Cumberland_Well Abandonment_20220826

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Gerald Eister 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed Indicate TOTAL NUMBER of
2394A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Bridger Drilling Enterprises, 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.UIC,County,State,Variance,etc.)iflmown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaltPublic ■Neat Cement Grout ❑Bentonite Chips or Pellets
❑Geothermal(Heating(Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
Ohrigation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
■Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Neat Cement Grout 20 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 Tremie
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
N
4.Date well(s)abandoned:
April 4, 2022
n n 1
So.Well location:' AUG 2
Naman Judson, LLC -
Facili /Owner Name Facility M#(if applicable) S.CertiBcati �Clrvrr .1e >'s iL1OG.
ty ty ( aPP ) ��
520 Judson Church Road 8/3/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Cumberland 00455489188000 By signing this form,I hereby certify that the well(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
350032.54 N 784857.18 `,i, 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)ifavailable.For muhiple injection ornon-water supply wells
ONLY with the same construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:Potable Well abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth:25 (fL) 1617 Marl Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter (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: (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 276994636
6e.Outer casing length(d known): 00 10c.For Water Sunoly&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casing/tubing length(d known): (fL) abandoned
6g.Screen length(if known): (fL)
Form GW-30 North Carolina Department of Enviromnental Quality-Division of Water Resources' Revised 2-22-2016
I '

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Gerald Elster 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
2394A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gaL)
Bridger Drilling Enterprises, Inc. FOR WATER SUPPLY WELLS ONLY:
CompanyName
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(Le.UIC,County,State,Variance,etc.)iflmown
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
❑lndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
01ni 'on ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
Monitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquif-Recharge ❑GmundwaterRemediation Neat Cement Grout 20 lb
❑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) ❑Traccr Tremmie
❑Geothermal(Heatmg/Cooling Return) ❑Other( lam under 7g)
4.Datewell(s)abandoned:April 4, 2022 AUG 2 t, 2022
5a.Well location:
Naman Judson, LLC F D1 o. ` ; ��
Facility/Owner Name Facility ID#(if applicable) 8.Certification-
520 Judson Church Roadxff&� 8/3/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Cumberland 00455489188000
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
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has beets provided to the well owner.
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
458180.8993 N 2054991.4543 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 ifnecessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction reeord(s)ifavailable.For multiple injection or non-watersupply wells
ONLY with the same construction/abandonment,you can submit oneform. 10a.For All Wells: Submit this form within 30 days of completion of well
6a.Well m#:MW-9 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth:19 (ft-) 1617 Marl Service Center,Raleigh,NC 276994617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter•4 (;n,) 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:10.55 —(ft.) Division of Water Resources,Underground Injection Control Program,
1636 Marl Service Center,Raleigh,NC 276994636
6e.Outer casing length(if known):9 (R,) 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
6E Inner casing/tubing length(if known): (ft) abandoned.
6g.Screen length(if known):10 (ft)
i
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Gerald Eister 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed Indicate TOTAL NUMBER of
2394A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gaL)
Bridger Drilling Enterprises, Inc. FOR WATER SUPPLY WELLS ONLY:
CompaoyName
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(Le.UIC,County,State,Variance,eta)iflmown
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
❑Geothemral(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
Dirrinfion ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
1111 4onitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Neat Cement Grout 201b
❑Aquifer Storage and Recovery ❑SahnityBamer
[]Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
Tremmle
❑Geothermal(Heating/Cooling Retum) ❑ther(explain under 7g)
.,.; a`�� aR„L
4.Date well(s)abandoned.A pril 4, 2022 �.,,,=�a.s
5a.Well location: AUG I G 2 6 2022
Naman Judson, LLC HU
Facility/Owner Name Facility ID#(ifapplieable) 8.Certification: ,n`GYY URii
jbocl
520 Judson Church Road �t'�a�8/3/
(A 8/3/2022
Physical Address,City,and Zip Signature of Certified Well Contract6r or Well Owner Date
Cumberland 00455489188000 By signing this form,I hereby certify that the well(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA 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/minatestseconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
458086.9866 N 2055096.2026 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 ifnecessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable.For multiple injection or non-watersupply wells
ONLY with the same construction/abandonment,you can submit oneform.
10a.For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:M W-8 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total wed depth:19 (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:4 (ffi,) 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-10.41 (fw) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known):9 (ft.) 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
6E Inner casing/tubing length(if known): (ft) abandoned
6g.Screen length(if known):10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources i Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Gerald Eister 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed Indicate TOTAL NUMBER of
2394A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s):
Bridger Drilling Enterprises, Inc. FOR WATER SUPPLY WELLS ONLY:
Companyxame
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable weft construction permits(Le.UIC,County,State.Variance,etc){(brown
7d.Amount of disinfectant used:
3.Well use(checkwell use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ■Neat Cement Grout I ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Coohng Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
01crigation. ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GmundwaterRemediation Neat Cement Grout 20 Ibs
❑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
❑Geothermal(Heating(Cooling Return) ❑Other(explain under 7g) Tremmie ,�__ 2' (ta n
4.Date well(s)abandoned:April 4, 2022 AI
5a.Well location:
Naman Judson, LLC Ins' ' _n
Facility/OwnerName Facility W#(ifapplicable) 8.Certification:
520 Judson Church Road A1.9 8/3/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Cumberland 00455489188000
By signing this form,I hereby certify that the well(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with I5A NCAC 02C.0I00 or 2C.0200 Well Construction Standards
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
458238.4733 N 2055092.1653 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 ifnecessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach wellconsrrvctionrecord(s)ifavailable.For multiple injection ornon-watersupplyxells
ONLY with the same construction/abandonment,you can submit oneform.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:MW-7 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth:19 (fL) 1617 Mail Service Center,Raleigh,NC 276994617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter.4 (�,) 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:11.02 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known):
9 10c.For Water Suooly&Iniection Wells: In addition to sending the form to the
(fk)
addmss(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
611 Inner casing/tubing length Cif known): (pL) abandoned
6g.Screen length(if known):10 (fk)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Gerald Eister 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed Indicate TOTAL NUMBER of
2394A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gaL)
Bridger Drilling Enterprises, Inc. FOR WATER SUPPLY WELLS ONLY:
CompanyName
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(La b7C,County,State Yariance�etc.)rflmown
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
i
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
OIrrigation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
Nvlonitoring ❑Recovery
Injection Well: 7L For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GmundwaterRemediation Neat Cement Grout 20 lb
❑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
❑Geothermal(Heating(Cooling Return) ❑Other(explain under 7g) _ ..
4.Date well(s)abandoned..April 4, 2022
n �
5a.Well location: wj
Naman Judson LLC
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification: � k" Rfli� rr a.<yi Zvi '
520 Judson Church Road 8/3/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Cumberland 00455489188000
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: ,
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
350032.54 N 784857.89 R, You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages ifnecessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable.For multiple injection ornon-watersupplywells
ONLY with the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#•M W-6 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth:19 (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.4 (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:11.15 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 276994636
6e.Outer casing length(if known):4 (fb) 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
6f.Inner casing/tubing length(if known): (it.) abandoned
6g.Screen length(if known):15 (ft)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Gerald Eister 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
2394A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Bridger Drilling Enterprises, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well conm=tion permits(Le.UIC,County,Ratq YariancA etc.)if/mown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all t i hat apply):
❑Agricultural ❑Municipal/Public ■Neat Cement Grout ❑Bentonite Chips or Pellets
❑Geothermal(Heating(Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
0hrigation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
Monitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroumdwaterRemediation Neat Cement Grout 20 lb
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stomtwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
Tremmle
❑Geothemial(Heating/CoolingReturn) ❑Other(explain under 7g) -
.rr
�
4.Date well(s)abandoned:A pril 4 2022
AUG .2 6 2022
Sa.Well location:
Naman Judson LLC — n�'�r::,- � " ��'�t'''`�' unK
r
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
520 Judson Church Road 8/3/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Cumberland 00455489188000 By signing this form,I hereby certify that the wen(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(if well field,one Wong is sufcient) 9.Site diagram or additional well details:
2055063.2064 N 458393.5156 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 ifnecessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable.For mrdtiple injection ornon-watersupplywetls
ONLY with the same constructionlabandomnent,you can submit one form.
10a.For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#•M W-5 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth:19 at.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6a Borehole diameter•4 (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•9.44 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 276994636
6e.Outer casing length(if known):
9 (ft.) 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
6E Inner casing/tubing length(if known): (R) abandoned
6g.Screen length(if known):10 (fl.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
George Eister 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well ContractorName(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
2394A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Bridger Drilling Enterprises, Inc. FOR WATER SUPPLY WELLS ONLY:
CompanyName
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well conshuction permits(Le.UIC,County,State,Variance,etc.)iflmown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Mtmicipal/Public ■Neat Cement Grout ❑Bentonite Chips or Pellets
❑Geothermal(Ileatmg/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑lndusttiallCommercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
❑bri 'on ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
EMonitoring ❑Recovery
Injection Well: 71.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Neat Cement Grout 20 Ibs
❑Aquifer Storage and Recovery ❑SalinityBarrier
❑Aquifer Test ❑Stommwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer _ - I, f;--..
❑Geoth®al(Heating/CoolingReturn) ❑Other explain under 7g) Tremmie Y e +p
4.Date well(s)abandoned:April 4, 2022 AUG 2 t L
5a.Well location: ; „;? •.; to
tjI
ref
1 flivr� E>+" j�irSQ�.%
Naman Judson, LLC
Facility/Owner Name Facility lD#(ifapplicable) 8.Certification: (' 8�3�2022
520 Judson Church Road Aa j"
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Cumberland 00455489188000 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
provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has beei
(ifwell field one Wong is sufficient) 9.Site diagram or additional well details:
2055095.3087 N 458301.0467 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)ifavailable.For multiple injection ornon-watersupply wells
ONLY with the same constructionlabandonment,you can submit one form.
10a.For All Wells: Submit this form,within 30 days of completion of well
6a.Well ID#:M W-4 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth:19 (ft) 1617 Mail Service Center,Raleigh,NC 276994617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter•4 (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:8.99 00 Division of Water Resources,Underground Injection Control Program,
1636 Matt Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known):9 (ft.) loc.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
6f.Inner casing/tubing length(if known): (R) abandoned.
6g.Screen length(if known):10 (fL)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
George R. Bridger 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
239A wells abandoned:r
NC Well Connacmr Certification Number 7b.Apprordmate volume of water remaining in weII(s): (gaL)
Bridger Drilling Enterprises, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(Le.WC,County,State,Variance,eta)rfbrown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublie ❑Neat Cement Grout 19 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑Indushial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
[]Irrigation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
GMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite 19,
❑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 r�
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(,)abandoned: April 4, 2022 A U I G v �n�
5a.Well location:
Naman Judson, LLC
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
520 Judson Church Road � C
8/3/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Cumberland 00455489188000
i by signing this form,I hereby certifj+that the well(,)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15-4 NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
Sb.latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lattlong is sufficient) 9.Site diagram or additional well details:
2055090.7199 N 458320.5523 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 wellconstruction record(s)ifavailable.For multiple injection or non-watersupplywells
ONLY with the same constructionlabandonmert,you can submit one form.
10a.For All Wells: Submit this firmt within 30 days of completion of well
6a.Well ID#: M W-3 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 19 (fL) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
4 above,also submit one copy of this form within 30 days of completion of well
6c Borehole diameter. (in.)
abandonment to the following:
I
6d.Water level below ground surface: 8'44 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 276994636
6e.Outer casing length(if known): 9 (fL) 10c.For Water Suooly&Infection 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
6E Inner casing/tubing length(if known): (fr) abandoned
6g.Screen length(if known): 10 (ft.)
Farm GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Gerald Eister 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
l
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,ept1,only 1 GW-30 is needed Indicate TOTAL NUMBER of
2394A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Bridger Drilling Enterprises, Inc. FOR WATER SUPPLY WELLS ONLY:
Companyxame
7c.Type of disinfectant used:
2.Well Construction Permit#
List all applicable well construction permits(&a VIC,County,Stag Variance,etc)if/mown
7d.Amount of disinfectant used:
3.Well use(checkwell use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Mtmicipal/Public ■Neat Cement Grout ❑Bentonite Chips or Pellets
❑Geothermal(Heafrng/Coolmg Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
Elh-rigation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
E Monitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GrotmdwaterRemediation Neat Cement Grout 20 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 Tremmie
❑Geothermal(Heating/Cooling Reterm) ❑Other(Main under 7g)
4.Date well(s)abandoned:April 4, 2022 � L ZUZZ
5a.Well location: '- Uri;
Naman Judson, LLC
Facility/Owner Name Facility lD#(ifapplicable) 8.Certifrcatr�
520 Judson Church Road 8/3/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Cumberland 00455489188000
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
been' ded to the well owner.
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has provi
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
2055072.0986 N 458322.2845 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)ifavailable_For multiple injection ornon-watersupply welk
ONLY with the same canstruction/abandomnent,you can submit one form
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:M W-2 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth:19 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter:4 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:8'06 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 276994636
6e.Outer casing length(if known):
9 (ft.) 10c.For Water Suooly&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f,Inner casing/tubing length(if known): (g) abandoned
6g.Screen length(if(mown):10 (fL)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
I
i

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Gerald Eister
7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed Indicate TOTAL NUMBER of
2394A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gaL)
Bridger Drilling Enterprises, Inc. FOR WATER SUPPLY WELLS ONLY:
CompanyName 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable we l construction permits(Le.UIC,County,State,Variance,etc.)ifk nown
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 N Neat Cement Clout ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
❑Irri ation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
SMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquif-Recharge ❑GroundwaterRemediation Neat Cement Grout 20 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) ❑Try Tremmie
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: April 4, 2022
A1 I f; 2 E 2022
5a Well location:
Naman Judson, LLC
%"v w
Facility/Owner Name Facility ID#(ifapplimble) 8.Certification:
3
520 Judson Church Road A�iAw 7t29/22
Physical Addttss,City,and Zip Sig6afure of Certified Well Contractor or Well Owner Date
Cumberland 00455489188000
By signing this form,I hereby certify that the well(s)was(were)abandoned in
County Parcel Identification No.(PH-1) accordance with I5A NCAC 02C.0100 or 2C.0200 Well Construction Standards
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field,one lot/long is sufficient) 9.Site diagram or additional well details:
2055080.2719 N 458303.8028 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)ifavailable.For multiple h jection or non-watersupply wells
ONLY with the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 20 (ft.) 1617 Mail Service Center,Raleigh,NC 276994617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter.. 4 (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: 9.2 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 276994636
1
6e.Outer casing length(if known): 5 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
6f.Inner casing/tubing length(if known): ( ) abandoned
6g.Screen length(d known): 15 (ft)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016