1812_DukeMarshall_Ph3_Abandon_CLF-303_CLF-304_cert_FID1770377_20230125

DUKE
ENERGY
January 25, 2023
North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section
2090 U.S. Highway 70
Swannanoa, NC 28778
Attn: Ms. Sarah Moutos (submitted electronically)
Re: Piezometer Abandonment Records (GW-30 Forms)
Industrial Landfill No.1 - Phase 3
Permit No.: 1812-INDUS-2008
Marshall Steam Station
Terrell, North Carolina 28682
Dear Ms. Moutos:
526 South Church St.
Charlotte, NC 28202
Mailing Address
P.O. Box 1006
Mail Code EC 13K.
Charlotte, NC 28201-1006
Duke Energy is providing well abandonment records for two piezometers installed to support the Geotechnical
Investigation for the Industrial Landfill No.1 (1812-INDUS) Phase 3. The piezometers CLF-303 and CLF-304
were abandoned due to site closure activities.
Ten (10) additional non -water supply monitoring wells, AB-3S/D, AB-4S/SL/D, AB-8S/DU/D, AB-13S/D were
also abandoned but were not associated with the Industrial Landfill No.1. These well records were included
due to timing of abandonment. The abandonments were conducted by S&ME, Inc. These records were also
submitted separately to the NCDEQ Information Processing Unit.
If you need additional information regarding this request do not hesitate to email or call me at
Ashley.HealvCcDduke-energy.com or [phone].
Respectfully submitted,
j4VAi
Ashley Healy, P.G.
Environmental Services
Attachments: GW-30 Forms (S&ME, January 2023)
cc (via e-mail): Claire Osborn, NCDEQ
Sherri Stanley, NCDEQ
Ed Mussler, NCDEQ
Scott Saunders, Duke Energy
Chris Varner, Duke Energy
Tom Leap, Duke Energy
Tyler Hardin, Duke Energy
Ed Sullivan, Duke Energy
www.duke-energy.com Page 1 of 1

January 23, 2023
North Carolina Department of Environmental Quality
Division of Water Resources — Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Attention: Information Processing Unit
Reference: Well Abandonment Records (GW-30 Forms)
Duke Energy — Marshall Steam Station
Abandonment of Wells in Support of Ash Basin Closure Activities
S&ME Project No. 21410007, Ph. 02
Information Processing Unit:
S&ME, Inc. (S&ME) is submitting the enclosed completed and signed Well Abandonment Records (GW-30 Forms)
for the abandonment of twelve (12) wells at Duke Energy's Marshall Steam Station in Catawba County, North
Carolina.
The following twelve (12) wells were abandoned by a North Carolina registered well driller on January 6, 11, and
18, 2023, in accordance with the 15A NCAC 02C Section .0113 Standards and Duke Energy's Guidance for Well
Abandonments in North Carolina (EHS Work Standard, Revision 1, dated 4/8/2021): AB-3S, AB-3D, AB-4S, AB-4SL,
AB-4D AB-8S, AB-8DU, AB-8D, AB-13S, AB-13D, CLF-303, and CLF-304.
S&ME thanks you for your receipt of these records. Should you have any questions or need additional
information, please do not hesitate to contact us at [phone].
Respectfully Submitted,
S&ME, Inc.
Jasmine Tayouga
Project Manager
Enclosures: Twelve (12) GW-30 Forms
Julie Robertson, P.G.
Principal Project Manager
Registration No. 1995
cc: Ashley L. Healy, P.G. - EHS Waste and Groundwater Programs, Duke Energy
S&ME, Inc. 12016 AyrsIey Town Blvd., Suite 2-A I Charlotte, NC 28273 1 p 704.523.4726 1 www.smeinc.com

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Justin Marlowe
Well Contractor Name (or well owner personally abandoning well on his/her property)
4452-A
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #: Not Applicable
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 1 /6/2023
5a. Well location:
Duke Energy Carolinas Not Applicable
Facility/Owner Name Facility ID# (if applicable)
8320 NC-150, Terrell, NC 28673
Physical Address, City, and Zip
Catawba
County
461803426350
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.6039829 N-080.9665781 W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: AB-3S
6b. Total well depth: 23.5 (ft.)
6c. Borehole diameter: 8.0 (in.)
6d. Water level below ground surface: Dry - 0
6e. Outer casing length (if known): N/A (ft.)
6f. Inner casing/tubing length (if known): 8.0 (ft.)
6g. Screen length (if known): 15.5 (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 0 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
a Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Approx. 4 gal. Quik-Grout used
(13% of 1 50 lb. bag of Quik-Grout)
7g. Provide a brief description of the abandonment procedure:
1 batch grout mix makes approximately 30 gal. grout
per Quik-Grout specs. (1 50 Ib. bag and 25 gal. water)
Grout pumped from bottom of well using 1" tremie
pipe until well is filled to ground surface or above.
8. Certification:
Z�' � 1/16/2023
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
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.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection 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
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. 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
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Justin Marlowe
Well Contractor Name (or well owner personally abandoning well on his/her property)
4452-A
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #: Not Applicable
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 1 /6/2023
5a. Well location:
Duke Energy Carolinas
Not Applicable
Facility/Owner Name Facility ID# (if applicable)
8320 NC-150, Terrell, NC 28673
Physical Address, City, and Zip
Catawba
County
461803426350
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.6039643 N-080.9665862
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 17.6 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
a Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Approx. 22 gal. Quik-Grout used
(74% of 1 50 lb. bag of Quik-Grout)
7g. Provide a brief description of the abandonment procedure:
1 batch grout mix makes approximately 30 gal. grout
per Quik-Grout specs. (1 50 Ib. bag and 25 gal. water)
Grout pumped from bottom of well using 1" tremie
pipe until well is filled to ground surface or above.
S. Certification:
1 /16/2023
Signature of Certified Well Contractor or Wcll Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: AB-3D
6b. Total well depth: 135
6c. Borehole diameter: 7.9, 4.9, 3.8 (in.)
6d. Water level below ground surface: 27.43 (ft.)
6e. Outer casing length (if known): 120.5
6f. Inner casing/tubing length (if known): 130.0
6g. Screen length (if known): 5.0 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection 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
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. 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
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Justin Marlowe
Well Contractor Name (or well owner personally abandoning well on his/her property)
4452-A
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #: Not Applicable
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 1 /6/2023
5a. Well location:
Duke Energy Carolinas Not Applicable
Facility/Owner Name Facility 1Dff (if applicable)
8320 NC-150, Terrell, NC 28673
Physical Address, City, and Zip
Catawba
County
461803426350
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.6102013 N-080.9715728 W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constru
ctct
ion/abandonment, you can submit one form.
6a. Well ID#: AB-8S
6b. Total well depth: 13.0 (ft.)
6c. Borehole diameter: 8.0 (in.)
6d. Water level below ground surface: 4.19 (ft.)
6e. Outer casing length (if known): N/A (ft.)
6f. Inner casing/tubing length (if known): 3.0 (ft.)
6g. Screen length (if known): 1 0.0 (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only I GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 1 .4 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
a Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Approx. 2 gal. Quik-Grout used
(7% of 1 50 Ib. bag of Quik-Grout)
7g. Provide a brief description of the abandonment procedure:
1 batch grout mix makes approximately 30 gal. grout
per Quik-Grout specs. (1 50 Ib. bag and 25 gal. water)
Grout pumped from bottom of well using 1" tremie
pipe until well is filled to ground surface or above.
S. Certification:
I-I� 1/16/2023
Signature of Certified Well Cnntmetor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
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.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection 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
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. 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
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Justin Marlowe
Well Contractor Name (or well owner personally abandoning well on his/her property)
4452-A
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #: Not Applicable
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 1 /6/2023
5a. Well location:
Duke Energy Carolinas Not Applicable
Facility/Owner Name Facility ID# (if applicable)
8320 NC-150, Terrell, NC 28673
Physical Address, City, and Zip
Catawba
County
461803426350
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.6102098 N-080.9715924
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 9.2 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
a Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Approx. 10 gal. Quik-Grout used
(33% of 1 50 lb. bag of Quik-Grout)
7g. Provide a brief description of the abandonment procedure:
1 batch grout mix makes approximately 30 gal. grout
per Quik-Grout specs. (1 50 Ib. bag and 25 gal. water)
Grout pumped from bottom of well using 1" tremie
pipe until well is filled to ground surface or above.
8. Certification:
1/16/2023
Signature of Certified Well Contrnctor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: AB-8 D U
6b. Total well depth: 60 (ft.)
6c. Borehole diameter: 6.0 (in.)
6d. Water level below ground surface: 4.01 (ft.)
6e. Outer casing length (if known): N/A (ft.)
6f. Inner casing/tubing length (if known): 50.0 (ft.)
6g. Screen length (if known): 1 0.0 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection 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
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. 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
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Justin Marlowe
Well Contractor Name (or well owner personally abandoning well on his/her property)
4452-A
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #: Not Applicable
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 1 /6/2023
5a. Well location:
Duke Energy Carolinas Not Applicable
Facility/Owner Name Facility 1Dff (if applicable)
8320 NC-150, Terrell, NC 28673
Physical Address, City, and Zip
Catawba
County
461803426350
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.6102136 N-080.9715643
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned: 7b. Approximate volume of water remaining in well(s): 15.8 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
a Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Approx. 16 gal. Quik-Grout used
(55% of 1 50 lb. bag of Quik-Grout)
7g. Provide a brief description of the abandonment procedure:
1 batch grout mix makes approximately 30 gal. grout
per Quik-Grout specs. (1 50 Ib. bag and 25 gal. water)
Grout pumped from bottom of well using 1" tremie
pipe until well is filled to ground surface or above.
8. Certification:
1/16/2023
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: AB-8D
6b. Total well depth: 100.0 (ft.)
6c. Borehole diameter: 7.9, 4.9, 3.8 (in.)
6d. Water level below ground surface: 3.96 (ft.)
6e. Outer casing length (if known): 84.0 (ft.)
6f. Inner casing/tubing length (if known): 95.0 (ft.)
6g. Screen length (if known): 5.0 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection 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
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. 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
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Justin Marlowe
Well Contractor Name (or well owner personally abandoning well on his/her property)
4452-A
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #: Not Applicable
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 1 /6/2023
5a. Well location:
Duke Energy Carolinas Not Applicable
Facility/Owner Name Facility ID# (if applicable)
8320 NC-150, Terrell, NC 28673
Physical Address, City, and Zip
Catawba
County
461803426350
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.6138787 N-080.9733645 W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructioonnlabandonment, you can submit one form.
6a. Well ID#: AB-1 3S
6b. Total well depth: 29.8 (ft.)
6c. Borehole diameter: 8.0 (in.)
6d. Water level below ground surface: 21.31 (ft.)
6e. Outer casing length (if known): N/A (ft.)
6f. Inner casing/tubing length (if known): 14.8 (ft.)
6g. Screen length (if known): 15.0 (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only I GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 1 .4 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
a Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Approx. 5 gal. Quik-Grout used
(16% of 1 50 lb. bag of Quik-Grout)
7g. Provide a brief description of the abandonment procedure:
1 batch grout mix makes approximately 30 gal. grout
per Quik-Grout specs. (1 50 Ib. bag and 25 gal. water)
Grout pumped from bottom of well using 1" tremie
pipe until well is filled to ground surface or above.
8. Certification:
1/16/2023
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
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.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection 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
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. 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
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Justin Marlowe
Well Contractor Name (or well owner personally abandoning well on his/her property)
4452-A
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #: Not Applicable
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 1 /6/2023
5a. Well location:
Duke Energy Carolinas
Not Applicable
Facility/Owner Name Facility ID# (if applicable)
8320 NC-150, Terrell, NC 28673
Physical Address, City, and Zip
Catawba
County
461803426350
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.6139231 N-080.9733794
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 10. 3 gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
a Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Approx. 14 gal. Quik-Grout used
(47% of 1 50 lb. bag of Quik-Grout)
7g. Provide a brief description of the abandonment procedure:
1 batch grout mix makes approximately 30 gal. grout
per Quik-Grout specs. (1 50 Ib. bag and 25 gal. water)
Grout pumped from bottom of well using 1" tremie
pipe until well is filled to ground surface or above.
R. Certification:
�'--� 1/16/2023
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: AB-13D
6b. Total well depth: 86.0 (ft.)
6c. Borehole diameter: 1 0.0, 4.8 (in.)
6d. Water level below ground surface: 23.29 (ft.)
6e. Outer casing length (if known): 77.0 (ft.)
6f. Inner casing/tubing length (if known): 81.0 (ft.)
6g. Screen length (if known): 5.0 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection 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
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. 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
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Justin Marlowe
Well Contractor Name (or well owner personally abandoning well on his/her property)
4452-A
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #: Not Applicable
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned: 1 /1 1 /23
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
5a. Well location:
Duke Energy Carolinas Not Applicable
Facility/Owner Name Facility ID# (if applicable)
8320 NC-150, Terrell, NC 28673
Physical Address, City, and Zip
Catawba
County
461803426350
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.6160127 N-080.9723535 W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: CLF-303
6b. Total well depth: 40.0 (ft.)
6c. Borehole diameter: 8.0 (in.)
6d. Water level below ground surface: 20.46 (ft.)
6e. Outer casing length (if known): N/A (ft.)
6f. Inner casing/tubing length (if known): 30.0 (ft.)
6g. Screen length (if known): 1 0.0 (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 3.2 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
a Bentonite Slurry N Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Approx. 7 gal. Quik-Grout used
(22% of 1 50 lb. bag of Quik-Grout)
7g. Provide a brief description of the abandonment procedure:
1 batch grout mix makes approximately 30 gal. grout
per Quik-Grout specs. (1 50 Ib. bag and 25 gal. water)
Grout pumped from bottom of well using 1" tremie
pipe until well is filled to ground surface or above.
8. Certification:
1/16/2023
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
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.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection 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
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. 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
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Jay Little
Well Contractor Name (or well owner personally abandoning well on his/her property)
2717-A
NC Well Contractor Certification Number
SWE, Inc.
Company Name
2. Well Construction Permit #: Not Applicable
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 1 /1 8/2023
5a. Well location:
Duke Energy Carolinas Not Applicable
Facility/Owner Name Facility ID# (if applicable)
8320 NC-150, Terrell, NC 28673
Physical Address, City, and Zip
Catawba
County
461803426350
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.6135559 N-080.9732255 W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: CLF-304
6b. Total well depth: 60.0 (ft.)
6c. Borehole diameter: 8.0 (in.)
6d. Water level below ground surface: 23.12 (ft.)
6e. Outer casing length (if known): N/A (ft.)
6f. Inner casing/tubing length (if known): 50.0 (ft.)
6g. Screen length (if known): 1 0.0 (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 6.0 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
a Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Approx. 10 gal. Quik-Grout used
(33% of 1 50 lb. bag of Quik-Grout)
7g. Provide a brief description of the abandonment procedure:
1 batch grout mix makes approximately 30 gal. grout
per Quik-Grout specs. (1 50 Ib. bag and 25 gal. water)
Grout pumped from bottom of well using 1" tremie
pipe until well is filled to ground surface or above.
8. Certification:
Z6 1 /23/23
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
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.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
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
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. 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
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Jay Little
Well Contractor Name (or well owner personally abandoning well on his/her property)
2717-A
NC Well Contractor Certification Number
SWE, Inc.
Company Name
2. Well Construction Permit #: Not Applicable
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 1 /1 8/2023
5a. Well location:
Duke Energy Carolinas Not Applicable
Facility/Owner Name Facility ID# (if applicable)
8320 NC-150, Terrell, NC 28673
Physical Address, City, and Zip
Catawba
County
461803426350
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.6052498 N-80.9681135 W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: AB-4S
6b. Total well depth: 21.0 (ft.)
6c. Borehole diameter: 8.0 (in.)
6d. Water level below ground surface: 7.64 (ft.)
6e. Outer casing length (if known): N/A (ft.)
6f. Inner casing/tubing length (if known): 6.0 (ft.)
6g. Screen length (if known): 15.0 (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 2.2 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
a Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Approx. 3 gal. Quik-Grout used
(11 % of 1 50 lb. bag of Quik-Grout)
7g. Provide a brief description of the abandonment procedure:
1 batch grout mix makes approximately 30 gal. grout
per Quik-Grout specs. (1 50 Ib. bag and 25 gal. water)
Grout pumped from bottom of well using 1" tremie
pipe until well is filled to ground surface or above.
8. Certification:
_ 1 /23/23
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
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.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
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
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. 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
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Jay Little
Well Contractor Name (or well owner personally abandoning well on his/her property)
2717-A
NC Well Contractor Certification Number
SWE, Inc.
Company Name
2. Well Construction Permit #: Not Applicable
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 1 /1 8/2023
5a. Well location:
Duke Energy Carolinas Not Applicable
Facility/Owner Name Facility ID# (if applicable)
8320 NC-150, Terrell, NC 28673
Physical Address, City, and Zip
Catawba
County
461803426350
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.6052544 N-80.9681414 W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: AB-4SL
6b. Total well depth: 48.5 (ft.)
6c. Borehole diameter: 8.0 (in.)
6d. Water level below ground surface: 8.11 (ft.)
6e. Outer casing length (if known): N/A (ft.)
6f. Inner casing/tubing length (if known): 38.5 (ft.)
6g. Screen length (if known): 1 0.0 (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 6.6 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
a Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Approx. 8 gal. Quik-Grout used
(27% of 1 50 lb. bag of Quik-Grout)
7g. Provide a brief description of the abandonment procedure:
1 batch grout mix makes approximately 30 gal. grout
per Quik-Grout specs. (1 50 Ib. bag and 25 gal. water)
Grout pumped from bottom of well using 1" tremie
pipe until well is filled to ground surface or above.
8. Certification:
�6 1 /23/23
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
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.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
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
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. 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
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Jay Little
Well Contractor Name (or well owner personally abandoning well on his/her property)
2717-A
NC Well Contractor Certification Number
SWE, Inc.
Company Name
2. Well Construction Permit #: Not Applicable
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
El Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 1 /1 8/2023
5a. Well location:
Duke Energy Carolinas Not Applicable
Facility/Owner Name Facility ID# (if applicable)
8320 NC-150, Terrell, NC 28673
Physical Address, City, and Zip
Catawba
County
461803426350
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.6052648 N-80.9681687 W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construc
tion/abandonment, you can submit one form.
6a. Well ID#: AB-4SL
6b. Total well depth: 76.5 (ft.)
6c. Borehole diameter: 7.9, 4.9, 3.8 (in.)
6d. Water level below ground surface: 7.88 (ft.)
6e. Outer casing length (if known): 68.5 (ft.)
6f. Inner casing/tubing length (if known): 71.5 (ft.)
6g. Screen length (if known): 5.0 (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 11 .3 gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
a Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Approx. 13 gal. Quik-Grout used
(42% of 1 50 lb. bag of Quik-Grout)
7g. Provide a brief description of the abandonment procedure:
1 batch grout mix makes approximately 30 gal. grout
per Quik-Grout specs. (1 50 Ib. bag and 25 gal. water)
Grout pumped from bottom of well using 1" tremie
pipe until well is filled to ground surface or above.
8. Certification:
6 5; ��'eW 1 /23/23
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
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.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
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
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. 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
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016