Durham_Well Abandonment_20231204

WELL ABANDONMENT RECORD porintemalUseONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Frank Beecher 7a.For Geoprobe/DPT or Closed-Loop 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
3225-A wells abandoned:WA !
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 0.32 (gal.)
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: N/A
List all applicable well construction permits(i.e.WC,County,State,Variance,etc.)iflmown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout R Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry •
0 Other(explain under 7g)
(Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Chips-26 Pounds
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑AquiferTest ❑StormwaterDrainage Water-2.00 gallons
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of theeabandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer !
OGeothermal(Heating/Cooling Return) ❑Other(explain under 7g) Slowly filled monitoring well with Bentonite Chips while checking to
ensure that bridging is not happening,then added water.
4.Date well(s)abandoned: October 24, 2023
The well was abandoned in accordance with
5a.Well location: 15A NCAC 02C .0113 .,.
Speedway 6971 0-015516 5 ,ti w, ,; , `.�
Facility/Owner Name Facility TDb(if applicable) 8.Certification: a 1` `.'m''a'
P.
803 E Geer Street, Durham, 27704 rj__ &e •',Drr 0 ' Nti 91
vedtber21,2023
Physical Address,City,and Zip Signature of Certified Well Contractor or Wellii'w,fip c,n p,-r,.;Datet,V2 1,s`s
n
Durham 8032-50-73-5548 ! � a-�;
WOG
By signing this form, I hereby cert(fy that the wen(s) was(Were)abandoned in
County Parcel Identification No.(PIN) accordance with 1SA 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:
36.0039452 N -78.8796570 `,1, 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-watersupplywelts
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 ID#: M W-21 abandonment to the following: J
1
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 13.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter 2'0 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following: 1
6d.Water level below ground surface 6.92> (ft) Division of Water Resources,,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
6e.Outer casing length(if known): N/A (ft.) 10c.For Water Supply&Injection 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
6L Inner casing/tubing length(if known): 3.0 (ft.) abandoned.
6g.Screen length(if known): 10.0 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
I

r
WELL ABANDONMENT RECORD For internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
i
Frank Beecher 7a.For Geoprobe/DPT or Closed-Loop 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
3225-A wells abandoned:WA
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 0.20
(gal.)
• AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#: N/A
List all applicable well construction permits(i.e.U/C,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 1 iI! Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
UMonitoring 0 Recovery
injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Chips- 14 Pounds
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Water-2.00 gallons l'
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of theabandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer I
Slowly filled monitoring well with Bentonite Chips while checking to
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
ensure that bridging is not happening,then added a water.
4.Date well(s)abandoned: October 24, 2023
The well was abandoned in accordance with
5a.Well location: 15A NCAC 02C .0113".
Speedway 6971 0-015516 ; E- -
8.Certification: 1 ` k-�,11.,�_,` ' -•• �1 Facility/Owner Name Facility Mg(if applicable) � :.r: i, ' y
803 E Geer Street, Durham, 27704 ;Lr t`` rr 0 ; ZAI vember21,2023
Physical Address,City,and Zip Signature of Certified Well Contractor or Wel Owner Date
Durham 8032-50-73-5548 By signing this form, I hereby cert(fy that theQvell(b))�trsr;(ive%}db ndoned in
County Parcel identification No.(PiN) accordance with 1SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has beenprovided 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:
36.0041714 N -78.8794213 `,I, 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 supplywells 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 ID#: M W-18 abandonment to the following: 1
Division of Water Resources,Information Processing Unit,
7.0 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 10a
6c.Borehole diameter: 2.0 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following: I
i
6d.Water level below ground surface 5.78 (fr) Division of Water Resources,,Underground injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): N/A (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): 1.0 (ft) abandoned. {
6g.Screen length(if known): 6.0 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
. 1.Well Contractor Information: WELL ABANDONMENT DETAILS
Frank Beecher 7a.For Geoprobe/DPT or Closed-Loop 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
3225-A wells abandoned:Nrn I o
7b.Approximate volume of water remainin in wells: 1-082 al.
NC Well Contractor Certification Number PP g O' (gal.)
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: N/A
2.Well Construction Permit#: N/A
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout I • Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: ❑ Bentonite Slurry 0 Other(explain under 7g)
"Monitoring 0 Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Chips-20 Pounds
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑AquiterTest ❑StormwaterDrainage Water-2.00 gallons
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer
Slowly filled monitoring well with Bentonite Chips while checking to
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
ensure that bridging is not happening,then added water.
4.Date well(s)abandoned: October 24, 2023 The well was abandoned in accordance with
5a.Well location: 15A NCAC 02C .0113_, 7 ..
�Speedway 6971 0-015516 l ,., ,_CC W 7
Facility/Owner Name Facility ID/I(if applicable) 8.Certification: �7
803 E Geer Street, Durham, 27704 !� - '%��G'---r- u . Melia-lber21,2023
Physical Address,City,and Zip Signature of Certified Well Contractor or WellICIWner.- i.11 ?:•.- 9ate,,,j I✓m,i
Durham 8032-50-73-5548 DW.,is./G
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 lat/long is sufficient) 9.Site diagram or additional well details:
36.0039165 N -78.8791098 `,l, 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 supplywells
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 rD#: MW-16RR abandonment to the following:
I
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 10.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
�f 10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter 2.0 (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 3.37 (ft.) Division of Water Resources,�Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): N/A (ft.) l Oc.For Water Supply&injection 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): 2.0 (ft.) abandoned.
6g.Screen length(if known): 8.0 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
i
I

I
WELL ABANDONMENT RECORD For internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
1
Frank Beecher 7a.For Geoprobe/DPT or Closed-Loop 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
3225-A wells abandoned:WA 1
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 0.86 (gal.)
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: N/A
2.Well Construction Permit#: N/A
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)([known
7d.Amount of disinfectant used: N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(cheek all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout i II Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
Obligation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
(Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Chips-20 Pounds
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑AquiterTest ❑StormwaterDrainage Water-2.00 gallons
['Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
Slowly filled monitoring well with Bentonite Chips while checking to
❑Geothermal(Heating/Cooling Return) [Other(explain under 7g)
ensure that bridging is not happening,then added water.
4.Date well(s)abandoned: October 24, 2023
The well was abandoned in'accordance with
5a.Well location: 15A NCAC 02C .0113". - •z P ;
Speedway 6971 0-015516 9n r r •
Facility/Owner Name Facility ID#(if applicable) 8.Certification: J 2023
803 E Geer Street, Durham, 27704 J e`'.,--Ir;,ur:r.,. :‘n awe-mbee
.gb 9oz
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 8032-50-73-5548 i
By signing this form, I hereby certfy 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: 1
(if well field,one lat/long is sufficient) 9.Site diagram or additional welt details:
36.0039021 N -78.8789294 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 consiruciionrecord(.$)rfavailable.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: M W-15 R abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 10.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: 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:
6d.Water level below ground surface 4.71 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): N/A (ft,) 10c.For Water Supply&Injection'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
6L Inner casing/tubing length(if known): 2.0 (ft.) abandoned.
6g.Screen length(if known): 8.0 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Frank Beecher 7a.For Geoprobe/DPT or Closed-Loop 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
3225-A wells abandoned:N/A 1 '
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 0.32 (gal.)
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: N/A
2.Well Construction Permit#: N/A
List all applicable well construction permits(Le.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
-
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout I e Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout ❑Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
MMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Chips-30 Pounds
❑Aquifer Storage and Recovery ❑Sal inky Barrier
❑AquiterTest ❑StormwaterDrainage Water-2.00 gallons
❑Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer
❑Geothermal(Heating/Cooling Return) ❑other(explain under 7g) Slowly filled monitoring well with Bentonite Chips while checking to
ensure that bridging is not happening,then added a water.
4.Date well(s)abandoned: October 24, 2023
The well was abandoned in accordance with
5a.Well location: 15A NCAC 02C .0113". ,- - _,
Speedway 6971 0-015516 . ti �• ,r�t._.,;: if I
Facility/Owner Name Facility ID!!(if applicable) 8.Certification: ,✓y
, ev DEC 0803 E Geer Street, Durham, 27704 2J- November zi,2023
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner' n Daley=° �: ij
Durham 8032-50-73-5548 f , ;:: `•�.3Z
By signing this form, I hereby certf that the well(s) was(were)abandoned in
County Parcel identification No.(PIN) accordance with 15A NCAC 02C.b100 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:
36.0040743 N -78.8801042 `,i, 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 wet/construction record(s)//available.For multiple injection or non-water supplywells
ONLY with the same construction/abandonment,you can submit one form.
It Al tt, �1 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well 1D#: M V V-14' abandonment to the following: I
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2.0 (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: 13-07 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
N/A 10c.For Water Snugly&Injection Wells: In addition to sending the form to the
6e.Outer casing length(if known): (ft.) 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
6L Inner casing/tubing length(if known): 5-0 (ft.) abandoned.
6g.Screen length(if known): 1 O'0 (ft.)
Form GW-30 North Carolina Department of Environmental Quality..Division of Water Resources Revised 2-22-2016
I

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS '
Frank Beecher 7a.For Geoprobe/DPT or Closed-L I op 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
3225-A wells abandoned:W^ 1 NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 2.18 (gal.)
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: N/A
list all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: ,N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout i @ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout 0 Drill Cuttings
❑irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
@Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Chips-34 Pounds
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑AquiferTest ❑StormwaterDrainage Water-2.00 gallons
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
OGeothermal(Heating/Cooling Return) ❑Other(explain under 7g) Slowly filled monitoring well with Bentonite Chips while checking to
ensure that bridging is not happening,then added a water.
A.Date well(s)abandoned: October 24, 2023
The well was abandoned in accordance with
5a.Well location: 15A NCAC 02C .0113". - r .:m;; d'fR
Speedway 6971 0-015516
8.Certification: n C C J FacilitylOwnerName Facility ID#(if applicable) - _ 2023
803 E Geer Street, Durham, 27704 eci".r {n; ,3_'::Npyember_?,1-2Q?r3'le
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner i)al i " `.l-`)
Durham 8032-50-73-5548
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 lat/long is sufficient) 9.Site diagram or additional well details:
36.0035110 N -78.8790847 `,l, 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-watersupplywetls
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 ID#: M W-1 1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 17.0 (ft.) 1617 Mail Service i Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2.0 (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: 3.65 (ft) Division of Water Resources,iUnderground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): N/A (ft,) 10c.For Water Sunnlv&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
6L Inner casing/tubing length(if known): 7.0 (ft.) abandoned. 1
6g.Screen length(if known): 10.0 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
1

WELL ABANDONMENT RECORD Forinter,ial Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAII!S
Frank Beecher
7a.For Geoprobe/DPT or Closed-Loop 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
3225-A wells abandoned:"
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 1.38 (gal.)
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name
A' 7c.Type of disinfectant used: N/A
2.Well Construction Permit#: N/A
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout I ' Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
'Monitoring ❑Recovery
injection Well: 7f.For each material selected above,provide amount of materials used:
[Aquifer Recharge ❑GroundwaterRemediation Bentonite Chips-26 Pounds
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑AquiterTest ❑StormwaterDrainage Wat@r-2.00 gallons
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Ocher(explain under 7g) Slowly filled monitoring well with Bentonite Chips while checking to
ensure that bridging is not happening,then added a water.
4.Date well(s)abandoned: October 24, 2023
The well was abandoned in accordance with
5a.Well location: 15A NCAC 02C .0113".
Speedway 6971 0-015516
Facility/Owner Name Facility T t(if applicable) 8.Certification: n C t] : 2023
803 E Geer Street, Durham, 27704 , r 6G' ;;;; ; .Rn Ngy tuber zo23
City,
Address, and Zip Signature of Certified Well Contractor or Well Owner �'�"�`•�Dai�`�
Durham 8032-50-73-5548
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.010,0 or 2C.0200 Well Construction Standards
and that a copy of this record has b teen 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:
36.0041858 N -78.8790709 , 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(.$)ifavailable. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment,you can submit one form.
�A n, 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well no: M V V-3 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 13.0 (fL) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For iniection Wells: in addition to sending the form to the address in I oa
6c.Borehole diameter: 2.0 (in.) above, also submit one copy of this form within 30 days of completion of well
A abandonment to the following:
6d.Water level below ground surface 4.54 (ft) Division of Water Resources,, Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): N/A (ft) 10e.For Water Suaaly&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
6L Inner easing/tubing length(if known): 3.0 (ft.) abandoned.
6g.Screen length(if known): 10.0 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016