RA-6716_33873_CA_LTRRPT_20230414_Well Abandonment

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Raleigh, NC 27605
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Wilmington, NC | Raleigh, NC | Washington, NC | Atlanta, GA | Charleston, SC

April 14, 2023 North Carolina Department of Environmental Quality Division of Waste Management UST Section
Attn: Mr. Mark Petermann
1646 Mail Service Center Raleigh, NC 27699-1646 Re: Letter Report – Well Abandonment
Cheek Road Grocery 5801 Cheek Road Durham, NC 27704 Incident Number: 33873 Risk Classification: High CATLIN Project No. 221007
Dear Mr. Petermann, 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 221007.4P, prepared March 1, 2023. Services were
authorized by the North Carolina Department of Environmental Quality (NCDEQ) Task Authorization (TA) #04, accepted March 6, 2023, and Contract Number N122019D. The approved scope of services for this Task Authorization included:
• Abandon five (5) monitoring wells (MW-01 through MW-05); and
• Prepare a letter report documenting the site activities.
Monitoring Well Abandonment On April 3, 2023, CATLIN personnel mobilized to the site and abandoned monitoring wells MW-01, MW-02, MW-03, MW-04, and MW-05. Well construction information for the wells is provided in the following table:

April 14, 2023 Page 2 of 2
NCDEQ; 33873_Cheek Road Grocery CATLIN Engineers and Scientists
CATLIN Project No. 221007 April 2023

Well ID Well Type Well Depth (feet) Well Diameter (inches) Abandonment Procedure
MW-01 Shallow 20.0 2.0 Pad removed, all well materials left in place
MW-02 Shallow 15.0 2.0 Pad removed, all well materials left in place
MW-03 Shallow 15.0 2.0 Pad removed, all well materials left in place
MW-04 Shallow 13.0 2.0 Pad removed, all well materials left in place
MW-05 Shallow 15.0 2.0 Pad removed, all well materials left in place
Monitoring wells MW-01 through MW-05 were abandoned under the 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). All well materials 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-01 and MW-03) or topsoil (MW-02,
MW-04, and MW-05) to the existing grade.
The well locations are shown on Figure 1 (Attachment A). The well abandonment records were submitted to the NCDEQ Division of Water Quality on April 5, 2023 and a copy is 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 us at [phone].

Sincerely,

Sean J. O’Neil, PE Project Manager
Attachments: A: Figure B: Well Abandonment Records C: Site Photographs RA-6716_33873_CA_LTRRPT_20230414_Well Abandonment

NCDEQ; 33873_Cheek Road Grocery CATLIN Engineers and Scientists
CATLIN Project No. 221007 April 2023

ATTACHMENT A FIGURE

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C H E E K R DT2T1T5T3T4
AST
WSW-2
MW-01
FORMER DISPENSERS
MW-03
MW-02
MW-05
MW-04
Source: Esri, Maxar, Earthstar Geographics, and the GIS User Community
FIGUREPROJECTTITLE
1CHEEK ROAD GROCERY5801 CHEEK RDDURHAM, NC SITE MAP
40 0 40 8020
Feet
INCIDENT NO.JOB NO.DATE SCALE DRAWN BY/CHECKED BY33873221007APRIL 2023 AS SHOWN KMC/SJO
Parcel Boundary
Active PotableWater Supply Well!(P
NOTE: Tank locations were obtained from previous reports prepared by other consultants and are approximate.
Approximate Location ofFormer UST/AST System
LEGEND
³
Abandoned MonitoringWell (Type II)!>
Unknown Lines
Electric Lines

NCDEQ; 33873_Cheek Road Grocery CATLIN Engineers and Scientists
CATLIN Project No. 221007 April 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
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:
Frank Clemmensen
5714 Cheek Road Grocery, Durham, NC 27704
0862-02-79-2014
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; 33873_Cheek Road Grocery CATLIN Engineers and Scientists
CATLIN Project No. 221007 April 2023

ATTACHMENT C SITE PHOTOGRAPHS

ATTACHMENT C SITE PHOTOGRAPHS – APRIL 3, 2023
NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 221007 April 2023
View of MW-01 after abandonment.
View of MW-02 after abandonment.
ATTACHMENT C SITE PHOTOGRAPHS – APRIL 3, 2023

NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 221007 April 2023
View of MW-03 after abandonment.
View of MW-04 after abandonment.
ATTACHMENT C SITE PHOTOGRAPHS – APRIL 3, 2023

NCDEQ; ATTACHMENT C SITE PHOTOGRAPHS CATLIN Engineers and Scientists
CATLIN Project No. 221007 April 2023
View of MW-05 after abandonment.