Brunswick_Well Abandonment_20221031

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WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
BobbyLee Allred II
+ 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
2610-A wells abandon
ed:-
NC Well Contractor Certification Number ' E 7b.Approximate volume of water remaining in well(s): 42O al.)
Charles R. Underwood Inc. �� 3 2022 FOR WATER SUPPLY WELLS ONLY:
Company Name
�,��f��yy7yt�ififlrj tjr►'i 7c.Type of disinfectant used: HTH
2.Well Construction Permit#:
List all applicable well construction permits(i.e.U/C,County,State,Variance,etc.)ifknown
7d.Amount of disinfectant used: 1 I b
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaVPublic ❑Neat Cement Grout ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
elndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: a Bentonite Slurry ❑Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 26 Bags (50lbs ea)
❑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
Removed submersible
❑Geothermal(Heating/CoolingReturn) ❑Other(explain under 7 ) pump system from the well
Insert 1-1/4"tremie pipe to the bottom of the well and
4.Date well(s)abandoned: 9/26/2022 pumped grout filling from the bottom back to surface
5a.Well location:
Capital Power
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
681 Powerhouse Dr. Southport NC, 28461 10/20/2022
Physical Address,City,and Zip rgoature o ertified l Contractor or Well Owner Date
Brunswick
By signing this form, !hereby certify that the we/1(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
33°56'36.08" N 780 O'32.86" `l You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable.For multiple injection ornon-watersupplywells
ONLY with the same construction/abandonment,you can submit one form.
10s. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: 1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 200 00 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: $ (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 40 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
s'6e Outer casing length(if known): (ft)N/A 10c.For Water Supply&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casingitubing length(if known): N/A (ft) abandoned.
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6g.Screen length(if known): N/A (ft)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
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i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Bobby Lee Allred, 11 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
_ wells abandoned:
2610-A �,� E-�r at- 800
NC well Contractor Certification Number , Q•�"� 1 � ' 76.Approximate volume of water remaining in well(s): (gal.)
I
Charles R. Underwood Inc. O C T 3 1 2022 FOR WATER SUPPLY WELLS ONLY:
Company Name � HTH
I� ,� �Y"Y'96�y�(,D� 7c.Type of disinfectant used:
2.Well Construction Permit#: DWQ/ 0G
List all applicable well construction permits 6.e.UIC,County,State,Variance,etc.)ijbrown
7d.Amount of disinfectant used: 2 lb
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
slndustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
Olrrijzation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: S Bentonite Slurry ❑Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 52 Bags (50lbs ea)
❑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 Removed submersible pump system from the well
[]Geothermal(Heating/Cooling Retum) ❑Other(explain under 7g)
Insert 1-1/4"tremie pipe to the bottom of the well and
4.Date well(s)abandoned: 9/26/2022 pumped grout filling from the bottom back to surface
5a.Well location:
Capital Power
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
681 Powerhouse Dr. Southport NC, 28461 10/20/2022
Physical Address,City,and Zip bltgnature qfCertified Well Contractor or,Well Owner Date
Brunswick
BY signing this form, 1 hereby certify that the well(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 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:
33°56'36.71" N 780 O'45.03" �, You may use the back of this page,to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ijavailable.For multiple injection or non-watersupply wells
ONLY with the same construction/abandonment,you can submit one form. 10a. For All Wells: Submit this;form within 30 days of completion of well
6a.Well ID#• 2 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 176 00 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
12 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.)
abandonment to the following:
40 Division of Water Resources,Underground Injection Control Program,
lid.Water level below ground surface: (fE) 1636 Mail Service Center,Raleigh,NC 27699-1636
N/A 10c.For Water Supply&Infection Wells: In addition to sending the form to the
lie.Outer casing length(if known): (ft) address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casing/tubing length(if known): NIA 00 abandoned.
6g.Screen length(if known): N/A (ft)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources; Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Bobby Lee Allred, 11 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
2610-A
NC Well Contractor Certification Number
L 7b.Approximate volume of water remaining in well(s): 785 (gal.)
Charles R. Underwood Inc. OCT 3 12022 FOR WATER SUPPLY WELLS ONLY:
Company Name
In'r��;r�-; ::��� fir,-,�� �� u►>kl: 7c.Type of disinfectant used: HTH
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: lb
3.Well use(check well use):
Water Supply Well: 7e.Seating materials used(check all that apply):
❑Agricultural ❑MunicipaVPublic ❑Neat Cement Grout ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
slndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: a Bentonite Slurry ❑Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 55 Bags (50lbs ea)
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal Heating/Cooling Return) ❑other lain under 7g) Removed submersible'pump system from the well
Insert 1-1/4"tremie pipe to the bottom of the well and
a.Date welt(s)abandoned: 9/26/2022 pumped grout filling from the bottom back to surface
5a.Well location:
Capital Power
Facility/Owner Name Facility lD#(if applicable) 8.Certification:
681 Powerhouse Dr. Southport NC, 28461 10/20/2022
Physical Address,City,and Zip Signat of Certified Well Contractor on'Well Owner Date
Brunswick By signing f fy (1
sr rn this orm, 1 here cent that the wells was were abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the 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:
33°56'48.51" N 78° O'42.85" �, 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 constructionrecord(s)ifavailable.For multiple injection or non-watersupply wells
ONLY with the same constmctionlabandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: 3 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 176 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 12 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 43 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): N/A (ft) 10c.For Water Snooty&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casing/tubing length(if known): NIA (ft) abandoned.
6g.Screen length(if known): N/A (ft)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources,' Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Bobby Lee Allred, II
- a a 7a For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally aband ' dell 6ftiMrWerE U well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
2610-A wells abandoned:
OCT 3 1 2022 7b.Approximate volume of water remaining in wells 900 at
NC Well Contractor Certification Number Pp g O' (g )
Charles R. Underwood Inc. lfj( fm"an PrnaseiFg Unti FOR WATER SUPPLY WELLS ONLY:
PlQF90G
Company Name 7c.Type of disinfectant used: HTH
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: 2 Ib
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 ❑Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7L For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 61 Bags (50lbs ea)
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
[]Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/CoolingReturn ❑Other(e lainunder7 ) Removed submersible pump system from the well
Insert 1-1/4"tremie pipe to the bottom of the well and
4.Date well(s)abandoned: 9/27/2022 pumped grout filling from the bottom back to surface
5a.Well location:
Capital Power
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
681 Powerhouse Dr. Southport NC, 28461 A&�W_ 10/20/2022
Physical Address,City,and Zip Siguat&eAdf Certified Well Contractor ors Well Owner Date
Brunswick
By signing this form, I hereby certify that the well(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one latAong is sufficient) 9.Site diagram or additional well'Idetails:
33056'39.34" N 780 O'56.26" W You may use the back of this page'to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS '
Attach well construction record(s)ifavailable.For multiple injection or non-watersupply wells
ONLY with the same construction/abandonment,you can submit one form.
10s. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: 4 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 191 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter.
12 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface:
38 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): N/A (ft) 10c.For Water Supply& i Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casing/tubing length(if known): NIA (ft.) abandoned.
i
6g.Screen length(if known): N/A (It)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources[ Revised 2-22-2016
k

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Bobby Lee Allred, 11 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
2610-A � -
' t"a- 4 p� I,.zx 7b.Approximate volume of water remaining in well(s): 930
NC Well Contrsctar Certification Number i (gal.)
Charles R. Underwood Inc. O C T 3 12022 FOR WATER SUPPLY WELLS ONLY:
Company Name r ,.i 4 4 7c T of disinfectant used: HTH
In ioma.:.n Pr.n5eser•,j Unit Type
2,Well Construction Permit#: CAA!Q1!S0i
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifbrown
7d.Amount of disinfectant used:.,3 I b
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
slndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
❑Iri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: a Bentonite Slurry ❑Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 70 Bags (50lbs ea)
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return ❑Other(explain under 7g) Removed submersible pump system from the well
Insert 1-1/4"tremie pipe to the bottom of the well and
4.Date well(s)abandoned: 9/27/2022 pumped grout filling from the bottom back to surface
Sa.Well location:
Capital Power
Facility/Owner Name Facility ID#(ifapplicable) S.Certification:
681 Powerhouse Dr. Southport NC, 28461 t 10/20/2022
Physical Address,City,and Zip Signa of Certified Well Contractor or Well Owner Date
Brunswick
By signing this form, I hereby certify that the well(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one]at/long is sufficient) 9.Site diagram or additional well'details:
33056'46.23" N 780 1'6.19" W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable.For multiple injection ornon-water supply wells
ONLY with the same constructionlabandonment,you can submit one form.
109. For All Wells: Submit this'form within 30 days of completion of well
6a.Well ID#: 5 abandonment to the following:
Division of Water Resources,Information Processing Unit,
fib.Total well depth:
206 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 12 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 48 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
fie.Outer casing length(if known):
N/A (ft) 10c.For Water Sunoly&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casing/tubing length(if known): NIA (fE) abandoned.
6g.Screen length(if known): N/A (ft)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016