FA-790_14709_CA_LTRRPT_20231026_Well Abandonment

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Raleigh, NC 27605
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October 26, 2023

North Carolina Department of Environmental Quality
Division of Waste Management
UST Section
Attn: Mr. Scott Ryals
1646 Mail Service Center
Raleigh, NC 27699-1646

Re: Letter Report – Well Abandonment
Ed’s Village Open Air Market
103 West Jackson Boulevard
Erwin, NC 28339
Incident Number: 14709
Risk Classification: I106D
CATLIN Project No. 220227.02

Dear Mr. Ryals,

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 220227.02P, prepared September 1, 2023. Services were
authorized by the North Carolina Department of Environmental Quality (NCDEQ) Task
Authorization (TA) #02, accepted September 4, 2023, and Contract Number N70522-A.
The approved scope of services for this Task Authorization included:

• Abandon 12 monitoring wells (MW-1 through MW-6, MW-06R, MW-7, P-1 through
P-3, and T-1); and
• Prepare a letter report documenting the site activities.

Monitoring Well Abandonment

On October 11, 2023, CATLIN personnel mobilized to the site and abandoned monitoring
wells MW-1, MW-3, MW-4, MW-5, MW-06R, P-1, P-2, P-3, and T-1. Monitoring wells
MW-2, MW-6, and MW-7 were not able to be located and are presumed destoryed. The
remainder of the approved scope of work was completed. Well construction information
for the wells is provided in the following table:

CATLIN
Engineers and Scientists
October 26, 2023
Page 2 of 3
NCDEQ; FA-790_14709_CA_LTRRPT_20231026 CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

Well ID Well Type Well Depth
(feet)
Well Diameter
(inches)
Abandonment
Procedure
MW-1 Shallow 20.0 2.0 All well materials left
in place
MW-3 Shallow 15.0 2.0 All well materials
removed.
MW-4 Shallow 15.0 2.0 All well materials left
in place
MW-5 Shallow 15.0 2.0 All well materials
removed.
MW-06R Shallow 17.0 2.0
Concrete and metal
removed. PVC left in
place.
T-1 Deep 30.0 2.0 All well materials left
in place.
P-1 Shallow 18.0 1.0 All well materials
removed.
P-2 Shallow 17.0 1.0 All well materials
removed.
P-3 Shallow 17.0 1.0 All well materials
removed.

Monitoring wells MW-1, MW-3 through MW-06R, T-1, and P-1 through P-3 were
abandoned under the 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). All wells were abandoned in place and packed
with bentonite chips to within six inches of the surface while simultaneously pouring water
to facilitate hydration. The remaining space was filled with concrete (MW-1, MW-4, T-1,
P-1, P-2) or topsoil (MW-3 MW-5, MW-06R, and P-3) to the existing grade.

The site and well locations are shown on Figure 1 and Figure 2, respectively (Attachment
A). The well abandonment records were submitted to the NCDEQ Division of Water
Quality and copies are provided in Attachment B. Photographs of the abandoned wells
are included in Attachment C.

October 26, 2023
Page 3 of 3
NCDEQ; FA-790_14709_CA_LTRRPT_20231026 CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023
CATLIN Engineers and Scientists appreciates this opportunity to be of service. Should
you have any questions or require additional information, please contact us at (919) 838-
2875.

Sincerely,

Sean J. O’Neil, PE
Project Manager

Attachments:
A: Figure
B: Well Abandonment Records
C: Site Photographs
FA-790_14709_CA_LTRRPT_20231026

NCDEQ; FA-790_14709_CA_LTRRPT_20231026 CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

ATTACHMENT A

FIGURES

FIGUREPROJECTTITLE
1ED'S VILLAGE OPEN AIR MARKET103 W JACKSON BLVDERWIN, NC
SITE VICINITY MAP
U
S

H
W
Y

4
2
1

S
N 13TH STSITE LOCATION
Copyright:© 2013 National Geographic Society, i-cubed
2,000 0 2,000 4,0001,000
Feet
³
INCIDENT NO.JOB NO.DATE SCALE DRAWN BY/CHECKED BY14709220227OCT 2023 AS SHOWN KMC/SJO
- -- -
CATLIN
Engineers and Scientists I I I
FIGUREPROJECTTITLE
2SITE MAP
!>
!>!>!>!=!(>!>!>
!>
!(
!(
!(
!(
!(
!(
!(
!(
!(
!(
!(
!(
!(
!(
!(
!(
!>!(
!(!(
U
S

HW
Y

4
2
1
MW-6(CNL)
MW-4
MW-7(CNL)
MW-1
MW-2(CNL)
MW-3
MW-5 T-1
MW-06R
STW-1
P-3
P-2
P-1
Source: Esri, Maxar, Earthstar Geographics, and the GIS User Community
60 0 60 12030
Feet
³
NOTES: 1. Pre-existing well and tank locations were obtained from previousreports prepared by other consultants and are approximate.2. CNL = Could Not Locate
ED'S VILLAGE OPEN AIR MARKET103 W JACKSON BLVDERWIN, NC
INCIDENT NO.JOB NO.DATE SCALE DRAWN BY/CHECKED BY14709220227OCT 2023 AS SHOWN KMC/SJO
Parcel Boundary
LEGEND
Monitoring Well(Type II)!>
Abandoned Monitoring Well (Type III)!(>Approximate Locationof Former Tank Basin
Slug Test Well!=Abandoned Piezometer!(
Abandoned Monitoring Well (Type II)!>□
□
CATLIN
Engineers and Scientists
I
- -- -
I I

NCDEQ; FA-790_14709_CA_LTRRPT_20231026 CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

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
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:
1. Well Contractor Information:
William J. Miller
2927A
CATLIN Engineers and Scientists
Bentonite
Concrete
33.33 lbs
16.66 lbs
10/10/2023
Well abandoned in place with hydrated bentonite to
~6 inches below land surface. Concrete was used to
bring the opening to grade.
Stanley H. Brown NA
103 West Jackson Boulevard, Erwin, NC 10/16/23
Harnett 0597-68-0294
35.337952 -78.677282
MW-1
20
4.25
10.50
NA
10
10
■
■
■
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:
William J. Miller
2927A
CATLIN Engineers and Scientists
Bentonite
Soil
33.33 lbs
40 lbs
10/10/2023
Well abandoned in place with hydrated bentonite to
~6 inches below land surface. Soil was used to bring
the opening to grade. All well materials were removed.
Stanley H. Brown NA
103 West Jackson Boulevard, Erwin, NC 10/16/23
Harnett 0597-68-0294
35.337952 -78.677282
MW-3
15
4.25
11.68
NA
5
10
■
■
■
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:
William J. Miller
2927A
CATLIN Engineers and Scientists
Bentonite
Concrete
25 lbs
16.66 lbs
10/10/2023
Well abandoned in place with hydrated bentonite to
~6 inches below land surface. Concrete was used to
bring the opening to grade.
Stanley H. Brown NA
103 West Jackson Boulevard, Erwin, NC 10/16/23
Harnett 0597-68-0294
35.337952 -78.677282
MW-4
15
4.25
11.36
NA
5
10
■
■
■
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:
William J. Miller
2927A
CATLIN Engineers and Scientists
Bentonite
Soil
25 lbs
40 lbs
10/10/2023
Well abandoned in place with hydrated bentonite to
~6 inches below land surface. Soil was used to
bring the opening to grade. All well materials
removed.Stanley H. Brown NA
103 West Jackson Boulevard, Erwin, NC 10/16/23
Harnett 0597-68-0294
35.337952 -78.677282
MW-5
15
4.25
12.91
NA
5
10
■
■
■
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:
William J. Miller
2927A
CATLIN Engineers and Scientists
Bentonite
Soil
25 lbs
40 lbs
10/10/2023
Well abandoned in place with hydrated bentonite to
~6 inches below land surface. Soil was used to
bring the opening to grade. All concrete and metal
removed. PVC left in place.Stanley H. Brown NA
103 West Jackson Boulevard, Erwin, NC 10/16/23
Harnett 0597-68-0294
35.337952 -78.677282
MW-06R
17
4.25
10.57
NA
2
15
■
■
■
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:
William J. Miller
2927A
CATLIN Engineers and Scientists
Bentonite
Concrete
10 lbs
16.66 lbs
10/10/2023
Well abandoned in place with hydrated bentonite to
~6 inches below land surface. Concrete was used to
bring the opening to grade. All well materials removed.
Stanley H. Brown NA
103 West Jackson Boulevard, Erwin, NC 10/16/23
Harnett 0597-68-0294
35.337952 -78.677282
P-1
18
4.25
11.27
NA
3
15
■
■
■
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:
William J. Miller
2927A
CATLIN Engineers and Scientists
Bentonite
Concrete
10 lbs
16.66 lbs
10/10/2023
Well abandoned in place with hydrated bentonite to
~6 inches below land surface. Concrete was used to
bring the opening to grade. All well materials removed.
Stanley H. Brown NA
103 West Jackson Boulevard, Erwin, NC 10/16/23
Harnett 0597-68-0294
35.337952 -78.677282
P-2
17
4.25
11.24
NA
2
15
■
■
■
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:
William J. Miller
2927A
CATLIN Engineers and Scientists
Bentonite
Concrete
10 lbs
16.66 lbs
10/10/2023
Well abandoned in place with hydrated bentonite to
~6 inches below land surface. Concrete was used to
bring the opening to grade. All well materials removed.
Stanley H. Brown NA
103 West Jackson Boulevard, Erwin, NC 10/16/23
Harnett 0597-68-0294
35.337952 -78.677282
P-3
17
4.25
10.54
NA
2
15
■
■
■
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:
William J. Miller
2927A
CATLIN Engineers and Scientists
Bentonite
Concrete
75 lbs
16.66 lbs
10/10/2023
Well abandoned in place with hydrated bentonite to
~6 inches below land surface. Concrete was used to
bring the opening to grade.
Stanley H. Brown NA
103 West Jackson Boulevard, Erwin, NC 10/16/23
Harnett 0597-68-0294
35.337952 -78.677282
T-1
40
4.25
34.5
30
30
8
■
■
■

NCDEQ; FA-790_14709_CA_LTRRPT_20231026 CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

ATTACHMENT C

SITE PHOTOGRAPHS

ATTACHMENT C SITE PHOTOGRAPHS – OCTOBER 10, 2023
NCDEQ; 14709_Ed's Village Open Air Market CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

View of MW-1 before abandonment.

View of MW-1 after abandonment.

ATTACHMENT C SITE PHOTOGRAPHS – OCTOBER 10, 2023
NCDEQ; 14709_Ed's Village Open Air Market CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

View of MW-1 finished.

View of MW-3 before abandonment.

ATTACHMENT C SITE PHOTOGRAPHS – OCTOBER 10, 2023
NCDEQ; 14709_Ed's Village Open Air Market CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

View of MW-3 after abandonment.

View of MW-3 finished.

ATTACHMENT C SITE PHOTOGRAPHS – OCTOBER 10, 2023
NCDEQ; 14709_Ed's Village Open Air Market CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

View of MW-4 before abandonment.

View of MW-4 after abandonment.

ATTACHMENT C SITE PHOTOGRAPHS – OCTOBER 10, 2023
NCDEQ; 14709_Ed's Village Open Air Market CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

View of MW-4 finished.

View of MW-5 before abandonment.

ATTACHMENT C SITE PHOTOGRAPHS – OCTOBER 10, 2023
NCDEQ; 14709_Ed's Village Open Air Market CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

View of MW-5 after abandonment.

View of MW-5 after abandonment.

ATTACHMENT C SITE PHOTOGRAPHS – OCTOBER 10, 2023
NCDEQ; 14709_Ed's Village Open Air Market CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

View of MW-06R before abandonment.

View of MW-06R after abandonment.

ATTACHMENT C SITE PHOTOGRAPHS – OCTOBER 10, 2023
NCDEQ; 14709_Ed's Village Open Air Market CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

View of MW-06R finished.

View of P-1 before abandonment.

ATTACHMENT C SITE PHOTOGRAPHS – OCTOBER 10, 2023
NCDEQ; 14709_Ed's Village Open Air Market CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

View of P-1 after abandonment.

View of P-1 finished.

ATTACHMENT C SITE PHOTOGRAPHS – OCTOBER 10, 2023
NCDEQ; 14709_Ed's Village Open Air Market CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

View of P-2 after abandonment.

View of P-2 after abandonment.

ATTACHMENT C SITE PHOTOGRAPHS – OCTOBER 10, 2023
NCDEQ; 14709_Ed's Village Open Air Market CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

View of P-3 before abandonment.

View of P-3 after abandonment.

ATTACHMENT C SITE PHOTOGRAPHS – OCTOBER 10, 2023
NCDEQ; 14709_Ed's Village Open Air Market CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

View of P-3 finished.

View of T-1 before abandonment.

ATTACHMENT C SITE PHOTOGRAPHS – OCTOBER 10, 2023
NCDEQ; 14709_Ed's Village Open Air Market CATLIN Engineers and Scientists
CATLIN Project No. 220227 October 2023

View of T-1 after abandonment.

View of T-1 finished.