinlion � �fg OAgttil'er Storage and Recovery °Salinity Barrier
C�.`�r- 5:9.40.46/6°Aquifer Test OStonnwater Drainage egmevarAucalia
/35:D Le0
°Experinmental Technology °Subsidence Control
7g.Provide a brief description of the abandonment procedure:
OGcothcrnal(Closed Loop) OT'raccr
❑Geothermal(Heating/Cooling Return) °Other(explain under 7g) -Pli+� 1)
04-
41:1L
f
4.Date tivdl(s)abandoned: k
•
Sa.Well location:
Facility/Owner Name Facility IDlf(ifapplicable) 8.Certification:
•
- 1240 Physical Address,City,and Zipdte 2 7 4J Q /�
tore of ifed Well Contractor or Well Owner Date �i 1
6# 4& katiL
By signing this form. I hereby certJr that the well(s) was(here) abandoned in
County parcel Identification No.(PIN)
accordance with I-c.4 A'C4C 02C.0l00 or 2C.0200 Well Construction Standards
5b.Latitude and longitude illdegreeshninutes/seconds or decimal degrees: and than a copy of this record has been provided to the wet/owner.
Orwell field,one lal/loan is sufficient)
/ Y n� � ' f1 a (� h�� 9.Site diagram fir additional well details:
Q v •
SIT N e �a_` t - + 11r 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 WELLIS)BEING ABANDONED
Attach well camstnrala,record(s)lfotallable. Irormultiple injection ornoli-u'alcrsitpplvwepa $UBAi1TTr1L INSTRUCTIONS
ONLY•with the.came construction/abandonment.you can suhrnit one farm.
10a. For All 1Vellb: Submit this form within 30 days of completion of well
C,a.11'ell 11)11: abandonment to the following:
(rb.Total well depth:� c ( t Division of Water Resources,Information Processing Unit,
f ) 16(7 Mail Service Center,Raleigh,NC 27699-1617
n
10b. For Inlectimt Wells: In addition to sending the form to the address in 10a
6c,Borehole diameter: (in-) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
35"
6d.Water level below ground surface: (ft.) Uivisiott of Wor wn ter Resources.Underground Injection Control Program,
I63G Mail Service Center,Raleigh,NC 27699-1636
Ge.Outer casing length(if Icnown); q J (ft.) .I0c.For Water Sunnly&Injection Wells: In addition to sending the fonn 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
61.Inner easing/tubing length(if known): (ft.) abandoned.
6g.Screen length(if known): (IL)
Form G W-30 North Carolina Department of Environmental Quality-Division of Water RCsources
Revised 3-22-20I6

rV.tJLL ABANDONIVIENT RECORD
• For Internal Use ONLY:
I.Well onfrac(or Information: WELL A13ANDONA•IEN'r DE'CAILS
4 R Mk 6)13 7a. For Gcuprobe/UPT or Closed-Loop Geothermal Wells having the same
Well ',4"'odorName(or/fall owner personally abandoning well on hisil,cr properly) well construction/depth,Only 1 W-30 is needed. Indicate TOTAL NUMBER of
'III wells abandoned:
NC Well Contractor Ccrtificailon Number 7b.Approximate volume of water remaining in well(s): .�Xf (gal.)
N.W. Poole Well & Pump Co. FOR\VATrx SUPPLY WELLS ONLY:
•
Company Nnnic F-ITH
7c.Type of disinfectant used:____
2.Well Coustruclion Pe nli(IY:
l,i.r,all a/plicnble+r&I cnn.rlrnerinn permits(i.e. UWC.Corm(,{Srnra, Variance.ore.)ifknmma 1�2 I b.
•
7 1 Amount of disinfectant used:_
3.Well use(check well Ilse): —
Water Supply\\'ell: 7c.Selling materials used(check all that apply):
❑Agricultural °Municipal/Public 0 Neat Cement Grout -.
OGcothcrmal(I leating/Coolin Supply) . 3cnlonilc Chips or Pellets
b csidcntial Water Supply(single) 0 Sand Cement Grout— �•''`'•• . •�" ' _ 0 Dry Clay •
❑ln(luslrial/Conrncreial ORcsidcntial Water Supply(shared) 0 Concrete Grout rout OCT0 1 2024 0 Drill Cuttings
Nmr-gamer Supply Well: _ Specialty Grout Gravel
Ocni-Wn r ng 0 l)cntonitc Slurr?:F :{r ''7,•y ;:.„
°Recovery : 0 Oihcr(explain under 7g)
Injection Well:
71. For each material selected above,provide amount of materials used:
OAquitcr Recharge °Groundwater Rcmcdiation i/l
OAquilcr Storage and Recovery /�6 v vai. _ /-3--,-
°Salinity Barrier ),, —_n ! A
❑Aquifer test OSlonnwater Drainage g/ �j?Air LFf/ :Je/ • / //LSs
OLxperimental Technology OSubsidctice Control ! /� (� (/
°Geothermal(Closed Loop) °Tracer 7P.1'rovidc a brief description of the abandonment procedure:
DGcolhcrnial(Heating/Cooling Return) ❑Other(explain under 7 ) p1,7 / 6,04411 /.._ 11.. D SO J aAJ1 T�.
% 6 4. Date well(s)abandoned: I "5ih-
�
5a.Well location: 6U /7P —
A 44 lttR4 W€1 I —
Feerlit)'/°ouch Name Pncilily IDll(i(applicable) 8,Certification:
rerk -57-7 . 4, ,_.,4e --- ....
Physic Address,City,and Zip V^', '7
hire of Cc tied Well Contractor or Well Owner Mc
Cout)' Parcel .signing this loin,. I hereby cent f,/hni the well(s) was (were) abandoned in
I arcel Identification No.(PIN) accordance with 1?.I A'C.dC 02C.0100 or 2C.0200 Well Construction Standards
5h.La li lade and long and that a copy of this record has been provided/o the well owner.
IUIdC ill dCgl'eCs/minutes/seconds or decimal degrees:
(irivelt Field.ace lal/loan is sufficient)
`-ir n s y��. ����s 9.Silo diagram nr additional well detail:::
G V t�• N CR `, You may use the back of this page to provide additional well Site details or well
abandonment details. You nay also alttLCll additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED
Urachu-e//cansollellonrecord(s)lfavailable. For multiple injection organ-u•arcr supply nwells SUBMITTAL t'AI,INSTRUCTIONS
PA'L 1'mitlh the snare cmrsn ucrlmr'nbrnlr/nlunen/,you can suhmit one form.
10a. For All Wells: Submit this form within 30 [lays of completion of well
6a.Well ID/l: abandonment to the following:
,�} L;
Division of Water Resources, formation Processing Unit,
rib.Total well depth: �'�� (ft,) 1617 Mail Service Center,Raleigh,NC 27699-1617
10h. For Infection Wells: to addition to sending the form to the address in I0a
6c.Borehole diameter: (in.) above, also submit one copy of Ibis form within 30 days of completion of well
abandonment to the following:
t`
6d.Water level below ground surface: 34> (ft.) Division of Water Resources,Underground Injection Control Program,
3 163G Mail Service Center,Raleigh,NC 27699-1636
q 2
6e.Outer casing length(if known): (ft.) IOc.Fur Wit(Cr Simply(Si:In(Minn Wells: In addition to sending the form to the
address(cs)above,also submit one copy of this loon within 30 days of completion
of well abandonment to the county health department of the county where
6f. Inner easing/tubing length(if known): (ft.) abandoned.
6g.Screen length(if known): (1-1.)
Porn,G\\'-36 North Carolina Dept-lumen!of Environnieutal Quality-Division of Water Resources
Revised___2_77_2
016

r r JIUJt.1.L ADA.1NpuiNM.ENT RECORD
—
For Internal Usc ONLY:
1,11'cl''Contractor Information: \1'IsLL A13ANDONi'Il NT DETAILS
WeItn�r ' /1)44041P 7a. For Gcoprobc/DPT or Closed-Loop Geothermal wells having the same
trnelorNanm rwall owner personally nbando,r ns well on his/her property) well construction/depth,Only I�W_30 is needed. Indicate TOTAL NUMBER of
9/ A
jb� wells abandoned:
/���' ..r
NC Well CortlraclorCc:lincotion Numbc+ 7b.Approximate volume of tvaler remaining in well(s): �•�' (gal.)
N.W. Poole Well & Pump Co. Vol tVATER SUPPLY WELLS ONLY:
Company Nam •
I-ITH
7c.Type of disinfectant used:__
2.Well Construction Permit N:
Lis,n//r/rplic•nblo moll cmn.d,•uclion parnri/.r(i.o. U/C.Cams/,,S,n°, Variance.etc.)ifknnu'n .i�2 lb.
7d.Amount of disinfectant used!_1
3.Well use(cheek well use):
Water Supply Well: 7c.Scaling materials used(check all that apply):
❑ngricunural ❑Municipal/Public •,
❑ Neal Cement Grout Xt3cntonitc Chips or Pellets
C1Gcothcrntal(Heating/Cooling Supply) "' • '��•• '� 4..ply) K5idcntial Water Supply(single) 0 Sand Cement Grout
❑Industrial/Conuncrcial OC T J 1 2024 0 Dry Clay
ORcSidcntial Water Supply(shared) ❑ Concrete Grout
❑Irrigation 0 Drill Collings
Nan-water Supply Well: Specially Greta.,, {: �, . :- Gravel
OMoniloring 0 Bentonite Slury D'W..:cl il;i 0 Oilier(explain antler 7g)
❑Recovery
Injection Well:
71.Ftn•end]material selected above,provide amount of materials used:
OAquil'cr Recharge ❑Groundwater Rcntcdiation
❑Aquifer Storage and Recovery ❑Salinity Barrier
� � /� �� ,�
❑Aquifer Test ❑StonnwatcrDrainage Si 'f)f ii- W t
❑lixperinlenlal Technology ❑Subsidence Control v —� D� ""
❑Geothcrnlal(Closed Loop) 1771'accr 7tkPjr��ov�idc as brief description or tl a abando,nucnt procedure:
DGeothermal(hleating/Cooling Return) ❑Other(e.xplain under 7g) _L 6-344(1
'. 727-1,44--F- €0641 t
d.Date tvcll(s):tbaudoucd: y 1Zi6
Sa.lVcll location: '^
4/���44 i -//j/' f V V I I ?j •
Faciliq/Onner Name Facility.IDIi(if applicable) 8.Certification:
,ysicil Address,Cat,and Zip
r'/i.`2L,1V
Zt;
/J� /)/y',1 / � 5rin one of Cc, filed 1 ell Con:rrc:or or We lI Owner t fe iL
nJ`/,�i�9i Parcel((lentil-tendon No.(PIN) By signing this tor•m tip dial. 1 here/v cart dial the Ire//(s) was (were) abandoned in
ity
ncco,•dm,ca will,15•1 NC:1C 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 ha.obeeu provided/o the ue//goner.
(if well field.anc Iat/long is sufficionl)
3l n C • Ln �(�' �, r 9.Silo diagram nr addilinnul well dclails:
vlY N � y pD 11 You may use the back of this page to provide additional well silo details or well
abandonment details. You may also attach additional pages if accessary.
CONSTRUCTION DETAILS OF WELL(S)13LINC ABANDONED:Irrochwe/lconsnvctionrecorrl(s)Ijarailable. For multiple injection ornou-a•ater supply wells SUBMITTAL INSTRUCTIONS
On'L.1'with the salve cnnslrlction!rrhontlnn,ncnl,you can submit rme jorur.
10a. For All Wells: Submit this form within 30 days of completion of well
Ga.Well II)ll: abandonment to the following:
i�s Division of Water Resources,Information Processing Unit,
6b.Total well depth: 1 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
106. For Injection Wells: In addition to sending the form to the address in 10a
Gc.Borehole diameter: (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
r---.
Gd.Water leycl below ground surface: (ft.) llirision of Waled'Resources,Underground Injection Control Program,
,� I636 Mail Service Center,Raleigh,NC 27699-I636
t
Ge.Oct er casing length(if i(uotvn):
(ft.) .10e,For Water Snugly& Inlet:lion('Veils: In addition to sending the form to the
address(cs)above,also submit one copy of this fonn within 30 dnys of completion
of
6f, tuna'casing/tubing length(if lutotvn): ~� (ft.) ofawell abandonment to the county Itcollh department of the county where
d.
6g.Screen length(if known): (ft.)
Pores OW-30 North Caroline Department of Cnvironliwntal Quality-Division or Waier Resources
Revised 2.32-1016

rrLLL ABANDONMENT RECORD For Internal Use ONLY:
I,Well tractor Information: WELL ABANDONMENT DETAILS
DY ` - i A)1dRilk/VD 7;1.For Gcuprobe/DVT or Closed-Loots Geothermal Wells having the sarnc
Well Contractor Name(o%yell o,oncr personally abandoning,yell on Lis/hcr properly) well construction/depth,only I Ci W,30 is needed. Indicate TOTAL NUMBER of
�w `c wells abandoned:
' !/ L/sue? .... f/}`
NC Well Contractor Certification Number 71).Approximate volume of water remaining in well(s): ��•� 4�(gal.)
N.W. Poole Well & Pump Co. FOR WATER SUPPLY WELLS ONLY:
Company NameI'"I-rH
7c.•I'ypc of disinfectant used:__
2.11'ell Construction Permit ti:
1,1„all ryr/VicnLle well cnarbvafimr permll.r(i.e. UIC..Canby,S/nle. rinrinnee,We.)ifkumru 1/2 lb.
7ti.Amount of disinfectant used:_
3.Well use(check well Ilse):
water Supply Well: 7c.Scaling materials used(check all that apply):
°Agricultural ❑Municipal/Public 0 Neat Cement Grout
°Gcothcrntal(l�leating/Coolin'Supply) /- .�3cnlonilc Chips or Pellets
b pP y) �tesidcntial Water Supply(single) O Sand Cement Grout a.,. -_
Olnduslrial/Conuncrcial ORI Dry Clay
csidcntial Water Supply(shared) 0 Concrete Grout OCTOT 0 1 2024 0 Drill Cuttings
Olrrigalion
Nun-}rater Supply Well: Et Spccialt)'Grout Gravel
❑Monitoring 0 13cnlonitc Slurry Ga`r`f '3t:.� 0 Other(explain under 7g)
°Recovery
Injection Well:
7f. For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groutldwatcr Rcmcdiation
°Aquifer Storage and Recover • UAL �'/Q�
Y ❑Salinity Barrier `-•_•�,
°Aquifer Test 0Slortnwater Drainage g / 1P/11r1 ,114,4 :_ j2
DExperintental Technology °Subsidence Control
°Geothermal(Closed Loop) °7 'acer 71:.Provide a�briief description of the abandonment procedure:
°Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Pur G,T ✓ 1- n,v1�' , b� ' / 11"ii[..I )J%t V/�/�1 !. _
!.Date well(s)ab:uulunc0: — � ' `� '
5a.Well location: �" • , f��
Facility/Owner liaise Facility ID/I(if applicable) 8.Certification:
&zaz-,0
(;Agiuk-_,,i0 A)401)e ,,e.4:5,--,
Physical Address,City,and Zip rid'_' /z----4 ��. /1 f�
w _ ��� ��i �i �5{{{guanine o nified Well Contractor ur 'iclI Owner p;ttc �L(il`�
County
Y�ATV/tY) Gi�(�/ parcel tdentificatinn No.(PIN) Q.'signing ibis form. I hereby curl fit,that the well(s) was (were) abandoned in
J
acc-ordmrco n.i h l SA,V .-lC 02C,0100 or 2C.0200 li'ell Construction Standards
51).Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a co!{) rldu:r record has been provided to the well ou'uer.
(if well field,one lal/Inns is surfeim,Q
3& (� � y �, t3y '. 9.Site Diagram or additional swell details:
v—{ n � N W You may use the back of this past to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF 1Vt;LL(S)BEING AI3ANDONL'-D
•Inad,well construction record(s)ifavailable. For multiple injection ornon-lralCr supply wells SUBMITTAL INSTRUCTIONS
OA'l,1'u'itlt the same ctnrsnvcrionrabnndonnen/,you can submit tutelar'''.
10a, For All Wells: Submit this form within 30 clays of completion of well
Ca.Well Mil: abandonment to the following:
Division of Water Resources,Information Processing Unit,
Pb.Total well depth:_� (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1(.17
lob. For Injection Wells: In addition to sending the form to the address in I0a
Gc.ilureltole diameter: �,li (ill.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Gd.Water level below ground surface: �1 (ft.) Division ol'Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
Gc.Outer casing length(if known): / A- (ft.) .1Oc.For Water Sunni& Infection Wells: In addition to sending the form to the
atldress(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, littler casing/tubing length(if known): (ft•) abandoned.
Gg.Screen length(if known): (ft.)
Form G W-30 North Carolina Dcpartuwot of-Environmental Quality-Division of Waler Resources
Revised 3-22-20I6