Rutherford_Well Abandonment_20220815

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
NICHOLAS HAYES 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-writer supply wells ONLY with the sane
A - 4121
construction abandonment,you can submit one form.
NC Well Contractor Certification Number
7b.Approximate volume ofwater remaining in well(s): 21'0 (gal.)
i
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
OIndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
❑irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry O Other(explain under 7g)
ElMonitoring ❑Recovery
injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 30.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BAROID AQUAGUARD
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
9. „-..
4.Date well(s)abandoned: 06/30/22 e���. a _5 V
n
5a.Well location: P.)1��
CLIFFSIDE STEAM STATION J
Facility/Owner Name Facility ID#(if applicable) 8.Certification: C.f im D1 pf^c:z%«-'+�Uti'il
al
573 DUKE_POWER ROAD MOORESBORO 28114 08/08/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
RUTHERFORD By signing this form, 1 hereby certify that the well(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 01C.0100 or 1C.0100 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.21324000 N 81.75237000 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Aaach well construction record(s)if available. For multiple injection or non-water supply
wells ONLY with the same consiruction.abandonment,you can submit one form. i Oa. For All Wells: Submit this form within 30 days of completion of well
ba.Well ID#: AB-3 BR abandonment to the following:
Division of Water Quality,Information Processing Unit,
188.09 1617 Mail Service Center,Raleigh,NC 27699-1617
66.Total well depth: (ft.)
10b. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2'0 (in,) above,also submit one copy of this;form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 58.02 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply& IniectionI Wells:, In addition to sending the form.to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit bne copy of this form within 30 days of
completion of well abandonment to the county health department of the county
4
6E Inner casing/tubing length(if known): where abandoned.
(ft.) p
6g.Screen length(if known):
f
Form OW-30 North Carolina Department of Environment and Natural Resources—Division of water Quality Revised March 2013
f

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
NICHOLAS HAYES 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) Tor multiple injection or non-crater supply wells ONLY with the some
constructiotvabandonment,you can submit one form.
A - 4121 1 15.2
NC Well Contractor Certification Number
7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknmrn
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublic ❑Neat Cement Grout ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry O Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 24.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BAROID AQUAGUARD
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) s e
4.Date well(s)abandoned: 06/30/22
5a.Well location:
CLIFFSIDE STEAM STATION i�Ut:.
Facility/Owner Name Facility IDN(if applicable) 8•Certification: i_ i _ _
573 DUKE POWER ROAD MOORESBORO 28114 j[Y/ 08/08/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
RUTHERFORD By signing this form, 1 hereby certify that the well(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.21322108 N 81.75240101 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. Tor multiple injection or non-water.supply
wells ONLY with the same construction'abandonmeni,you can submit one jorin. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: AB-3BRA abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 147.2 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
2.0 above,also submit one copy of this;form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: 53.86 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply& Iniectio[Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft. 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
6E Inner casing/tubing length(if known): (ft.
where abandoned.
u
6g.Screen length(if known):
Form G W-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
h

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
l
1.Well Contractor Information: WELL ABANDONMENT DETAILS
NICHOLAS HAYES I 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water supply wells ONLY with the same
construction'abandonment,you can submit one jorm.
A - 4121 I 13.0
NC Well Contractor Certification Number
7b.Approximate volume of water remaining in well(s):
'.
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc)ijknown 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry O Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 21.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BAROID AQUAGUARD
❑Geothermal(l leating/Cooling Return) ❑Other(explain under 7g) Sq _
4.Date well(s)abandoned: 06/30/22
5a.Well location:
CLIFFSIDE STEAM STATION
p+nrOl�p,v,
Facility/Owner Name Facility ID#(if applicable) 8•Certification: iY-
573 DUKE POWER ROAD MOORESBORO 28114 08/08/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
RUTHERFORD By signing this form, 1 hereby certify that the well(s)was(were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy ojlhis record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lot/long is sufficient) 9.Site diagram or additional well details:
35.21319990 N 81.75243990 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply
wells ONLY frith the same construcvimt/ubandanment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: AB-3BRUA abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 132.83 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2.0 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following: j
6d.Water level below ground surface: 53.04 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
t
10c.For Water Supply&Iniection�Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft•) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to d d abanone . 11 j he county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where I
i
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
E
0

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells k
1.Well Contractor Information: WELL ABANDONMENT DETAILS
NICHOLAS HAYES 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) (or multiple injection or non-water supply wells ONLY with the same
constructimt'abandonment,you can submit one form.
A - 4121
7b.Approximate volume of water remaining in well(s):
NC Well Contractor Certification Number 9'0
l
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit 0:
List all applicable well construction permits(i.e.County,State,Variance,etc)ifknown 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry IB Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 17.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BAROID AQUAGUARD
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4,Date well(s)abandoned:
06/30/22 - '
5a.Well location: J : 2 _
CLIFFSIDE STEAM STATION Ink;:rra is;-' ?r^�-.. i Uru1
Facility/Owner Name Facility lDk(ifapplicable) $•Certification: /_ �ipf�it'�`t�h'.�
573 DUKE POWER ROAD MOORESBORO 28114 � 08/08/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
RUTHERFORD By signing this form, 1 hereby certify that the ivell(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one lit/long is sufficient) 9.Site diagram or additional well details:
35.21326869 N 81.75233075 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply
wells ONLY with the same cunstruction/abandonntent,you can submit one form. 10a. For All Wells Submit this form within 30 days of completion of well
6a.Well ID#: AB-3I abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 103.86 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
2.0 above,also submit one copy of this Torm within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: 48.35 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) lOc. For Water Supply& Iniectio 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
6f.Inner casing/tubing length(if known): (ft.) where abandoned. ii
8
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
t
f
f

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
NICHOLAS HAYES i 1
7a.Number of wells being abandoned:'
Well Contractor Name(or well owner personally abandoning well on his/her property) ror multiple injection or non-wale'r supply wells ONLY with the .same
construction/abandonment,you can submit Co
A - 4121 ne form.
7b.Approximate volume of water remaining in well(s): 2'5 (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc.)j known 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry IV Other(explain under 7g)
[?]Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 10.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BAROID AQUAGUARD
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 06/30/22 ��
5a.Well location: +
ZQ2Z
CLIFFSIDE STEAM STATION pl L
Facility/Owner Name Facility(Dk(if applicable) $•Certification: ;��ICti r.Wit;l�f^C✓ t:T3 UD"(
�k7 D�'��1�130u
573 DUKE POWER ROAD MOORESBORO 28114 08/08/22
Physical Address,City,and Zip Signature ofCenifred Well Contractor or Well Owner Date
RUTHERFORD By signing this form, /hereby certify that the well(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one ha/long is sufficient) 9.Site diagram or additional well details:
35.21334860 N 81.75229877 �� You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply
wells ONLY with the some constructionlabandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.well ID#: AB-3 MA15 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 64.25 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Weill: In addition to sending the form to the address in 10a
2.0 above,also submit one copy of this form within 30 days of completion of well
Gc.Borehole diameter: (in.) abandonment to the following:
Gd.Water level below ground surface: 48.71 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) lOc.For Water SuMy& Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
bf.Inner casing/tubing length(if known): where abandoned.
(ft.)
6g.Screen length(if known):
I
Fonn GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
I
I
I

fi
I
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
NICHOLAS HAYES 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water ! supply wells ONLY with the saute
construction/abandonment,you can submit one form.
A - 4121 1
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
list all applicable well construction permits(i.e.County,State,Variance,etc)ijknown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublic ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry O Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 6.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BAROID AQUAGUARD
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 06/30/22 `a?� d—s ---
Sa.Well location: AIJr ! 2022
CLIFFSIDE STEAM STATION
g
Facility/Owner Name Facility 1Dk(if applicable) •Certification: f I1�vSr u�:tr Pf^C-?>i '3 URM
<
J JQ,r30ir.-.
573 DUKE POWER ROAD MOORESBORO 28114 08/08/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
RUTHERFORD By signing this form. 1 hereby certify that the wells)was(were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one Wilting is sufficient) 9.Site diagram or additional well details:
35.21331957 81.75225728 You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply
wells ONLY with the,ante constructionlabandomnenr,you can submit oneJarnt. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well 1D#: AB-3S abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth:
38.33 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
20 above,also submit one copy of this form within 30 days of completion of well
.
6c.Borehole diameter: (in.) abandonment to the following:
i
DRY Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service C Inter,Raleigh,NC 27699-1636
10c. For Water Sunnly&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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
6f.Inner casing/tubing length(if known): (ft.) where abandoned.
r
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
i
P
i

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells j
1.Well Contractor Information: WELL ABANDONMENT DETAILS
NICHOLAS HAYES 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water supply wells ONLY with the saute
construction/abandonment,you can submit one firms.
A - 4121 t
NC Well Contractor Certification Number
7b.Approximate volume of water remaining in well(s): 4.25 (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County.State,Variance,etc)ijknown 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
OAgricultural ❑Municipal/Public ❑Neat Cement Grout ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) O Sand Cement Grout ❑Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) O Concrete Grout O Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry O Other(explain under 7g)
OMonitoring ORecovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 12.0 GALLONS
❑Aquifer Storage and Recovery OSalinity Barrier
❑Aquifer Test OStormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BAROID AQUAGUARD
OGeothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 06/30/22
5a.Well location: -' 1 v 022
CLIFFSIDE STEAM STATION tr►fc;�t3ss1f
Certification:
tit r /.3 "t7 URi
Facility/Owner Name Facility IDl1(ifapplicable) 8. /A�!/- J� OG
573 DUKE POWER ROAD MOORESBORO 28114 08/08/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
RUTHERFORD By signing this form, i hereby certify that the well(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.21330431 n, 81.75227965 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
.Attach well conftruction record(s)if available. For multiple injection or non-water supply
welts ONLY with the same construction✓abandomnent,you can submit one forms. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: AB-3SL abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 74.11 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In additi n to sending the form to the address in 10a
2.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
i
47.68 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
i
6e.Outer casing length(if known): (ft.) 10c. For Water So ply&Iniection Wells: In addition to sending the form to
the address(es) above, also submit�on'e copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f.Inner casing/tubing length(if known): (ftJ where abandoned. f
i
6g.Screen length(if known):
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quallity Revised March 2013
I

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
This forth can be used for single or multiple wells
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
NICHOLAS HAYES 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-Crater I supply wells ONLY with the same
construction/abandonntent,you can submit one form.
A - 4121
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 4.25 (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS 0NLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc)ifknown 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout1 ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry El Other(explain under 7g)
01vionitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 12.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BAROID AQUAGUARD
❑Geothermal(Hcating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 06/30/22
5a.Well location: p1JF t v
CLIFFSIDE STEAM STATION
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
/� C� -
573 DUKE POWER ROAD MOORESBORO 28114 08/08/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
RUTHERFORD By signing this fonn, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well held one fat/long is sufficient) 9.Site diagram or additional well details:
35.21333631 N 81.75223701 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply
wells ONLY with the same constructioniabandonment,you can submit one form. 109. For All Wells: Submit this foot within 30 days of completion of well
6a.Well ID#: AB-3SLA abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 75.54 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2.0 (in,) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
i
6d.Water level below ground surface: 48.55 (ft) Division of Water Quality,Underkround Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
loc. For Water Supply&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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
6f.Inner casing/tubing length(if known): (ft.) where abandoned. �
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
1
P,

Y
i
WELL ABANDONMENT RECORD For Internal Use ONLY: p
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
NICHOLAS HAYES 1
7a.Number of wells being abandoned:,.
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water I supply hells ONLY with the same
construction'abandonment,you can submit one form.
A - 4121 24.0
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
I
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable we//construction permits(i.e.County,State,Variance,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) O Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry El Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 32.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test OStormwater Drainage
OExperimental Technology ❑Subsidence Control 7g•Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE RIFE WITH BAROD
Y.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) ' a c
4.Date well(s)abandoned: 06/30/22 pr I I
5a.Well location: F'J 1^^
CLIFFSIDE STEAM STATIONJY' mot"3 Ufa
Facility/Owner Name Facility lDk(if applicable) $•Certification:
573 DUKE POWER ROAD MOORESBORO 28114 08/08/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
RUTHERFORD By signing this forni, 1 hereby certify that the ivell(s)ivas(were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.01,00 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one fat/long is sufficient) 9.Site diagram or additional well details:
35.21415127 N 81.75239159 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction records)if available. For multiple injection or non-water supply
wells ONLY with the same consiructionabandonmem,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: AB-7BR abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 198.6 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
i
10b.For Infection Wells: In addition to sending the form to the address in 10a
2, above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: 0 (in.) abandonment to the following:
51.62 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
I
10c. For Water Suoaly& Iniectidn Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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
6E Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.) I
i
Form G W-30 North Carolina Department of Environment and Natural Resources—Division of Water Qui lity Revised March 2013

I.
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAIIIIS
NICHOLAS HAYES 7a.Number of wells being abandoni�d: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-wafer! supply wells ONLY with the same
A - 4121 construction/abandonment,you can submit ione form.
7b.Approximate volume of water remaining in well(s): 17'0
NC Well Contractor Certification Number I (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit k:
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑IndustriaUCommercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Itri ation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry El Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 26.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BAROID AQUAGUARD
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
EEEC F � '
4.Date well 06/30/22s)abandoned: A.YG 1 o✓ 2@2
5a.Well location:
CLIFFSIDE STEAM STATION
Facility/Owner Name Facility ID#(if applicable)
8.Certification:
573 DUKE POWER ROAD MOORESBORO 28114 08/08/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
RUTHERFORD By signing this form, 1 hereby certify that the well(s)was (were)abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 01C.0100 or 1C.0100 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one[at/long is sufficient) 9.Site diagram or additional well!details:
35.21408979 81.75234958 You may use the back of this page,to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply
wells ONLY with the some construction'abandonmem,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: AB-7BRU abandonment to the following:
Division of Water Quality,Information Processing Unit,
160.1 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2'0 (in,) above,also submit one copy of this form Within 30 days of completion of well
abandonment to the following:
56.12 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supnly&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit'one copy of this form Within 30 days of
completion of well abandonment io:the county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where abandoned.
i
6g.Screen length(if known):
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
I