Stokes_Well Abandonment_20220912

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
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on Iris/her property) For tntdliple h jecvion or non-troterl supply u•e/ls O.Nt.Y with the same
conva•ttc iion'abmtdotttttenr,you c•an submii otre f n-In.
C -4421
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC-EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.Countw State,Variance,etc.)il'known i
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 O 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 El Other(explain under 7g)
[?]Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 1.75 GALLONS
OAquif'er'Storage and Recovery ❑Salinity Barrier
I
❑Aquiter 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:
06/22/22SEP
i .t
ia.Well location:
BELEWS CREEK STEAM PLANT 'i3- 'ngUnh
Facility/Owner Name Facility ID9(if applicable) 8.Certification: j .D�glQ1 Q�
i
3195 PINE HALL-ROAD BELEWS CREEK_ 27009 09/07/22
Plrysical Address.City,and Zip Signature of Certified-Well Contractor or Well Owner Date
STOKES By signing this form. I hereby ceriiy that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with ISA NCAC 02C.0100,or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
ill.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details-
920875.11 1689181.47 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 I
Attach well construction record(,)if arailable. -For mubiple hyeetion or non-water supply i
wells ONLY with the same construction%abnndonntent,you con submit onefmrtn. 10a. For All Wills: Submit this form within 30 days of completion of well
Ga.Well IDs: FGDLFPZ-1 abandonment to the following:
i'
Division of Water Quality,Information Processing Unit,
Gb.Total well depth: 49.59 lft) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob. 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
6c.Borehole diameter: 1.0 (in.) abandonment to the following: P
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 Sunnly& Iniecti 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.
i ;
6g.Screen length(if known): (ft.)
�. I -
Norm Ow-.,0 Noah Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
11
1 ,

p ,
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
DAMES MORRISON 7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For i ndtip/e injection or non-tracer supply ii'elts ONLY with Me .canie•
coitsn•ucvionRthamlorrnient,you can submit one firm.
C - 4421
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in w•ell(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Narne 7c.Type of disinfectant used: .
i
2.Well Construction Permit#:
List all applicable%re//construction permits(i.e.County,Stare,Pariance,eic)ijknomn i
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 O Other(explain under 7g)
Oivlonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.0 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(Hcating/Cooling Return) ❑Other(explain under 7g) `-`- v� E D
d.Date well(s)abandoned: . 06/22/22
ia.Well location:
r,.
BELEWS CREEK STEAM PLANT /yam
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
3195 PINE HALL ROAD BELEWS CREEK 27009 "' 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or well Owner Date
STOKES By signing this form, I hereby certify that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with I5A NCAC 02C.0l00 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:
920796.33 N 1689242.27 `� 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.
i
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well cohstraetion record(s)tJ ai•ailable. kor nwhiple injection or nan-Crater supply
wells ONLY frith the some caun•uciiotr'abaudonnicnG you can subinin one forin. 10a. For All Wells: Submit this;form within 30 days of completion of well
Ga.well ID#: FGDLFP7-2 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth 57.88 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in l0a
1 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 leiel below ground surface: (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
t
I
Ge.Outer casing length(if known): (ft.) 10c. For Water Supply&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 abandoned.
GC Inner casing/tubing length(if known): (ft.)
Gg.Screen length(if known): 'ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised Nlarcli 2013

l
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned. 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple li jection or non-irate;• supply wells ONLY frith the same
construction/abandonnnetu,you can snburit are firm.
C -4421
7b.Approximate volume of water:remaining in well(s): (gal.)
NC Well Contractor Certification Number f
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.Count),,State,Irariance,etc.)/('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 El Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stonmvater Drainage
i
❑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(1-leating/Cooling Return) ❑Other(explain under 7g) _ r
I
4.Date well 06/22/22s)abandoned:'.
Sa.Well location:
BELEWS CREEK STEAM PLANT
Facility/Owner Name Facility ID#(ifapplicable) S.Certification: -
f
3195 PINE HALL ROAD BELEWS CREEK 27009 "'; '°` 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES By signing this form. 1 hereby certify,that the irel/(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 bee»provided to the spell owner.
5b.Latitude and longitude in degrees/mintites/seconds or decimal degrees:
(ifwell field,one]at/long is sufficient) 9.Site diagram or additional well details:
920777.22 N 1689302.29 „ 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(v)if available. I-or multiple injection pr non•u•aer supply -
wellrONLPwiihthe same consrructionnbandonineut.yat con subnnit one.form. 10a. For All %yells: Submit this tbrin within 30 days of completion of well
6a.well ID#: FGDLFPZ-3 abandonment to the following: I
Division of Water Quality,Information Processing Unit,
Gb.Total well depth:
62.15 (ft.) 1617 Mail Service Cen t ter,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
1.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
I
Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
loc. 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 the county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where abandoned.
i
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality I Revised March 2013

II
ii
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS;
DAMES MORRISON 7a.Number of wells being abandon I ed: 1
Well Contractor Name(or well owner personally abandoning well on his/her property For multiple injection or Iron-ira'mrl supply irells• ONLY uvOh the some
co)id•ir?tciian%abaii(h)tment,you c•an subuut one farm.
C -4421 I
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well canstruc•iion permits(i.e.County.Stale,Variance,etc.)ifknoirn 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 i ❑ 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 l 171 Other(explain under 7g)
OMonitoring ❑Recovery i
Injection Well: 7E For each material selected above;!.provide amount of materials used:
❑Aquifer Recharge ❑GrOtlndwaterRemediation 2.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier 1
❑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: 06/22/22
Sa.Well location:
BELEWS CREEK STEAM PLANT 0WCOOG
Facility/Owner Name Facilitv I DU(if applicable) 8.Certification:
3195 PINE HALL ROAD BELEWS CREEK 27009 •,,. 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or W611 Owner Date
STOKES By signing this form. I hereby certify;lhal the well(s) tuns (lucre) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.01011 or 2C.0200 Well Construction Standards
and that a copy of this record has been;provided to the well owner.
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one]at/long is sufficient) 9.Site diagram or additional well details:
920640.33 N 1689275.32 `� 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.
i
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Atiac•h irel/construction record(y)if i-ailahle. For multiple itjection or non-water supply
wells ONLY wiih the sane consa•tiction/abandontiient,you cat?submit one firm. 10a. For All Wells: Submit this foam within 30 days of completion of well
6a.Well ID#:
FGDLFPZ-4 abandonment to the following:
Division of Water Quality;,lnformation Processing Unit,
68.4 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ftJ
10b. For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 1'0 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following: I
Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Ccnter,!Raleigh,INC 27699-i 636
6
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 icopy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6E Inner casing/tubing length(if known): (ft.) i
i
6g.Screen length(if known):
Forin GW-30 North Carolina Department of Environment and Natural Resources—Division.of Water Qualt Revised iblarch 2013

f '
WELL ABANDONMENT RECORD For Internal Use ONLY: i
This form can be used for single or multiple wells f
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON I
7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or no supply, wrells ONLY with the same
c•onsiructioMabondon[nent,you can subniii ohe firm.
C -4421 f
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number ! I
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List oll applicable ire/if construction permits(i.e.Count),,State,Variance,etc.)iiftnowit 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 i' ❑ Bentonite Chips or Pellets
OGeothennal(Heating/Cooling Supply) ❑Residential Water Supply(single) O Sand Cement Grout ❑ Dry Clay
Olndustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout O Drill Cuttings
i
Olrri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry i 21 Other(explain under 7g)
MMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,Provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test. OStorinwater Drainage
❑Ex erimental Technolog ❑Subsidence Control '•
P Y 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BAROID AQUAGUARD
OGeothermal(Heating/Cooling Return) []Other(explain under 7g) .
I�
06/22/22 °'" ff` 9'
4.Date svell(s)abandoned: i, 06—` 7 �� 4
Sa.1Ve11 location: ,S t P 1 2
BELEWS CREEK STEAM PLANT
S.Certification: Ifhrvft37s D l Pr-,=4^,,j;3E,' Ling
Facility/Owner Name Facility IDit(if applicable)
3195 PINE HALL ROAD BELEWS CREEK 27009 "°` 09/07/22
Physical Address.City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES By signing this jbi•iin, /hereby cerlify that the well(s)iiias (were) abandoned in
County Parcel Identification No.(PiN) accordance with 15A NCAC 02C.0100 a•2C.0200 Well Construction Standards
and that a copy of this record has beet1 provided to the trel!oumer.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lai/long is sufficient) 9.Site diagram or additional well details:
920513.83 1689185.35 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.
I
i
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach mel/constriction record(s)J arailable. For multiple h jec•tion or non-iraier supple
mells ONLY with the same consu•tic•iion%aliamlotuneiii,you can submit one forab 10a. For All Wells: Submit this form within 30 days of completion of well
6a.1Vel1 ID# FGDLFPZ-5 abandonment to the following:
Division of Water Quality,Information Processing Unit,
70.89 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b. For Iniection 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
6c.Borehole diameter: 1'0 (in.) abandonment to the following:
(ft.) Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface:
1636 Mail Service Center;Raleigh,NC 27699-1636
loc. For Water Sunniv&-lniectionAYells: 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
where abandoned.
6E Inner casing/tubing length(if known): (ft.)
i
1
fig.Screen length(if known): (ft.)
Form Gw'-30 North Carolina`Department of Environment and Natural Resources-Division of Water Quality i Revised March 2013
i

• I �
WELL ABANDONMENT.RECORD For Internal Use ONLY:
form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON ' 1
_ 7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For ror/rip/r it jecoron or nor-u•citerl supply ire/la ONLY with the .enure
C - 4421
cou.+vrucaion/aborclonulent,you c•an.cahndi one firm.
4
7b.Approximate volume of water re 1 aining in well(s): (gal.)
NC Well Contractor Certification Number l
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
I
Company Name 7e.Type of disinfectant used:
I
2.Well Construction Permit#:
List all applicable well construction perrnilx ri.e.Couoy,State,farianc•e,etc.)ifknrnrrr 7d.Amount of disinfectant used:
3.Well use(check well use): I
Water Supply Well: 7e.Scaling materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout 1 ❑ 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
❑Irrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry El Other(explain under 7g)
OMonitoring 0Recovery
Injection Well: 7E For each material selected above;provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation. 2.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormy ater 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 06/22/22
s)abandoned: S 1'P 2 7n27
5a.Well location:
BELEWS CREEK STEAM PLANT
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
3195 PINE HALL ROAD BELEWS CREEK 27009 �""'!�"� """� 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES
By signing This form, /hereby certify, that the welt(s) wns(were) nbmldotied in
County Parcel Iddntification No.(PIN) accordance with 15A NCAC 02C.0I00 or 2C.0200 Weil Construction Standards
and that a copy of this record has been p6,ided to the well orner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I
(ifwcll field,one lai/long is sufficient) 9.Site diagram or additional well details:
920514.37 N 1689302.45 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.
I
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach+rell construction record(t)if arahable. For oultiple iijecvion or non-+rater supply
rre//s ONLY with the same c•ousirrtction,abandonnrent,you call s•ubnrit one fin•nr. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: FGDLFPZ-6 abandonment to the following:
Division of Water Quality,Information Processing Unit,
74.15 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b. For Infection Wells: In addition to sending the form to the address in l0a
above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: 1 (in.) abandonment to the following:
6d.Water level below ground surface: (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center;Raleigh,NC 27699-1636
i
10c. For Water Supply& Injection Wells: In addition to sending the form to
Ge.Outer casing length(if known): 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
Gf.loner casing/tubing length(if known): (ft.) where abandoned. I
6g.Screen length(if known):
i
1
Form G W-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality ' Revised\•larch 2013
{

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells j
I '
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON I 1
7a.Number of wells being abandoned: -
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple ht ecdon or non-IrO/er supply u•elLr ONLY with the eannr
can.ciructiau'abanlonment,you can subtitit one form.
C - 4421 i
7b.Approximate volume of water'remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Narne 7c.Type of disinfectant used:
2.Well Construction Permit#:
Lint all applicable well construction permits(i.e.County,State,Variance,etc.)ttrknoirn
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
❑irrigation ❑ Specialty Grout j ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry El Other(explain under 7g)
El Monitoring _ ❑Recovery
Injection Well' 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundmuter Remediation 3.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Storm++ater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) _ ❑Tracer ABANDONED VIA TREMIE PIPE WITH BAR=AQUAGUARD
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well( )abandoned:s 06/22/22rE
Sa.Well location: SFP 1 29 2022
BELEWS CREEK STEAM PLANT,
Facility/Owner Name Facility IDit(if applicable) 8•Certification: j Information f rac&,,z:irg (Jeri
3195 PINE HALL ROAD BELEWS CREEK 27009 Dt rtlQlaOG09/07/22
Physical Address,City,and Zip Signature of Cerlified Well Contractor or Well Owner Date
STOKES By signing this form, 1 hereby certifj�that the+ve/1(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/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
920493.25 N 1689408.77 ,� 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.
I
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(v)if available. For multiple inyection or non-crater supply
rrellc ON1.Y with the same cotstruciirin%abmrdonment,yam can submit one farm. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
FG D LF PZ-7 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth:
86.19 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
1O above,also submit one copy of this foam within 30 days of completion of well
.
6c.Borehole diameter: (in.) abandonment to the following:
I
6d.Water level below ground surface: (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center;Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c. For Water Suppiv& Iniection Wells: In addition to sending the form to
the address(es) above, also submit ohe,copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6E Inner casing/tubing length(if known): (ft.)
i
6g.Screen length(if known): (ft-)
Fonn GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

i �
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON i, 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For nntlliple inieclion or non-waler supply bells ONLY wish the same
C -4421 conairucliota'abandonu+e+n,you con subsidl o%m fitrn+.
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
I
2.Well Construction Permit#:
List all applicable well construction permlte(i.e.Counly.State.Variance,etc.)ij'known 7d.Amount of disinfectant used:
t
3.Well use(check well use):
I
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout i' ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout j ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout i ❑ Drill Cuttings
❑irri ation ❑ Specialty Grout ! ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry 0 Other(explain under 7g)
oMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 3.2S GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stortmvater 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) :y t:_'1`y, eIs
nR}' 1
4.Date well(s)abandoned: 06/22/22 i S t P 1 71+��
5a.W611 location: l+
BELEWS CREEK STEAM PLANT lnI^I D%.rPQlP�', 04G'�9
! !OG
Facility/Owner Name Facility ID9(if applicable) 8•Certification:
319S PINE HALL ROAD BELEWS CREEK 27009i '"'�°" 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES
By signing this form. /hereby certhr that the vvell(s)\vas (were) abandoned in
Comity 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: i
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
920534.94 1689498.23 You may use the back of this page to provide additional well site details or\veil
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 orailable. l•br multiple injeclion or non-barer supply
I'
Ire/Is ONLY will)the same conxm•rtctioniabandotmmeni,you can submit one form 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well iD#• FGDLFPZ-8 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth:
90.41 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
Gc.Borehole diameter: 1'0 above, also submit one copy of this form within 30 days of completion of well
(in.) abandonment to the following: l
i .
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 Supuly& IniectionVells: 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 tile;county health department of the county
6E Inner casing/tubing length(if known): (ft.) where abandoned,
i
6g.Screen length(if known): (ft.)
i
I
Fonn G W-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY: '
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 11 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) for multiple h yection or non-water supply wells ONLY with the same
C -4421 c onstruc tion/abandorrmem,you can.submii one farm.
NC Well Contractor Certification Number 7b.Approximate volume of water ri.mining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: 1
2.Well Construction Permit#:
List all applicable well construction permits(i.e.Coto qe State.Vorionce,etc)if'known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7c.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 I ❑ Dry Clay
❑Ind ustrial/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)
OMonitoring ❑Recovery
.Injection Well: 7E For each material selected above;provide amount of materials used:
❑AquiferRecharge ❑GroundwaterRemediation 3.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier i
❑Aquiter Test ❑Stotmwater 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 udder 7g) ^q g
4.Date well(s)abandoned: 06/22/22 I'
SEP
5a.Well location: !
BELEWS CREEK STEAM PLANT Iniro;n Yti-vri PrDc.; q,,tg Unit
Facility/Owner Name Facility IDk(if applicable) 8.Certification: EANQ/6OG'
3195 PINE HALL ROAD BELEWS CREEK 27009 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Wcll Owner Date
i
STOKES
By signing this fora:, /hereby certify,that the tvell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.010 0 or2C.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:
920569.93 1689553.31 You may use the back of this page toiprovide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS.
Attach well construction record(y)if orailable. For multiple ityection or non-water supply
wells ONLY with rhesante constrrtevion/abandattnrenr,you consubnrii onefinm. 10a. For All Wells: Submit this forim within 30 days of completion of well
Ga.Well ID#:
FGDLFPZ-9 abandonment to the following:
'
Division of Water Quality;Information Processing Unit,
Gb.Total well depth 92.6 (ft.) 1617 Mail Service Cente ;r Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
1 above,also submit one copy of thisform within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
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 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 or
completion of well abandonment to the county health department of the county
611 Inner casing/tubing length(if known): (ft.) where abandoned.
I
I .
6g.Screen length(if known): (ft.)
Form G W-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
I

I 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'
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) Par multiple hliec•tion or non-water l supply iretls ONLY with the .yarn
c onxvue lion4rhanlonnneut,you can submii one/ornt.
C - 4421
NC Well Contractor Certification Number 7b.Approximate volume of water retaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
i ,
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
Lis!all applicable fret'construction pernths(i.e.Coun(v,State,Variance,etc.)tf'knowm 7d.Amount Of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check alb that apply):
OAgricultural ❑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 El Other(explain under 7g)
01VIonitoring ❑Recovery
injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.5 GALLONS
❑Aquiter 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 WP B-tRflIE RD
❑Geothennal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date wells)abandoned:
06/22/22 SEP 1 2, 20122
5a.Well location Ift vilii �''Jil Pia Civ;1 i��uni,
BELEWS CREEK STEAM PLANT
Facility/Owner Name Facility ID#(if applicable)
S.Certification:
319S PINE HALL ROAD BELEWS CREEK 27009 "` 09/07/22
Physical Address,City,and Zip Signature ofCertifted Well Contractor or Well Owner Date
STOKES By signing this farm. 1 hereby certh:that the wells) was (here) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 a•2C.0200 Well Construction Standards
anal that a copy of this record has beeti provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one ledlong is sufficient) 9.Site diagram or additional well details:
920506.30 N 1689155.43 NV abandonment
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 WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if arailable. For nnitiple ityeelion or non-Crater supply
ire/ls ONLY n•ith the sage consvntction/abandonntenrt,you con submit one frnro. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
FGDLFPZ-10 abandonment to the following:
Division of Water Quality;information Processing Unit,
6b.Total well depth: 67.87 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in l0a
above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: 1'0 (in.) abandonment to the following: J
i
Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Centgl Raleigh,NC 27699-1636
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 or
completion or well abandonment to the county health department of the county
where abandoned.
6f.Inner casing/tubing length(if known):
I
6g.Screen length(if known): (ft.)
Fonn GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality i Revised March 2013
t

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple Wells I.
I.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) 1'it+' nmtip/e it jection or non-u•a'erl supple hells ONLY +rith the saute
constrt+etiontabandoim+ent,pun can submit one fornt.
C - 4421 I
76.Approximate volume of water remaining in ivell(s): (gal.)
NC Well Contractor Certification Number I
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit
List all applicable troll conru-uction permits(i.e.Cotn/(y,State,Vmrianc•e,etc.)ifknown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Scaling 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 El Other(explain under 7g)
O Monitoring Q Recovery
Injection Well: 711 For each material selected above;,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Storm,.ater Drainage
i
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIP�I U BAROID AQUAGUARD
❑Geothermal(f leating/Cooling Retum) ❑Other(explain under 7g) ",` '
�-
� is U
I
d.Date well(s)abandoned: 06/22/22 SF P 1 .�i 2022
5a.Well location: IDt`vrFna
BELEWS CREEK STEAM PLANT J�JQ75x
Facility/Owner Name Facility ID#(ifapplicable) S•Certification:
3195 PINE HALL ROAD BELEWS CREEK 27009 ' '""'"` 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES By signing this fora. 1 hereby certifyi that the well(s) 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 retard has beer?provided to the the//owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: i
(if well field,one]at/long is sufficient) 9.Site diagram or additional well details:
920481.44 1689142.70 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 ifnecessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach ire//construction record(v)if available. 1-or+nultiple lnleclion or non-water supply
yells ONI.Y frith the same constriteiimt/abmtdonntent,roll can submit one./brit. 10a. For All Wells: Submit this form within 30 days of completion of well
Ga.Well ID#:
F G D LF PZ-11 abandonment to the following:
. ,
Division of Water Quality,Information Processing Unit,
66.03 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b. For Infection Wells: In addition to sending the form to the address in 10a
above,also submit one copy of this torn within 30 days of completion of well
6c.Borehole diameter: 1.0 (in.) abandonment to the following:
Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
i
l0c. For Water Supply& Infection!W'ells: In addition to sending the font to
Ge.Outer casing length(if known): (ft.) the address(es) above, also Submit 6ne1 copy of this forth within 30 days.of
completion of well abandonment to the'county health department of the county
where abandoned.
6111 Inter casing/tubing length(if known): (ft.)
i
t i
6g.Screen length(if known): (ft.)
Form G W-30 North Carolina Department of Environment and Natural Resources—Division of Water Quali y Revised i larch 201 3
li

f I
I
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells I'
I.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON ! 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally apandoning well on his/her property) For uur/liple it jection ar non-u•titer supply wells ONLY with the shine
construction'abandonmem,you can submit o(teJorm.
C -4421
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
list all opplicable well eonrlritc•tioit pernti(s(i.e.County.Slate,Variance,etc.)ifknouw 7d.Amount of disinfectant used:
3.Well use(check well use): !
Water Supply Well: 7e.Scaling 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 El Other(explain under 7g)
l7lMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.75 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)
S i x
4.Date well(s)abandoned:
06/22/22 W '4—11­�'
5a.Well location:
BELEWS CREEK STEAM PLANT 1n;,;c,, .; ^� '� ��aYirt3 un:'
Facility/Owner Name Facility ID#(if applicable) g•Certification: •�
I
3195 PINE HALL ROAD BELEWS CREEK 27009 ""'^` 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES By signing this form 1 hereby cent f that die irell(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 tVell Construction Standards
and that a copy of this record has been provided to the ire//owner.
>b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: j
(if well field,one lai/long is sufficient) 9.Site diagram or additional well details:
920445.59 1689222.86 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.
i
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction recard(v)if available. For multiple hyeclion or non-irater supply
irel/s ONLY irilh the scone con.struclian47banhnutient,you can submit one.fartn 10a. For All Wells: Submit this Iffirm within 30 days of completion of well
6a.Well ID#:
FGDLFPZ-12 abandonment to the following:
Division of Water Quality;Information Processing Unit,
76.92 1611 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b. For Infection Wells: In addition to sending the form to the address in 10a
above,also submit one copy of this torm within 30 days of completion of well
6c.Borehole diameter: 1.0 (in.) abandonment to the tollowing:
Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
1
10c. For Water Supply& Injection Wells: In addition to sendine 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
where abandoned.
611 Inner casing/tubing length(if known): .
Y '
I
6g.Screen length(if known):
Form G W-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
i
i
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
JAMES MORRISON 7a.Number of wells being abando ne
1
d:
Well Contractor Name(or well owner personally abandoning well on his/her property) For nnrltiple inleciion or non-,ra�eri supply welts ON/.Y with the sane•
C - 4421 c•am7nictioNabandatuneai,you can submit one forts.
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit h:
List all applicable well construction permits(i.e.County.State,flariauc•e,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
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry 0 Other(explain under 7g)
fB Monitoring ❑Recovery
injection Well: 7111 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
0Ag6ifer 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) r,
a.Date well(s)abandoned: 06/22/22 K~
ia.Well location:
BELEWS CREEK STEAM PLANT
Facility/Owner Name Facility IDS 8.Certification:(i(.yrplicable) �
3195 PINE HALL ROAD BELEWS CREEK 27009 "` '°"` 09/07/22
Physical Address,City,and Zip Signature of Cenified Well Contractor or Well Owner Date
STOKES By signing this form. I hereby certi�that the well(s) ivas (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.
ib.Latitude and longitude in degrees/ininutes/seconds or decimal degrees: i
(ifwell field.one Iai/long is sufficient) 9.Site diagram or additional well details:
920420.82 IN 1689178.39 " 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 sell construction record(s)if arbilable. For nudtiple inieclion or non-ti•ater.supply
wells ONLY with the same c•oasiructionlabando»ntent,you can submit one fort. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID/h FGDLFPZ-13 abandonment to the following:
I
Division of Water Quality,information Processing Unit,
6b.Total well depth:
76.02 (ft.) 1617 Nlail Service Center,Raleigh,NC 27699-1617
10b. For Iniection 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
6c.Borehole diameter: 1.0 (in.) abandonment to the following:
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 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 the county health department of the county
j I
6E Inner casing/tubing length(if known): (ft.) where abandoned.
I '
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division or Water Qualill• Revised March 2013
I
I �

i
i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells i
1.Well Contractor Information: WELL ABANDONMENT DETAILS,
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple it fecdon or non-i roterl supple wells ONLY rritb the .same
c•onslructioniabandmvnent,you can subntti mie farm.
C -4421 1
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
list all applicable u•e//construction permits(i.e.County,State,Nm•ionce,etc.)iij'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 Cl Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry O Other(explain under 7g)
Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stonmwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BAROID AQUAGUARD
❑Geothermal(lieating/Cooling Return) ❑Other(explain under 7g)
�,
d.Date well(s)abandoned: 06/22/22 `" — � '"y -'
Sa.Well location: t 2) 2022
BELEWS CREEK STEAM PLANT
S.Certification: rt+, Urti
Facility/Owner Name Facility ID#(if applicable)
3195 PINE HALL ROAD BELEWS CREEK 27009 '''"` 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES By signing this forme, /hereby certify that the we/l(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Strandardr
and that a copy of this record has been provided to the ivell oirner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one]at/long is sufficient) 9.Site diagram or additional well details:
920381.82 N 1689020.53 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 SUBIMITTAL INSTRUCTIONS
Atwell well consa•nciinn record(v)Y'm•nilable. For multiple h jection or non-neater supply
ite/1s ONLY rrith the sameconstrttctiotn'abatrdorrnreut,you Call submiloneform. 10a, For All Wells: Submit this form within 30 days of completion of well
Ga.well iD#: FGDLFPZ-14 abandonment to the following:
Division of Water Quality,Information Processing Unit,
79•9 1617 Nlail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b. For Infection Wells: In addition to sending the form to the address in 10a
1.0 above,also submit one copy of thisjform within 30 days of completion of well
Gc.Borehole diameter: (In.) abandonment to the following:
Gd.Water level below ground surface (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Ylail Service Center,Raleigh,NC 27699-1636
I .
10c. For Water Suonly& 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 courtly
_ Gf.Inner casing/tubing length(if known): (ft.) where abandoned. �
6g.Screen length(if known): (ft.)
Form OW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
fl
I

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells i
I.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON � 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on Iris/her property) 1--or nuilliple injection or non-waler suppl}, wells 0,VLt' with the sonic
c•on.cirticlioiiiabandolinteni•wnt call subuiil vine fiunr.
C - 4421
NC Well Contractor Certification Number 7b.Approximate volume of water'remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.type of disinfectant used:
2.Well Construction Permit#:
List all applicable ire/1 construction perniiis(i.e.Counl),,Slate,Variance,elc•.)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
❑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)
oMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 3.0 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 W -dPAl/RflI9-AQUAG�l1�D
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) d c,
4.Date well(s)abandoned: 06/22/22 _P 2
5a.Well 10ea110n: '
lllYvi f:.3:ln l . 7.;.-:?S�(, nil,
BELEWS CREEK STEAM PLANT
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
3195 PINE HALL ROAD BELEWS CREEK 27009 " '^` 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or,Well Owner Date
STOKES By signing this form, 1 hereby cerlhi than the well(s) )vas (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Consu•ticiion Standards
and that a copy of this retard has been provided to the well owner.
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lai/long is sufficient) 9.Site diagram or additional well details:
920334.51 N 1689071.93 „ 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
AaaM n•el/construction record(r)ijarailable. !•in•wtdliple infection at-non-water supp/y
wells 0AILY with the same cansirticiion%abandnnutent,y-ou can submit ane,(brut. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDY• FGDLFPZ-15 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.•,(oral well depth:
85.03 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
1.0 above, also submit one copy of thiss form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
r
6d. \'atcr level below ground surface: (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Suooly& 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
where abandoned.
6E Inner casing/tubing length(if known): (ft.) I
i
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Departnient 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
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
DAMES MORRISON 7a.Number of wells being abandoned-
Well Contractor Name(or well owner personally abandoning well on his/her property) 1;,or multiple it jeclion or nor-iraIlerl supplj, hells ONLY with the .cane
c•onxtructio✓abandonment,you c•mr subtnii one form.
C - 4421
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit ft:
List a//applicable n•ell consiruc•tinn permits(t.e.Connry,Slate, Variance,etc.)tfknoawu
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(lieating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
Olttdttstrial/Commercial ❑Residential Water Supply(shared) O Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry 0 Other(explain under 7g)
El Monitoring ORecovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stonttwater Drainage
OExperimental 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 wells)abandoned: 06/22/22 i�� 'E -y y f
ia.Well location: t `) 2022 i �
BELEWS CREEK STEAM PLANT llyfi�LYt, _:On r'fac�.� ?3 Uri
Facility/Owner Name Facility IDk(ifapplicable) S.Certification: Dtn/O/6OG
3195 PINE HALL ROAD BELEWS CREEK 27009 "'"� 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES ay signing This form, I hereby certfy that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 a•2C.0?00 Well Construction Standards
and that a copy of this record has beery provided to the well owner.
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one)atllong is sufficient) 9.Site diagram or additional well details:
920264.20 �, 1688925.93 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
Anach we/1 construction record(n)if available. For multiple byection or non-water s'upp/y
wells ONLY with the same constrnctiotYabanlonutent,you can submit are jinn. 10a. For All Yells: Submit this'form within 30 days of completion of well
6a.WeI11Dtt: FGDLFPZ-16 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth:
74.25 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 101
1.0 above,also submit one copy of this form within 30 days of completion of well
Gc.Borehole diameter: (In•) abandonment to the following:
Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
lac. For Water Supply& Injection 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
where abandoned. i
Gf.Inner casing/tubing length(if known): (ft.)
I
6g.Screen length(if known):
Form G W-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
r
' � I

i �
t
WELL ABANDONMENT RECORD For Internal Use ONLY: �
This form can be used for single or multiple wells !
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON I 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) l•br i nihiple injection or non-wa,ier, supplj• ❑'ells ONLY with the sunte
c•onstrtinioti'ahandotrinent,you can submit ohe jiirm.
C -4421
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Ce,tification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
list all applicable+cell consiruciian perutit.r(i.e.Coumjt State,Variance,etc.)tfknou•ti
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
❑lrri 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 2.S GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stonmttater 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 7e) v
06/22/22 S_ i ,
.Date well(s)abandoned: FP 2n97
I)
5a.Well location:
BELEWS CREEK STEAM PLANT
Facility/Owner Name Facility ID9(ifapplicable) 8•Certification:
3195 PINE HALL ROAD BELEWS CREEK 27009 " 09/07/22
Physical Address.City,and Zip Signature ofCettified Well Contractor or Well Owner Date
I
STOKES By signing this forin, 1 hereby certify that the ivell(s) was (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 ihis 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:
920154.81 �, 1688860.69 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(y)ij'arallable. For inuhiple injection or non-water.supply ;I
,relLs ON/.1'u•idi the.ronre cacrirnctinicnbondrnmirni,you can submit am Jnrm. 1 Oa. For All Wells: Submit this loam within 30 days of completion of well
Ga.Well ID#:
FG D LF PZ-17 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth: 69.9 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition'to sending the forin to the address in l0a
1 0 above,also submit one copy of this;forin within 30 days of completion of Weil
6c.Borehole diameter: (in.) abandonment to the following:
i
Gd.Water level below ground surface: (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
loc. For Water Suonhv& 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
where abandoned.
6f.Inner casing/tubing length(if known):
6g.Screen length(if known):
Form GWvO North Carolina Department of Environment and Natural Resources—Division of Wnte.r Qua�itt) Revised Nlnrch 201

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: - 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For nuhiple injection or non-o•a r
tel supply ire/A ONLY with Me same
cwrstruc/ion/obandannteut,you can subuii one fi�rni.
C -4421
7b.Approximate volume of water remaining in well(s):
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit iY:
List all applicpble well c•onsiruc•tion permits(i.e.County,Siam,6 nriance,etc.)i/•knouvr
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
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Sluiry El Other(explain under 7g)
RlMonitoring ❑Recovery
injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.5 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: 06/22/22
r _
Sa.Well location:
BELEWS CREEK STEAM PLANT Un;:
Facility/Owner Name Facility IDH(ifapplicable)
8.Certification:
3195 PINE HALL ROAD BELEWS CREEK 27009 "' 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES By signing this form, l hereby certify'lhat the ivell(s)tvas (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200{Yell Construction Siandm-ds
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:
920106.58 1688935.22 You may use the back of this pageto provide additional well site details or well
1.
N W� abandonment details. You may also'attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Anach a•el/conrirmcoon record(v)ijm•ailoble. /,or multiple byection or non-water supply
trel/s ONLY❑-iilt the sane carsrrvcviom-nbandonureur,gnu can suburit one farm• 10a. For All Wells: Submit this'torri within 30 days of completion of'well
6a.Well IDtt: FGDLFPZ-18 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.'fotal well depth:
66.1 1617 Mail Service Center,Raleigh,NC 27699-1617
(ft.)
10b. For Infection 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
6c.Borehole diameter: 1.0 (1n.) abandonment to the following:
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 Supply& Iniection,Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(cs) 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.
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
Form G W-30 North Carolina Department of Environment and Natural Resources-Division of water Qu I
ality Revised idarch 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 DETAILS•
JAMES MORRISON 1 ' 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) l'or multiple inleclion or non-irareri supply u•el1.s ONLY a71h the snore
c•onstrrrc•IioMabandonnient,you can submit one form.
C - 4421 i
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well constrtiction perniiiv(i.e.Cornuv,State,Variance,etc.)i/'knonvr
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Publie ❑ 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
❑lrri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry 0 Other(explain under 7g)
0Monitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
i
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothenmal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BAROID AQUAGUARD
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
J.Date well(s)abandoned: 06/22/22 C EP i 2 2n9�
5a.Well location:
BELEWS CREEK STEAM PLANT
Facility/Owner Name. Facility IDN(if applicable) 8•Certification: 1
D%,N'Q/*OG
3195 PINE HALL ROAD BELEWS CREEK 27009 "''`"" 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES By signing this farm, l hereby certify that the ivell(s) was(here) abandoned in
County Parcel Identification No.(PIN) accordance with 15A A'CAC 02C.0100 or 2C.0200 We//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 W/long is sufficient) 9.Site diagram or additional well details:
919920.24 1688744.71 You may use the back of this page to provide additional.well site details or well
N H' abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Minch ire/I construction record(s)if ar•ailable. For milhiple inlee•lion or non-water supple
ire/h ONLY irith ihe.same c•on.sn•mctiolr'abarclotuuetrt,you can submit one/orin. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
FG D LFPZ-19 abandonment to the following:
Division of Water Quality,,Information Processing Unit,
Gb.Total well depth:
59.9 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
10 above,also submit one copy of this'form within 30 days of completion of well
.
6c.Borehole diameter: (in.) abandonment to the following:
I
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 Supply& Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit lone copy of this form within 30 days of
completion of well abandonment toithe county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where abandoned. �
i
6g.Screen length(if known):
f
Fonn GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
I ,

P
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: FELL ABANDONMENT DETAILS
JAMES MORRISON r 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For maniple i,jec•tion or nnn-water supply ,rellr ONLY with the .van,e
c•ort.riractian cibattclonnteni,you c•an submit one forut.
C - 4421
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number ;
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well conriruciion permits(i.e.County.State,Variance,etc.)ifknown
7d.Amount of disinfectant used:
3.Well use(check well use):
Rater 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
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry 0 Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 1.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stonnwater 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)
C7�� y
4.Date well(s)abandoned: 06/22/22 S F t3 1 2 2022
ia.Well location: If1;�i'=;i.;;t 1 'T '3 F•j:7 Url:
BELEWS CREEK STEAM PLANT
Facility/Owner Name Facility IDN(if applicable) S•Certification:
3195 PINE HALL ROAD BELEWS CREEK 27009 "" 09/07/22
Physical Address,City,and Zip - Signature of Certified Well Contractor or Well Owner Date
STOKES By signing this fornr, I hereby cerlify that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with hA NCAC 02C.0100 or 2C.0200)Yell Construction Standards
and that a copy of this recorcl has been provided to the well owner.
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one]at/long is sufficient) 9.Site diagram or additional well details:
919837.90 168882788 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
Attac•lt trell construcliott record(.,)if available. l-or multiple ittiectiort or non-trmer.supply
u•ellr ONL3'with ihe.rnnre consn•uc•riun/nbandonn,eat,yntt c•cn,.,ubtnit n,m,ior,n. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDP:
FGDLFPZ-20 abandonment to the following:
I .
Division of Water Quality,Information Processing Unit,
Gb.Total well depth:
49.92 1617 Mail Service Center, ,Raleigh,NC 27699-1617
(ft.)
10b. For Iniection Wells: In addition to sending the form to the address in l0a
above,also submit one copy of this form within 30 days of completion of well
Gc.Borehole diameter: 1.0 (in.) abandonment to the following:
6d.Water level below ground surface: (ft.) Division of Water Quality,Unrier-round Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
f
10c. For Water Supply& Iniection Wells: In addition to sending the form to
6c.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 ttie county health department of the Count)'
where abandoned. j
6E Inner casing/tubing length(if known): (ft.)
I
Gg.Screen length(if known):
I
i
Form G W-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 201
i

f
I '
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: 1YELL.ABANDONMENT DETAILS
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) Far nnthiple ii jecfion or nor-iraier suppl}' ire/Is ONLY with the .came
cotrrirtiction/abmuloument•yoe call submit one form.
C - 4421
7b.Approximate volume of water 'remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List.till applicable well construction perurits(1.v.Commjt State•liariance,etc.)ifkuorn 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
❑Irrigation ❑Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry IZI Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stortmvater 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 Retum) ❑Other(explain tinder 7g) _,i.t i; , (�N,� �r..
4.Date well(s)abandoned: 06/22/22 j
SEP i ? 2n22
5a.Well location:
BELEWS CREEK STEAM PLANT
Facility/OwnerNanic Facility IDf!(ifapplicable) 8.Certification:
3195 PINE HALL ROAD BELEWS CREEK 27009 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES By signing this form. /hereby certify that the well(s) teas (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 N%ell 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: i
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
919839.72 1688660.23 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(v)if'available. rar multiple h jeclinn or nor-water supply
ire/ls ONLY with the same c•onstrnctiott/abandotin+ent,you call submit one firm.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
FGDLFPZ-21 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth:
55.68 (ft.) 1617 Mail Service Center,, Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in l0a
above,also submit one copy of this,form within 30 days of completion of well
6c.Borehole diameter: 1'0 (in.) abandonment to the following:
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 Surnh'& Infection Wells: fit addition to sending the torn to
Ge.Outer casing length(if known): (ft.) the address(es) above, also submit;oi'ie copy of this torn 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 Departiitent of Environment and Natural Resources—Division of Water Quahq' Revised March 201

WELL ABANDONMENT RECORD For Internal Use ONLY: i
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) 1--or inulriple it jection or non-u•titer. supply u•e/h ONLY irirh the sane
construc•tion%abandountent,you can submit one onn.
C -4421
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION 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,Sete,Variance,eic•.)iij'knowtt
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MLtnicipal/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 E)Other(explain under 7g)
01vionitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 2.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑AquiferTest ❑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)
d.Date well(s)abandoned: 06/22/22 S F P I .� 2022
ia.Well location: Unit
BELEWS CREEK STEAM PLANT
Facility/Owner Name Facility ID9(if applicable) g•Certification:
3195 PINE HALL ROAD BELEWS CREEK 27009 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES By signing this farm. 1 hereby certify that the well(s) was (here) 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-.
ib.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:
919790.62 N 1688705.51 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(()if orailable. For nurhiple h jection fir non-troter supply
wells ONLY frith the s'one c•onsvruciiotvbbandonntett,you can subndt one.1brut. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: `
FGDLFPZ-22 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb."total well depth: (ft.)
55.35 161.7 Mail Service Center,Raleigh,NC 27699-1617
-
10b. For Iniection Wells: In addition to sending the form to the address in 10a
10 above,also submit one copy of this,form within 30 days of completion of well
.
6c.Borehole diameter: (in.) abandonment to the following:
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 Sunoh'& 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
where abandoned.
6E Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known):
Form G W-30 North Carolina Department of Environment and Natural Resources—Division o(Water Quality Revised March 2013
i
i

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
i,
1.Well Contractor Information: WELL ABANDONMENT DETAILS
DAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) /'ar nadtiple in jecvtnu or non-u aretI .rupply netts ON1.1' a irb the scone
coastrnctioitiabcmdotttttent,you van subnm one fi rin.
C -4421
7b.Approximate volume of water I remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction perutits•(i.e.Cntnu),,State,Variance,ere.)y1nmrn 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
❑fndustrial/Commercial ❑Residential Water Supply(shared) D Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry D Other(explain under 7g)
OMonitoring ❑Recovery
injection Well: 7E For each material selected above,provide amount of materials used:
DAquifer Recharge ❑Groundwater Remediation 2.0 GALLONS
DAquifer Storage and Recovery ❑Salinity Barrier
DAquifer Test OStormwater Drainage
DExperimental 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: 06/22/22 ' "� } V q f­;
ia.Well location: r 1 2 2@22
BELEWS CREEK STEAM PLANT Urfii
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
3195 PINE HALL ROAD BELEWS CREEK 27009 " ' '°� 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES By signing this farm. I hereby certify that the ire/l(s) ivas(here) abandoned in
Countv Parcel Identification No.(PIN) accordance with ISA NCAC 02C.0I00 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided io the hell owner.
ib.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:
919686.74 1688809.11 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 ifnecessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBNIiTTAL INSTRUCTIONS
Attach well cansiructimt record(,)if available. Por undliple h jectiot at,non-water stipplj'
wells ONLY with the sane consvrtictionkthandohutent,you can sulintii one fora. 10a. For All Wells: Submit this'form within 30 days of completion of well
FGDLFPZ-23 abandonment to the following:
6a.Well ID#: -
Division of Water Quality,Information Processing Unit,
Gb.Total well depth: 59.9 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection 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
6c.Borehole diameter: 1'0 (in.) abandonment to the following:
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 Supply & lnieeti6n,Yells: 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 ol•the county
where abandoned. I
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
i I
Fonn GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Q lali Iy Reviscd March 201

fl
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) 1--or onthiple byeclion or non-iratei supply a•eNs ONLY u•ilh the saute
conslrucliW7tabatrtlonntetrt,you can subniir one ftmn.
C -4421
7b.Approximate volume of watet•iremaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS'ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable ate//construction pernuas(i.e.County.State,llarianc•e,etc.)tfknotrn 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
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry (Z] Other(explain under 7g)
hJMonitoring ❑Recovery
Injection Well: 7f.For each material selected aboye,•provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 2.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stonmvater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PiTk,WI.TF�BQk2QID A�UAGUARD
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) 1 `�
4.Date well(s)abandoned: 06/22/22 S F P 1 2) 2022
5a.Well location: Pr c;rT,.;.ng Un;'
BELEWS CREEK STEAM PLANT
i
Facility/Owner Name Facility lD#(if applicable) S.Certification:
3195 PINE HALL ROAD BELEWS CREEK 27009 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
STOKES By signing this form. I hereby ceril ,that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15.4 NCAC 02C.0I00 or 2C.0200 Well Construction Standards
and that a cop),of this record has been provided to the well owner.
i
5b.Latitude and longitude in degrees/tninutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well(details:
919786.80 1688676.53 You may use the back of this pagelto,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 SUBNIITTAL INSTRUCTIONS
Attach trell construction record(t)if arailable. Por nntltiple injection or non-water supply
rreUs ONLY with the.some constrttciiordabmrdonnuent,you call stulunu one jbrin. 10a. For All Wells: Submit this form within 30 days of completion of well
6..Well ID#:
FGDLFPZ-24 abandonment to the following:
Division of Water Quality,Information Processing Unit,
55.54 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b. For Infection 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%velI
6c.Borehole diameter: 1.0 (in.) abandonment to the following: i
I
i
Division of\\'.ter Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Cenier,Raleigh,NC 27699-1636
1 1
10c. For"later Supply& Iniection4ells: 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
where abandoned.
6f.Inner casing/tubing length(if known): (ft.)
I
6g.Screen length(if known):
II
Form G W-30 North Carolina Department of En•viromnent and Natural Resources-Division of Water Qr,ality 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 DETAILS
DAMES MORRISON 7a.Number of wells being abandoned: 1
Well Conti-actor Name(or well owner personally abandoning well on his/her property) For nwhiple ii jection or non-crater supply wells ONLY with the same
C - 4421 cwtvirrtctiatrtabandonnteitt,vat can subnth one.1brm.
NC Well Contractor Certification Number 7b.Approximate volume of water)remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLYWELLS,ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
list all applicable well construction permits(i.e.County,State,Variance,etc.)i1'knouvt
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
❑frri 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 2.0 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 06/22/22s)abandoned:
5a.Well location: Un12l
BELEWS CREEK STEAM PLANT
Facility/Owner Nmne Facility ID#(if applicable)
8.Certification: J JOIN
3195 PINE HALL ROAD BELEWS CREEK 27009 " ^` 09/07/22
Physical Address,City,and Zip Signature of Certified Well Contractor or.Well Owner Date
STOKES By signing this form, I hereby certify that the wells) was(here) abandoned in
County Parcel Identification No.(PIN) accordance with 15,4 NCAC 02C.0100 0•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 tat/long is sufficient) 9.Site diagram or additional well details:
919715.57 1688550.15 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 SUM9ITTAL INSTRUCTIONS +,
.Attach well con irtction record(s)iiarailable. hor nnilliple it/ection or non-Crater supply
wells ONLY with the scone construciinnnbanclonnteni,yort can submit one jorm' 10a. For All Wells: Submit this,form within 30 days of completion of well
Ga.lYell ID#:
F G D LF PZ-25 abandonment to the following:
,
Division of Water Quality,Information Processing Unit,
55.88 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
lob. For Infection 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
6c.Borehole diameter: 1 (in.) abandonment to the Iollowing:
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 Surmly& Infection:Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit 6ne copy of this form within 30 days of
completion of well abandonment to the county health department of the county
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6f.Inner casing/tubing length(if known): (ft.) where abandoned.
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6g.Screen length(if known):
I
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
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