Cleveland_Well Abandonment_20221216

WELL ABANDONMENT RECORD FortmnslUw ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Norman T. Costello f( 7s.For Geoprobe/DPT or Closed-Loop Geothermal K'ells having the same
Well Contractor Name(or well owner personally abandoning well onkq heryfbperp - well construction/depth,only l GW-30 is needed. Indicate TOTAL NUMBER of
4, wells abandoned'.
2251-A413.4
SC well Contractor Ccmfica"on amber J 2l L2 7b.Approximate volume of water remaining to well(s): (gale)
TNJ Brush Cutters, LLC ;j'-Or. FOR WATER SUPPLY WELLS ONLY:
Company Name Yc„'_.t _ •
3G 7e.Type of disinfectant used:
2.Well Construction Permit n: N/A
Lm all appheable well consrruttmn prrm.s o e.WC,(o.nry,Slaw,Viertance,ere.)Ifbwwn
7d.Amount of disinfectant used:
3.Well an(check well use):
Water Supply Well: 7e.Sending materials used(check all that apply):
❑Agricultural OMunicipal/Public ■Neat Cement Grout ❑ Bentonite Chips or Pellets
OC,cothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial OResidential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
OIrrigatim ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑ Other(explain under 7g)
IlMonitoring ORecovery
Injection Well: 7L For each material selected shove,provide amount of materials used:
OAquifer Recharge OGroundwater Remediation 18.2 gallons
OAquifer Storage and Recovery OSalinity Barrier
OAquifer Test OStorrnwater Drainage
OExpenmental Technology OSubsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeolherenal(Closed Loop) OTracer
OGreothermal(Heatin Conlin Permm) OOther(explain under 7g) 2-inch diameter well abandoned in place
a.Date wdga)abandoned: 12/05/2022
using tremie methods in accordance with:
NCDEQ regulations Subchapter 02C—Well Construction
5a.Well location: Standards— 15A NCAC 02C .0113 Abandonment of Wells
Duke Energy Carolinas, LLC
FacilitylOwner Name Fuiht3 ID#(ifapplicable) 8.Certification:
Rogers Energy Complex-573 Duke Power Rd,Mooresboro,NC 37161 ,.✓.As` 12/05/2022
Physics]Address,City.and Zip Signature ofCerrified Well Contractor or Well Owner Date
Cleveland 1574840424
By signing this form, I hereby terrify that the well(s) was(were)abandoned in
Carry Parcel Ideenificarion No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Como non Standards
and that a cape of this retard has been provided to the well owner.
SM Latitude and longitude indegrees/minutes/seconds or decimal degrees:
(if ell field,one latlong is sufficient) 9.Site diagram or additional well details:
350 12'45.90" 81 a44'58.00" 11 You mac 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(SI BEING ABANDONED SUBMITTAL INSTRUCTIONS
Aaachvrlh.......caoorecarda)ifavolable. Farmulliplein/eerionarnon-wmersupply wells
ONL I'.,,h rim came oonsnvemn ah.nd,,o.,w.fro.can srrbmn oce jbrm.
His. For All Wells: Submit this form within 30 days of completion of well
6a.Well M., AB-4BR abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b. I of„I well depth: 1 1 1 .6 (R.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob. For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole dinmctee 6-8 (in) above, also submit one copy of this form within 30 days of completion of will
abandonment to the following:
6d.water level below ground surface: 29.4 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if knows): 0-52.5 (n) 100.For Water Supply&lateetion Wells: In addition to sending the torn to the
addresses)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
0-105
6f. Inner casing/Inbing length(if known): 0-70.5. (ft) abandoned.
6g.Screen length lif known): 105-110 (R.)
Form GW-30 North Carolina Depumsent of EmiromnenW Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For lmemal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Norman T. Costello 7s.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on lusher papeny1a�^-rr�^���s? well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
.-,- � s y I C— V wells abandoned:I
2251-A � ; tjit--V
NC Well Cwnacto Cenificsawn Number Y ""� j 7b.Approximate volume of water remaining in wells):I1 (gaL)
TNJ Brush Cutters, LLC pF C l r 2OZ2 FOR 11 A IER SUPPLY WELLS ONLY:
Company Name
:asp r- 7c. I%pe of disinfectant used:
2.Well Construction Permit N: N/A
Lar a//appbcable we/1 comrrvnion perrmtr(ie UIC.County.Sane, Yartarwe,e/c.)thrown
7d Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural OMunicipaVPublic ■ Neat Cement Grout ❑ Bentorute Chips or Pellets
OCseothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Industnal/Commercial OResidential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
DIrrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Berdonite Slurry ❑Other(explain under 7g)
eMonnoring ❑Recovery,
Injection Well: 7E For each material selected above,provide amount of materials used:
OAquifes Recharge OGroundwater Remedimion 4.9 gallons
OAquifer Storage and Recovery ❑Salinity Barrier
OAquifer Test ❑Stonnwater Drainage
❑Experimental Technology OSubsidence Control 7g-Provide a brief description of the abandonment procedure:
OCxothertnal(Closed Loop) OTracer
OCxothermal(Heating/Cooling Return) DGther(explain under7g) 2-inch diameter well abandoned in place
using tremie methods in accordance with:
4.Date well(a)abandoned: 12IO5IZO22 NCDEQ regulations Subchapter 02C—Well Construction
So.Well location: Standards—15A NCAC 02C .0113 Abandonment of Wells
Duke Energy Carolinas, LLC
Facility/Owner Name Facto)IDK(,l app)icable) 8.(ertification:
Rogers Energy Complex-573 Duke Power Rd,Mooresboro,NC 37161 - 12/05/2022
Physical Address,City,and Zip Signature of Certified Well Comractor or Well Owner Date
Cleveland 1574840424 By signing this form, thereby certify that the well(s) was /were) abandoned m
County Parcel Idemificaion No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field one liulong is sufficient) 9.Site diagram or additional well details:
350 12'45.91" N 81-44-57.90" 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 WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Armchwell.orucuonrernM/e)rfwm/able, FarmWnplelnjecnonarnorr-watersupplywells
ONLYwah thesame b odnnmeru.you cansubmitorwform. His. For All Wells: Submit this form within 30 days of completion of well
6s.Well Ira,: AB-4D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 60 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob. For loiection Wells: In addition to sending the form to the address in 10a
be.Borehole diameter: 3 (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.urfacr: 23.1 (it) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 0-53.1 (ft) Joe.For Water Sunoly&loiection Wells: In addition to sending the form mthe
address(es)above,also submit one copy of this forth within 30 days of completion
of well abandonment to the county health department of the county where
611 Inner casing/tubing length(if known): 0-55.7 00 abandoned.
6g.Screen length(if known): 55.7-60.7 (a)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Us ONLY:
1.well Contractor Information: WELL ABANDONMENT DETAILS
Norman T. Costello 7a.For Gesprobe/DPT or Closed-Loop Geothermal R'elb having the same
Well Contractor Name(or well owner peroomilly abanddNag wen onlowher property) r. well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
2251-A .. a -` ; - wells abandoned'1
f n q
NC went ContractoContractorCenir-.���.,���,::�.�:� � � .,7 ��2� 76.Approximate volume of water remaining in w<II(s): 2'4 (gaL)
TNJ Brush Cutters, LLC II!;,;i FOR WATER SUPPLY WELLS ONLY:
Congwry Name __.
7e Type of disinfectant used:
2.%'ell Construction Permit N: N/A
Lerr all applicable well conswcnnn permnn(i.e.U/C,Coun i,Jmre,Variance,erc.J if brawn
7d.Amount of disinfectant used:
3.Well use(check well am):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural OMtmicipal/Public ■Nat Cement Grout ❑ Bentonite Chips or Pellets
DCreodtermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Indusinal/Commercial ORes denial Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
oIrrigatim ❑ Specialty Grout ❑Gravel
Non-Wafer Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g)
eMonitoring ORecovery,
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge DGroundwater Remediatiou 6.1 gallons
OAgmfer Storage and Recovery OSalinity Barrier
OAquifer Test OStormwater Drainage
OExperimental Technology DSubsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed op) DTracer 2-inch diameter well abandoned in place
OGenthermal(Heating/CoolingReturn) OOlher(explain order 7 )
using tremie methods in accordance with:
4.Dote well(s)abandoned: 12�05�2022 NCDEQ regulations Subchapter 02C—Well Construction
5a.Well location: Standards— 15A NCAC 02C .0113 Abandonment of Wells
Duke Energy Carolinas, LLC
Facility'Owner Name Facility IDe(if applicable) S.Certification:
Rogers Energy Complex-573 Duke Power Rd,Mooresboro, NC 37161 _ - «-✓` 12/05/2022
Physical Address,City,and Zip Sigrarme of Certified Well Contractor or Well Owner Date
Cleveland 1574840424
By signing this form, 1 hereby certify that the welds/ was(were)abandoned in
Carew Parcel Ident ficahoa\.. ,PIN) accordance with 15A NCAC 02C.0/00 or 2C.0200 Well Construction Standards
56.Latitude and longitude in degras/minutes/secoods or decimal degrees: and that a copy of this record has been provided to the well owner.
(if well field,one laOong is sutficiea) 9.Site diagram or additional well details:
350 12'45.89" N 81-44-58.08" µ. You may use the hack 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
Anachwelicom,r lionmcord(s)Ifs ilable. F'or multiple in/ection ar nnn-wa"rsupplywells
ONLY with the same ematrum.ah mdononro you can submit mu/nm
' IOa. For All Wells: Submit this form within 30 days of completion of well
6a-Well IDN: AB-4 LA 15 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b-Total well depth: 37.4 (It) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in l0a
6c.Borehole diameter: Unknown (lo) abuse, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 22.4 (R.) Division of Water Resources,I odetground Injection Control Programs,
1636 Mail Service Center,Raleigh,NC 27699-1636
be.fluter casing length(if know n): (FL) IOc.For Water Suooly&lniecfron 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
611 Inner casing/tubing length(if known): (ILI abandoned.
6g.Screen length(if known): (it)
Font,CAN-30 North Carolina Department of Environmental Quality-Division of Weser Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Interval Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Norman T. Costello 7a.For Geoprobe/DP7 or Cloud-Loop Geothermal N'ella having the same
Well Comactor Name(or wen owner - well consmwt plh,onl ion/d¢ y
personally ab4odorvmg welfon his]er P I GW-30 is needed. Indicate TOTAL NUMBER of
Wells abandoned:)
2251-A
�c tcell Contractor Cerdfcation]anther C { j �_f CL. 71L Approximate volume of water remaining to well(s): 0.1 (gaL)
TNJ Brush Cutters, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name -
7a Type of disinfectant used:
2.Well Construction Permit k: N/A
Liss all applicable well ronsrrvcnon penman(i.e.UIC.C.-Hy.9".Va...ere.)ifbawn
7d.Amount of disinfectant used:
3.Well use(check well use):
W'star Supply Walk 7e.Sealing materials used(check all that apply):
IJAgnicultuml DMlmicipaVPublic ®Neat Cement Grout ❑ Bentordte Chips or Pellets
oGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
Ohnigation ❑ Specialty Grout ❑Gravel
Non-Rater Supply Well: ❑ Benton Slurry ❑Other(explain under 7g)
e Monitoring DRecovery
Injection Well: 7E For each material selected above,provide amount of materials used:
OAquifer Recharge OGroundwater Remedimion 3.3 gallons
DAquifer Storage and Recovery DSdinity Barrier
DAquifer Test OStortnwater Drainage
DExpenmental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
DGeodwnnal(Closed LAW) OTracer
DGeothamd(Heating/Cooling Return) DOther(explain under7 ) 2-inch diameter well abandoned in place
using tremie methods in accordance with:
4.Date wells)abandoned: 1 L/O5/2022 NCDEQ regulations Subchapter 02C—Well Construction
5s,Well location: Standards—15A NCAC 02C .0113 Abandonment of Wells
Duke Energy Carolinas, LLC
Facility./Owner Name Facility Me0f applicable) R.Certification:
Rogers Energy Complex-573 Duke Power Rd,Mooresboro,NC 37161 12/05/2022
Phyn.&I Address,Car,and Zip Signature ofCenified Well Contractor or Well Owner Date
Cleveland 1574840424 By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
Canty Parcel Idersificanon No.(PIN) accordance with 1 SA NCAC 02C.0100 or IC.0100 Well Construction Standards
Sb.Latitude and longitude indegrees/minutes/seconds or decimal degree: and that a copy of this record has been provided to the well owner.
(if well field,one lavlong is su iciem) 9.Site diagram or additional well details:
35012'45.90" N 81-44-57.95" 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
Ana'hwe/I mnsvu,rain rerord/aJ ifatnilable Formdnple inlernon ornon-wareravpply wells
ONLY wah she.rem.......1rvcl,.abardonowm you can suborn one lorm-
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well 1Dh: AB-4 S abandonment to the following
Division of Water Resources,Information Processing Unit,
6b.Total sac ell depth: 20 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniecton We In addition to sending the font to the address in 10a
6c.Borehole diameter: 4 (in) above, also submit one copy of this font Within 30 days of completion of well
(�
abandonment to the following.
6d.Water level below ground surface. 19.6 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length I if know n): (R-) 10c.For Water Supply&Injection Wells: In addition to sending the form to the
addresses)above,also submit one copy of this font within 30 days of completion
of Well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known)): 0-4.6 00 abandoned.
6g.Screen length(if know n): 4.6-19.6 (R)
Fan 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 DETAR S
Norman T. Costello 7s.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
well Com.,.em Name(or well cwxr personaly abandoning well on by her prop.nv). well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
2251-A wells abandoned ,
NC AdI( c,mficioi ii Number I ;, i n)1) 7b.Approximate volume of water remaining in weB(s): 0 (gal.)
TNJ Brush Cutters, LLC FOR WATER SUPPLY WELLS ONLY:
Compmr Same 4P1..V;, ✓`s,�,y✓ti - le.Type of disinfectant used:
2.Well Construction Permit it: N/A
Lao all appitcabie a-e/i cor.rrrun,on pernuls bye.UIC,County Slam.Yarlmrce,etc.)srhamm
7d Amount of disinfectant used:
3.Well use(check well am):
Water Supply Well: 7e.Sealing materials used(check all That apply):
OAgricultuml OMunicipaVPublic III Neat Cement Grout ❑Bentonite Chips cur Pellets
DGeothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial DResidential Water Supply(shared) ❑Concrete Grout ❑Drill Cunings
OIrrigartion ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
!!Monitoring ORecovery
Injection Well: 7E For each material selected above.provide amount of materials used:
OAquifef Recharge OGruunlwater Remediation 3.2 gallons
OAquifer Storage and Recovery ❑Salinity Barrier
DAquifer Test ❑Stormwater Drainage
DExperjmental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGoothermal(Closed Loop) OTruseef 2-inch diameter well abandoned in place
—
usingal(Heatin oolin Return) OOther(ex lain under 7g)
using tremie methods in accordance with:
4.Dale weil(s)abandoned: 12/05/2022 NCDEQ regulations Subchapter 02C—Well Construction
S&Well location: Standards— 15A NCAC 02C .0113 Abandonment of Wells
Duke Energy Carolinas, LLC
Facility/Owner Name Facility IDe(if applicable) It.Certification:
Rogers Energy Complex-573 Duke Power Rd,Mooresboro, NC 37161 12/05/2022
Physical Address,City,and Zip Signature of Caused Well Contractor or Well Owner Der.
Cleveland 1574840424
By signing this form, 1 hereby certify that the well(s)was (were)abandoned in
County Pastel ldma fic.Iom 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.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one hul.ng is sutRciem) 9.Site diagram or additional well details:
350 12'45.89" N 81 n44'58.05" W, You may use the back of this page in provide additional well site details or well
abandonment details. You may also much additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Avaehwelicomiry mnrecord(s)Ifmadable. FormWnplemyecuon ornon-waorsupplywells
ONLY with the same consimc non ahnndonmenl,you can submit ore form.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well 110: AB-4 U A 15 abandonment to the following.
Division of Water Resources,Information Processing L'nit,
6h. l otal„ell depth: 1 9.9 IILI 1617 Mad Service Center,Raleigh,NC 27699-1617
10b. For Infection Weds: In addition m sending the form to the address in IOa
Unknown above,also submit one copy of this form within 30 days of completion of well
bc. Borehole dinmMer: (in.) abandonment to the following.
6d.V%ater level below ground surface: 19.9 (ft.) Division of Water Reaourees,Underground Injection Control Program,
1636 Mad Service Center,Raleigh,NC 27699-1636
6e.fluter casing length(if know n): Oft.) 10c.For Water Supply&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f Inner casing/tu hi ng length(if know n): (D,) abandoned.
6g.Screen length Iif know n): (R.)
Form OW-30 North Camlim Department of Environmental Quality-Division of want Resources Revised 2.22-2016

s--,, dew'
WELL ABANDONMENT RECORD Fnrlmnnd Ute ONLY —
1.Well Contracts,infarmalhm. W'F,LL ABANDONMENT DE,1'All,S
( 1r: 7a.For GewprohNl2PT or(losed-Lsup Gfmtbnrmal WeIkhAYinglhe Notes
Well[lavoctar Namnmwdinwncr panmaliv alwianrtu,wd Iran hisfhcr pn+paryl wel l constructkm/depth,only I(A%-11)iv necdod. IndicmeTOTAL NUMBER of
wells abenduned'.
NC Well ensworfw Cemfeawa Narm+n 7h.Apprnalnulc toluene of venter rcmsining In weRls): Ig•I.1
Cascade DrBmp LP FOR WA'I'F7R SUPPLY WF1.I,S//YI Y:
[mnme,Nano
7t.Type sl'd+vinl'rclnnl used:
2.Well('rinflmettfm h'redl A:
l nr n/l nAnhn+hh wMl+,.mn nnm lavwn.de UIC.Caasxy Aiew.Fxnwor^ns:l1/lonmr
7d.Amnvn(of Ahinlwlant need: __ I
).Wall iota(chick well use); -------------
Wolff 1 opply Won: le.Seating materials mrd(check all that apply):
I"Agricultural flMnmmpaVAtbbe 44 Neat Cement(inxll IQ Manner Chips or Pellets
(imlbemlal tHoming,Cmling Supply) 171truflemial Water Supply(single) USand Ccmmt(Imut II Dry Clay
IndnstrudWomme¢ml UResxlenlla:Water Supply(tharedl fT Concrete C•mrnt I.I DRII Cultmga
:'7m alien f7 Spminlly(twos 1-1(knvrl
Non-Water Supply Well: U Bontomty Shury D Other(expkdn unfkr 7g)
,Sbmltorm UReenem
Infection Well: 7L For mein rglmrhd wkcfed mhose,provide summit of malmials owd:
Aft uikr R¢Nmge U(Nrmtdwner Rcmdialism
-Aquifer Storage and Recovery ElSollmty,harden --
:'-Agnifcr Tort USmrmwalm Drainage --
Nvpm+menlal feelmohsky 11•Gdrsitlncc C{n"I
7g.ProvNle a M1rlrf deserlptN(m of the glundngmenl prxninrc:
'Crrorhnmal(CNwml l.mp) UTnan r :/'?.s T=al 'fie+) iu a.(•1=
I torthem+ai(I lamin '...n Room) "bhor cot iainnnder7 F —
j J
4.Bate welh%)ahindoned:
9n.Well Ioradnn:
AliCllMlln C{If�efailell _�
1 a.d;ye r.nn\ram i.eJiry lux liftpplkMkl A.C<rtiBmlkq:
it
319 IhAidov het Unsm.Kn1as Mnmdnln,NC 281Ah ,,��.�L
III wvl..I Add.,.,I'w.vent/al` [ipnlunerffpr+ Well('mrtrnawrm W<II Uwm+ Dal,
Glevulallfl _ Nv nx,wmi th,fiwm.I horhv 1"fib, 14.1 flv xvd/(r)on,(xvnr)nM od"'l n
t mov 11.wd Id md.icen+No.(PIN) orrnrr ,nnm work 15.4 N(IAC 07C niIM n,X 02017 Well C-nou,snow Sfon/lmd,
sad Ihnf or rep.n/Ihir mrnrt/hot Fern pmeidn/In Ihr wcl/must,
4b.Latllude and Innchode In degrees/minuln/seeands or decinml degrees:
nfwr'I odd ax•IUMne i•.nTrwml 9.SRe diagram or additional well details:
S \V Ynu may use he(sack of this page In prfwule additional wall site Jddls nr m II
abamhmmfslt ddnils. Yml mny Alm atLreh mldilitmal pnRrs if Inwaswy.
CONSTRIXTION DETAILS OIr WF (S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
dmoAweNfemnra.Mr ra+udrrl dumifuAh. F­mxlrfplarryrrMa+r+xw-wemr.nppl/'w*fl
n.vty rmF ura...«.n.....r,,,,.„wn�neanr.s.a,ran avMan oar W.n lots. For All Wells: Suhm t IN, floor within 10 d:Ws of f.•omPICIRM n1'oral
out,Wellahemlo ment m the follnw:ng'
Ti DWItion of Wmer Resources.Information Prucessing Unit,
6M1.lmni well fkpth: -3 J (0.1 1617 Mall Srrvkr Crglrr.Bsklgh.NC.27699-1617
loth. Fot'Igittlllm Y�ell�: In addition'o sending the form m Ihr Ndresc in Wa
he floret...I'dUmelem G IhL) sbovs•also veMm:mw copy nl this form within At dgx of'."Imim of wv II
xbandnnment to the lullowmit:
6d.W'ater level below ground snrfaee: (/1.) INvidon o!Water Revoorcn.Umfernrannd InJrothm Control Pragrmnr.
1636 Mail Smite('enter,Ralrlgh,NC 27690-1676
6r,qulur cstMg Imgtk(if known): (((,J Ilk.For I'a1LSpout &lalttll Th' IIs: to sdditimt In sendng the form InIhr
nddms,,(c.)Above,Alan subnal one espy of this form within W days m min pldum
of well abandonment to the emmry henllh depmlme l of the county wit,
no.Inner raslnt:/tobinA length fir known): (11.) niVidoncil.
6p.Mrern length lit koow nl: f11.)
I-.1LW to Nfrlh ranmkm DOWmnl of isnoronnxnwl(/anhry.Dwirinn M Wmm Aesx+ne.

'VED
WELL ABANDONMENT RECORD For National UK04LY DEC 1 lei 20221
1.Well Cmuraehor Inbtrmadnn: WELL ABANU 'f:]�ayf:/�l 0lint'}
1s.For Geoprobe/UPT or Clamd-temp Geothermal Wells having IFeiaoe
Writ['nMoon.No.In,wellrwawa pnuxwllv.1cmdoinrweif Ihialhn none yl well ramnlruclionidgnh,mils/GW'-1D to needed hdieate TOTALNUMBr..Rof
well.nhindoned'.,
NI'Wall Cmrrna•Cenifkann Nnrriwr 71,Approximate volume mf water remaining in weitMh_ (iPt•1
Caarodo Drthhlg LP FOR WA I%R SUPPLY WELLS ONI A:
Cae91say Name
7e TrPe of Jivinhrtxnt nand:
2.Well C."Mruetmn Permit a:
I n,nN np/do-.rfik eels.�urrs.e,n Iwrwrlr N.v 1/lf,f%Mrv.Fla¢.Y�nerut mJ tfkmwa
7d.Amount of tllalnleclanl nmA: ._
1.Well me(dmek well me): - -_— —
Water Supply Well: 7e.4rnlhrg materials used(cheek all that apply):
^Agriculmml ❑mamolvrallpubhe rNINCAI(calmt(main fN Rentrnde t-hey.o P0I1Je
.,Gcomenonl(NrWmtpCcolmg Supply) ❑Ratk enllal Water Supply(single) ❑Sand Cement Grout (I❑ry,Clay
—Inbistnal'Cutornemml ❑Rcskknhal Water Supply(shared) Cl Concrete Grout I l I/nll('u0mg.
lbegaition ❑Spnaally(rout II Grove[
Nno-Wamr Aapply Wait: LI tmirntk Slurry :l Other lcxp)an under'gi
Minor L1Rccminy
n Kt n 71t.For ruelt material olklerrd ahoy.,prnvidr mmen of of oalerini.owl:
"Aglllfer Rrehagtr ❑foramalwint Rem"batim
''.Aqui(n Wnrugc+Ixl Reslwcty (/Salinity R.nwiw -- -�-��
I.IAgmler'rcal ❑Simrnwxlo Drainage — --- -
Fvpno mul Trehnoknly ❑.Nulraulmut,f wrool
7g.Provide o hrlefdeseripllnn of the abandnnmrnr pmeMnrc:
;:Gaxhamni(Ckwet!lmpl ❑Toren
6(icMhennal(lleain AVil" Rehm )the(explain under 7 i�L're
..[late welt,)shimdimed:
So.Well laaadnn:
Abennade Gorpcunfinn
Pacihn'T)orrr W^R I acddy 110 fila"IRAJ.) R.CeruflestlM: l
718 Holiday Inn Dewar,lfirgs Mountain.NC 7811811
P.hyrcal Addw,a_Cry,and Zip kmvuarrnf CaPlRal 1 .monnororwelt(twter, Ore
(:htuolarRl 8,1'signim,IAi,Iona, /hmrhv verli2)'that rhr larlifxl wu.Iwvvr)ahandnml rn
1"any raven 6hndaann No.(PIN) a,ver.lnmw web ISANCAC 021'.01M or 2C 0200 Well f'amlowhow Staadlr.lr
and Ibal a•'Oyu of th/.r Omanl Im.,lwn pravw/nl In der reel!lo"
Sh.LaRtude and longitude In degrrr./minmeO.ovid,or electoral degrees:
Ww.l 11.111.mm helm,a loll 9.Sue Mngrom or additional well details:
You may ne..he hack of Sure page an provide addilinnal well,tn,daaile or wv II
N W abamlonmcn drl:nl.v. You may alwr etch eddilinnal page,if racm%ay.
gy9STRUCf1ON UETQQ S{J'WF1.Arf LUINC ARANDONED SfRMITI'AL INSTRUCTIONS
dNnrb Wlllrnnamrlaamard/e lfnmilnliM. For nuh9,6 inr,:fhn nrmnxxlrrxuly'Ir xrl4
rly/,1' w16 r6•maw.,.ar.wann.b6nmm�wrn.r..ana+anwa aw'hmn. IRe. Far All WeRa: School thin farm within 10 daw of completion of w,11
net.Well InaJr rr ('7 < J'y21 nMndoemmUn the following:
Divbkrn of Water Removers,Information Proc,utng Unit.
Nh I.,at wr0 depth. ! �� IR.) 1617 Mull S hie(•.emir.Raleigh.NC 17699-1617
I nh.EILLNLKqoa 1..Addition to,cming the form no the Kd.,m toe
shove, elan ar.lmlt oar:copy of this loam within 1n days of utm(rinun of well
6r.Borehole diameter: ( fin.) ebxmlonment or the fallowing.
nhA,bm o!Well,,Re,onrem,Underground Injraton Control Prmo.a.,
6d.Mi tner I...I brow ground sc lisre: IO.) 16.a6 h1A11 Sevvirr Center,RaklRh•N('17699-1616
Ilk.EjLA&ct SgfypjyAAgjfStimn Wells: In oddilimn la.ending the form In the
or.(fuser easing length 111 known): in.) :uldm,gcA)aMrve,nlm.uhmrt me"illy of phi9 form within U)My%of completion
of well ahnndonmml to the munry health derynnmenl of the county, whirr,
a
of.Inner eadnRnt' hing length(if known): (R.1 handonal.
hE Serven length III known 1:
IownllwAll Nooh Camlim Department of Fnvimnmotal(palaY.fiminion of Water Reoaxc.a Revwed2.22-20.6

o
4 3
DEC 1 5 2022
WELL ABANDONMENT RECORD For Lvem.:LanONIv
1.WeU CON"O"ful r tlon: WELL ARAN1213NMENT DETAILS
, +, /! 70.Nor feRprohe/RPT nr Classed-LAirip f:emhrrmal N'rlh havingdW same
wrin'nnusrtar Nnne l�t.11"Wmt prnasnlly nMMlnninR well na 1.1 l 'pmpm9) well ctms:m9lion!UCplh,rely l GW-10nnmled. hake.).ITJrAL NUMRCR n"
_ W9IN nhamNneB..________
Nr'Writ fsxmrtur t'rnihannt9undnr 76.4pprn+imole.olunw of wNn r<malelag la we01e1: (gs1.)
(;nanntM DrdIh1R t P FOR WATL:R Sl;l'PI.Y WF.IJAN ONLY:
cnspt6y Nroe 7<.type of dislnfmtant used:
2.Well Conslrtrrtlon P<rrdl a:
I nl r,flln'111L/,l,l,•Mel/tonne.n,wller/n k(I M f//f:.r.iNN6..CbY.IOIIP4Y,rIGJ IrfM11M
7d.Ammmt of dlslnfrrinnt used:
3.Well use(check well uw): -
Winer Supply Well: 7"NMI
pe�.Srnllug materials used Ichech all that apply):
Agne c3
dlu,nl 'lMtmlcipa;R'tlhlic NMICamart(hmlt I.I Hcakwile Clops m peRrax
-.Gculhcmual(Hra(inpGnulinp Supply) ❑Rrstdenlial Water Supply(nnge) U Sand Comcat(imttt LI Thy Guy
:'Mdutlnak1 ormnoeiel 71tesidenlial Woe,Supply(shared) C Conctele liroul fa)hill Cul0uip:
-lenjiatin. O 9peclelly(rmul fl Gravel
Non-Were Supply Wm: ❑Renamne S:urry LJ fhhm(capktin tinder 7p•)
Mamma:, URewwry
Inject on Well: 711.For each marrrlal wlrclni nhns r.provide amount of maleriah I.":
Aquifer Reclurgr I.1(honmlwal<r RemaRatmn
1_Agnife Stooge one Rewsvey nSRllmty Hanie --- - - _
f-Aquila lon l.'JStnnnwarn(hang. —
CFsperimenW Technuingy nsuhaiderne('unlrnl 7R,Provide a brief description of the alurrdooment proreier:
f'(iemhannal Wi mal lmrp) UTrocer
C'.(ieolhermal(I hatinglCricaling Return) (hhtt(explain under] )
R.Dole welRsl ahondaneds _4. i 17 —
i ._J-a, ._
IR.Well location:
Aboorinde Cnrporatkw
r¢ILry/(hrc,Vnas fm,Lq lne Id Rmb"ANrl RCertMntbo:
548 Hokday Inn Onw.Kings Mountain,Mt NC 284M (4 I !
Pkyau'aI AAArca,aaly.Ml.IP glpnmm ft Lad Well Cmxadorm Well Owrcr DRI[
ClevrAwd it,signing thle(tern), f hereby[W#.v'that the WU(I)"M(wer')aMhlnnW/in
t-Ivmv revel oniflerunn No(PIN) orordance with IJA NCAC'02C.Irfo0 w 7r a10R IFr(I Cmn6ratom Sm,Anm'r
and llel a r17ry al this envoi lm,Imrn P,nvalyd In 16r well n,wu,
Mr.IAtilude and longitude in degrees/mfoulee/saaondo or decimal degrees:
AO xd f N one sat t kn.,.aIM".m 1 9,Slur i logrwn at,additional well delnih:
You may use the back of this Pape W provide aldAinult well.,to&w*,r
N W abandonment Jahn)+. You ma}non ausch achilio n l pNgs if nmiAsary.
CONS fRl;C71ON DETAILS(IF W��f,Lti1 RE1Nf.ARANDO\RD 1jVRMTTAf,INSTRUCTIONS
AMrN xslirnmaxrlMnrraN/Adnwllnhle hn xtuominxrrcurm nr wxavrauPnly xeRr
pyl.Y.161/vrnw uwryrvnnmti�lrMlwX,mm�n.r .an..mm�nnr!nrn. 10.. For All Wells: Suhmn this form ,vulan 10 days of nxnplolln of xis
60.Well(RR: SNKM22 ithand nmrnt m the following:
M
Oielslnn of Water Rvw. umve,Information Protesting Unit.
1617 Mail Srn9re('enter,Raleigh,NC 17A99-1617
6h. 1'o121welldept" (R•)
IOb.For loieelio Wells: la"Id"ina Io undtam the form Iv the a khe+s m Ise
nI.W.also niltmit ore opy of Ili,.iron with.. 30 dots of cnmpk+.rn of xis
6r.Racehorse dlam<Rr �' (In.) ahandnnmat in the following:
Dirfian of Water Reaourcen,UntlergrnlmA injection Cl ntrol P"it'son,
6d.Water I"d lotion grunad surface: (R.) 1636 Atoll Servler(entre.Raleigh,NC 17699-1616
h<.onto. ending Irnglh lit known): fR,) l0<.Nor Walrr SunnW k In)relinn"'el) : In a(kliumt:o striding the fain to ti:c
nddresslosl.hovc,nlsu submit uoc Ropy""It"farm Wlihm 1R dnys of atnlplchon
of well nlaumknm...I M the cmmty health department of the emmly afie,e
nlundnnrd.
of.Inn<r ra+ingnabing lengl6111'knownl: (R•)
66 Screen length of known): (ft.)
F.(iW4n NRdh t'amlinn nepnnmem orpnrironaercl Outlay-DWisionof Wsmr ltv naoa RniaM J3181un

rVCC
WELL ABANDONMENT RECORD Fa lneindDaeONLY ULU ID f12�-1
Ij J
/.WeR Cmermfirr hmn manmr WEi.I,AtlANIM(ONMg.IV'I'OR'1'Ail1i IOW+„I-„
-Cl 7a.Fur(:teprahalDlsT or Chwd-larep(;enlhermal Welk having the mete -
tyrn('wetsov Nrr,,l,n wr.a„w..r,In„+mn.11,h'v,ks,fiu"it hisrtrr prnoer.)q well em,lmdion/depth,rmIY I CW-10 is nmdcd Imiicale TOTAL NUMBER e'
well,ebnnd.mcd:
W'well fanuu.m Pm,f mn Samher 7b.Approaimalr ralamr of wain remaining in nellls): __ (gal.)
CA6cn_de Drilling LP FOR WA I TR SUPPLV W'ELUS ONLV: — --�---
('annpu,y New_
7<.1'ypc of dfrinfmlant u,dl:
2.Well Canprualbo Permit 0:
Inr ell aaldxaM1lr„NI,..v,rmamn l.mmRn ter f/a:.Crrmh.Ano.Vmacw ow),fennwn
7d.Ammutl n/Jialnfcelonl used:
5.Well to.ebeck well me): —_.------_----------
Water Supply Wen: 7a,Setting materials need(ahem ell lhtt�apply):
rlApnnJli ril r-,MunicipAl/Vnblic _ Neat Cancel onnu f-Tl,Fknhnitc('hqw nr 7Ylld•
rt(',mlhemYal(I Icahng,(("Ing 8uppty) ❑ittedential Water Supply(,ingte) ❑Send CovIrnl Omm ❑Dry Clay
t`kxlnamnVl'mmmcmul C1Rcneicnbal Wow Supply(shared) O Conerde Ortan I: Drill Cmlings
"irr, murn ❑Speciahy Omtu ❑(irmel
wn_waar Supply Well: a Rrnlannc Slurry I other(rrplam.Imlrr 7PY
Msmlh); LlRecovory
a ter• nn r 7L For ueh maledsl,ekdrd shore,prnridr amount of mmrriah nsrvl:
(Ayuifnr Recharge CJOroundwaler Rcmalionim,
t Aquifer SllrrNlc and Recovery 0Snhnnv Ranter -
Aquact,rest -1stnrntwale,Dminagc
LXsrfie i.....hit 1'«In:nhrgy i:1SUh%xIn¢c CMnMII 7g.Previte a brderdmr4mloa arlhe shmvinamrnl pr,wrdnn:
A;cnahewral(Cla+cJ l ntrp) ❑Tracer
C:(lcmlwmml(Ilea(in K;no:in Serum) OOthcr implarn Under 7 ) I &VI'e & /r)
1.IMIe weWe)abmdondt
5,Well location:
Altermada CrR1>o(alion
Frsmwnlwncr Vax ForMy no fifq,plioablc) a.Cer111kallaa:
548 Holiday Inn Drive.Kings Mwnlam.NC 28086
cooUJ
1'Iry.aal Adw,Cn dxv.an,l].m S,gnnWm rfCan,deJ Wolllbnvu.mmtYdl.rwx, Ilene
CAnyoland Or rigmryp AL,farm, 1 here Sr reify tint lhr "U(r)war(i,rrrl aJ..k o-d,n
r a:nw Panrl kfie,sn ian Not(PIN) ncrnrdnncr MA I5A NCAC 02C.010I nr 2C WIN)R'rfl Cowvin,rinv..t6neln.rrs
oml,6n1.rap,ofIA0 rmmrl 6nr 6rra lwnridrd,n the writ nwrr,r
Ins lAiltude and longitude In degrren/mimnedsecnnda or deeimal degrcec
orwP.;fold.one:aVlnng h.ulfw,.nq e.Site dingran nor nddWanal wrR detalk:
V..mny uw lie back of this page In pnwide addilimml wen vile dcteik m we
VV abandmrment dcmity. Y.m moY oL v x;inh wklilimal imgMs i(nm�aarv.
CONSTRICTION MAILS OF W£1LM BEING ABANDONED SODMITTAI,INEl R0fTION'S
one h,.rlf, nw rem n,n•Jh/i/mudxblr. P.rrmulrir+le rnlr,.vtnrr nr nun-xmern,rpnlr•NI•
0.v1.f.•rrx/x,nn,n-...�nrurn,+nxuml.mm�nr,wen wn rxxmu net Man
Ilk. For Atl WtJly: Suhmn Iba Inrm wnbm 71 days nl rmmpleum of rvr I
ry as well llw: SNKM24iM
ahardmmenl to the rollnwing
/�5� Divid..n of Water Remnren.L m rfnralinn Prnn raing Unit-
fib.Tmul well depth: J -k1 (f..l 1617 AMd15.•rrlrr Center,Raleigh,NC 2769a 1617
10b.For li lttBon Well In ad,lilmn In scadmg the fmm ur the addrms m Ina
6r.IMrehulr dlnmrtrn (inJ aZe.al+v submit me r..py of.his fmm within 10(to"of frnnpkpnn(%! wr I
ahandennml m thr fnllowmg:
Ivi.Nit air,Irvd I.I.grooved vurfare:__- (IL) INriaMn of Vvelrr Newnrtrrr,I;ndergmnnJ Injdllon fBnlrnl Prngmm,
1656 Mail Smkr Cr,I N91righ,NC 27699-I656
It,.Outer rating Itrglh fit known): (R,) Ilk.For Witter S l ph,&1 ittl'on Welk: In oddiu9 n:M sending the.'onn to tl,e
ukimns(cs)ub9ve,eko submit one copy of this toms w.lhin 511,loyn al'naryddinn
or well ahan,linnneni :n the emm(v health derranmml of the ,:Munro• what
6(Inner eaving/lubing lc..glh(lr knnnn): IR.1 ohardmrM
he, i,re,n length dr knownl:. ______—(R•1
,,r-,Ill,' -it NatthI aml,m Depsnment oflinvimrmen.al VMalry-Dwiwm ofWa.m Rcttxtr, Rst,I,Mbl-xnh

NOTE:
THE AERIAL PHOTOGRAPH FROM GOOGLE EARTH WAS MODIFED BY S&ME. DRAWING IS FOR GENERAL INFORMATION
ONLY AND SHOULD NOT BE USED FOR THE MEASUREMENT OR ESTIMATION OF QUANTITIES OR DISTANCES.
T 10
a` 11R7 1193 1194
It
`+
a r �..
1V3
1 l 3 � 4+
A 'Tr I AP
I �w d1G Tt
Jit
eh `
I
Well Locations
�zoz
JOB NO.:212012 FIGURE NO.: 1A
Well Abandonment Location Plan
Duke Energy Rogers Energy Complex(Cliffside)Active Ash Basin SOURCE: Google Earth DRAWN BY: IBB
11) Mooresboro, North Carolina
DATE. December 2022 CHECKED BY: FPM

NOTE:
THE AERIAL PHOTOGRAPH FROM GOOGLE EARTH WAS MODIFED BY S&ME. DRAWING IS FOR GENERAL INFORMATION
ONLY AND SHOULD NOT BE USED FOR THE MEASUREMENT OR ESTIMATION OF QUANTITIES OR DISTANCES.
ik
ABdBR
AB-41-A15
AB413 AB4S
AB-4UA15
i
e -
Approximate
Well Location
JOB NO.: 212012 FIGURE NO.: 1B
Q Well Abandonment Location Plan
(• — Duke Energy Rogers Energy Complex(Cliffside)Active Ash Basin SOURCE:Google Earth DRAWN BY: IBB
Mooresboro, North Carolina
DATE: December 2022 CHECKED BY: FPM