WI-7165_32322_CA_LTRRPT_20220901

220 Old Dairy Road
Wilmington, NC 28405
[phone]
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Wilmington, NC | Raleigh, NC | Washington, NC | Atlanta, GA
ENVIRONMENTAL | CIVIL | GEOTECHNICAL

Wilmington, NC | Raleigh, NC | Washington, NC | Atlanta, GA | Charleston, SC
September 1, 2022
North Carolina Department of Environmental Quality
Division of Waste Management
UST Section Attn: Ms. Linda Blalock 1646 Mail Service Center Raleigh, NC 27699-1646
Re: Letter Report – Well Abandonment Herb’s BP Service Station 306 N. Lake Park Blvd. Carolina Beach, NC 28428
Incident Number: 32322
CATLIN Project No. 221181
Dear Ms. Linda Blalock,
CATLIN Engineers and Scientists (CATLIN) is pleased to provide you with this letter
report documenting well abandonment field activities performed in general accordance with CATLIN proposal number 221181.P, prepared July 14, 2022. Services were authorized by the North Carolina Department of Environmental Quality (NCDEQ) Task Authorization (TA) #01, accepted July 14, 2022, and Contract Number N122019D. The
approved scope of services for this Task Authorization included:
•Abandon nine (9) monitoring wells (MW-2, MW-3, MW-4, MW-5, MW-06, MW-07,MW-08, MW-10, and TMW-01); and
•Prepare a letter report documenting the site activities.
Monitoring well MW-08 could not be located during site activities and therefore was not abandoned. The remaining scope of services was conducted in accordance with the
approved TA.
September 1, 2022 Page 2 of 2
NCDEQ; 32322_Herb's BP Service Station CATLIN Engineers and Scientists
CATLIN Project No. 221181 September 2022
Monitoring Well Abandonment
On July 27, 2022, CATLIN personnel mobilized to the site and abandoned monitoring
wells MW-2 through MW-07, MW-10, and TMW-01. Well construction information for the wells is provided in the following table:
Well ID Well Type Well Depth (feet) Well Diameter (inches)
MW-2 Shallow 11.5 2.0
MW-3 Shallow 13.0 2.0
MW-4 Shallow 13.0 2.0
MW-5 Shallow 13.0 2.0
MW-06 Shallow 13.0 2.0
MW-07 Shallow 13.0 2.0
MW-10 Shallow 13.0 2.0
TMW-01 Intermediate 40.0 2.0
Monitoring wells MW-2 through MW-07, MW-10, and TMW-01 were abandoned under direct supervision of a North Carolina Certified Well Contractor (CWC) according to guidance provided in the North Carolina Administrative Code (NCAC) Title 15A 02C .0113 (Abandonment of Wells). The well locations are shown on Figure 1 (Attachment A). The well abandonment records were submitted to the NCDEQ Division of Water Quality on
July 28, 2022 and copies are provided in Attachment B. Photographs of the abandoned wells are included in Attachment C.
CATLIN Engineers and Scientists appreciates this opportunity to be of service. Should you have any questions or require additional information, please contact me at (910) 726-
1307.
Sincerely,
Benjamin J. Ashba, PG
Project Manager
Attachments: A: Figure B: Well Abandonment Records C: Site Photographs
WI-7165_32322_CA_LTRRPT_20220901
NCDEQ; 32322_Herb's BP Service Station
CATLIN Project No. 221181
CATLIN Engineers and Scientists September 2022
ATTACHMENT A
FIGURE
!?
!?
!?
!?
!?
!?
!>
!?
!?N LAKE
PARK
BLVD
FORMER DISPENSERS
FORMER UST BASIN
MW-08(CNL)
MW-07
MW-06
MW-5
MW-4
MW-3
MW-2TMW-1
MW-10
Source: Esri, Maxar, GeoEye, Earthstar Geographics, CNES/Airbus DS,USDA, USGS, AeroGRID, IGN, and the GIS User Community
FIGUREPROJECTTITLE
1
HERB'S BP
SERVICE STATION306 N LAKE PARK BLVDCAROLINA BEACH, NC
SITE MAP
30 0 30 6015
Feet
INCIDENT NO.JOB NO.DATE SCALE DRAWN BY/CHECKED BY32322221181SEPT 2022 AS SHOWN KMC/BJA
³
LEGEND
!>Monitoring Well(Type II)
NOTES:1. Well and tank location were obtained from previous
reports prepared by other consultants and are approximate.2. CNL = Could Not Locate
Parcel Boundary
!>Abandoned Monitoring
Well (Type II)
Approximate Locationof Former UST System
NCDEQ; 32322_Herb's BP Service Station CATLIN Engineers and Scientists
CATLIN Project No. 221181 September 2022
ATTACHMENT B
WELL ABANDONMENT RECORDS
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
Agricultural Municipal/Public
Geothermal (Heating/Cooling Supply)Residential Water Supply (single)
Industrial/Commercial Residential Water Supply (shared)
Irrigation
Non-Water Supply Well:
Monitoring Recovery
Injection Well:
Aquifer Recharge Groundwater Remediation
Aquifer Storage and Recovery Salinity Barrier
Aquifer Test Stormwater Drainage
Experimental Technology Subsidence Control
Geothermal (Closed Loop)Tracer
Geothermal (Heating/Cooling Return) Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
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):(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
Bentonite Slurry Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
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 Injection 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
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
abandoned.
For Internal Use ONLY:
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
Agricultural Municipal/Public
Geothermal (Heating/Cooling Supply)Residential Water Supply (single)
Industrial/Commercial Residential Water Supply (shared)
Irrigation
Non-Water Supply Well:
Monitoring Recovery
Injection Well:
Aquifer Recharge Groundwater Remediation
Aquifer Storage and Recovery Salinity Barrier
Aquifer Test Stormwater Drainage
Experimental Technology Subsidence Control
Geothermal (Closed Loop)Tracer
Geothermal (Heating/Cooling Return) Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
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):(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
Bentonite Slurry Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
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 Injection 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
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
abandoned.
For Internal Use ONLY:
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
Agricultural Municipal/Public
Geothermal (Heating/Cooling Supply)Residential Water Supply (single)
Industrial/Commercial Residential Water Supply (shared)
Irrigation
Non-Water Supply Well:
Monitoring Recovery
Injection Well:
Aquifer Recharge Groundwater Remediation
Aquifer Storage and Recovery Salinity Barrier
Aquifer Test Stormwater Drainage
Experimental Technology Subsidence Control
Geothermal (Closed Loop)Tracer
Geothermal (Heating/Cooling Return) Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
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):(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
Bentonite Slurry Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
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 Injection 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
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
abandoned.
For Internal Use ONLY:
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
Agricultural Municipal/Public
Geothermal (Heating/Cooling Supply)Residential Water Supply (single)
Industrial/Commercial Residential Water Supply (shared)
Irrigation
Non-Water Supply Well:
Monitoring Recovery
Injection Well:
Aquifer Recharge Groundwater Remediation
Aquifer Storage and Recovery Salinity Barrier
Aquifer Test Stormwater Drainage
Experimental Technology Subsidence Control
Geothermal (Closed Loop)Tracer
Geothermal (Heating/Cooling Return) Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
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):(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
Bentonite Slurry Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
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 Injection 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
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
abandoned.
For Internal Use ONLY:
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
Agricultural Municipal/Public
Geothermal (Heating/Cooling Supply)Residential Water Supply (single)
Industrial/Commercial Residential Water Supply (shared)
Irrigation
Non-Water Supply Well:
Monitoring Recovery
Injection Well:
Aquifer Recharge Groundwater Remediation
Aquifer Storage and Recovery Salinity Barrier
Aquifer Test Stormwater Drainage
Experimental Technology Subsidence Control
Geothermal (Closed Loop)Tracer
Geothermal (Heating/Cooling Return) Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
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):(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
Bentonite Slurry Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
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 Injection 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
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
abandoned.
For Internal Use ONLY:
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
Agricultural Municipal/Public
Geothermal (Heating/Cooling Supply)Residential Water Supply (single)
Industrial/Commercial Residential Water Supply (shared)
Irrigation
Non-Water Supply Well:
Monitoring Recovery
Injection Well:
Aquifer Recharge Groundwater Remediation
Aquifer Storage and Recovery Salinity Barrier
Aquifer Test Stormwater Drainage
Experimental Technology Subsidence Control
Geothermal (Closed Loop)Tracer
Geothermal (Heating/Cooling Return) Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
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):(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
Bentonite Slurry Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
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 Injection 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
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
abandoned.
For Internal Use ONLY:
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
Agricultural Municipal/Public
Geothermal (Heating/Cooling Supply)Residential Water Supply (single)
Industrial/Commercial Residential Water Supply (shared)
Irrigation
Non-Water Supply Well:
Monitoring Recovery
Injection Well:
Aquifer Recharge Groundwater Remediation
Aquifer Storage and Recovery Salinity Barrier
Aquifer Test Stormwater Drainage
Experimental Technology Subsidence Control
Geothermal (Closed Loop)Tracer
Geothermal (Heating/Cooling Return) Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
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):(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
Bentonite Slurry Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
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 Injection 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
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
abandoned.
For Internal Use ONLY:
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
Agricultural Municipal/Public
Geothermal (Heating/Cooling Supply)Residential Water Supply (single)
Industrial/Commercial Residential Water Supply (shared)
Irrigation
Non-Water Supply Well:
Monitoring Recovery
Injection Well:
Aquifer Recharge Groundwater Remediation
Aquifer Storage and Recovery Salinity Barrier
Aquifer Test Stormwater Drainage
Experimental Technology Subsidence Control
Geothermal (Closed Loop)Tracer
Geothermal (Heating/Cooling Return) Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
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):(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
Bentonite Slurry Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
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 Injection 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
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
abandoned.
For Internal Use ONLY:
NCDEQ; 32322_Herb's BP Service Station CATLIN Engineers and Scientists
CATLIN Project No. 221181 September 2022
ATTACHMENT C
SITE PHOTOGRAPHS
ATTACHMENT C SITE PHOTOGRAPHS – JULY 27, 2022
NCDEQ; 32322_Herb’s BP Service Station CATLIN Engineers and Scientists CATLIN Project No. 221181 September 2022
Herb’s BP Service Station MW-2 Before Abandonment
Herb’s BP Service Station MW-2
After Abandonment
ATTACHMENT C SITE PHOTOGRAPHS – JULY 27, 2022
NCDEQ; 32322_Herb’s BP Service Station CATLIN Engineers and Scientists CATLIN Project No. 221181 September 2022
Herb’s BP Service Station MW-3
Before Abandonment
Herb’s BP Service Station MW-3 After Abandonment
ATTACHMENT C SITE PHOTOGRAPHS – JULY 27, 2022
NCDEQ; 32322_Herb’s BP Service Station CATLIN Engineers and Scientists CATLIN Project No. 221181 September 2022
Herb’s BP Service Station MW-4
Before Abandonment
Herb’s BP Service Station
MW-4 After Abandonment
ATTACHMENT C SITE PHOTOGRAPHS – JULY 27, 2022
NCDEQ; 32322_Herb’s BP Service Station CATLIN Engineers and Scientists CATLIN Project No. 221181 September 2022

Herb’s BP Service Station MW-5
Before Abandonment
Herb’s BP Service Station
MW-5 After Abandonment
ATTACHMENT C SITE PHOTOGRAPHS – JULY 27, 2022
NCDEQ; 32322_Herb’s BP Service Station CATLIN Engineers and Scientists CATLIN Project No. 221181 September 2022

Herb’s BP Service Station MW-6
Before Abandonment
Herb’s BP Service Station
MW-6 After Abandonment
ATTACHMENT C SITE PHOTOGRAPHS – JULY 27, 2022
NCDEQ; 32322_Herb’s BP Service Station CATLIN Engineers and Scientists CATLIN Project No. 221181 September 2022

Herb’s BP Service Station
MW-7
Before Abandonment
Herb’s BP Service Station
MW-7 After Abandonment
ATTACHMENT C SITE PHOTOGRAPHS – JULY 27, 2022
NCDEQ; 32322_Herb’s BP Service Station CATLIN Engineers and Scientists CATLIN Project No. 221181 September 2022

Herb’s BP Service Station MW-8
Could Not Locate
Herb’s BP Service Station
MW-10 Before Abandonment
ATTACHMENT C SITE PHOTOGRAPHS – JULY 27, 2022
NCDEQ; 32322_Herb’s BP Service Station CATLIN Engineers and Scientists CATLIN Project No. 221181 September 2022

Herb’s BP Service Station
TMW-1 Before Abandonment
Herb’s BP Service Station MW-10
After Abandonment
ATTACHMENT C SITE PHOTOGRAPHS – JULY 27, 2022
NCDEQ; 32322_Herb’s BP Service Station CATLIN Engineers and Scientists CATLIN Project No. 221181 September 2022
Herb’s BP Service Station TMW-1 After Abandonment
(well shield subsequently emplaced)