Washington_Well Abandonment_20221222

WELL ABANDONMENT RECORD Far lmmmal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/lieu property) well construction/depth,only I GW-30 is needed Indicate TOTAL NUMBER of
wells abandoned.
4330-B 'IN /
NC well Contact«Certification Number i^ r V D 76.Approximate volume of water remaining in well(s): (gal.)
. 4
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name ./
7c.Type of disinfectant used:
2.Well Construction Permit#: NA Un'
List a!!app/rcuble wet!construction permits(i.e.f/I(',(.'nwM.SIaM.�yr [t�llknown
7d.Amount of disinfectant used:
3.Well use(check well uu):
Wafer Supply Well: 7e.Seating materials used(check all that apply):
Agricultural OMunicipal/Public ❑Neat Cement Grout Il Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial OResideitial Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
Dirrigation ❑Specialty Grout ❑Gravel
Non-Water Supply Weed ❑Bentonite Slurry ❑Other(explain under 7g)
IlMonitoring OReccivery,
Injection Well: 7E For each material selected above,provide amount of materials used:
OAquifer Recharge OGroundwater Remediation Bentonite Pellets '- 50 lbs
OAquifer Storage and Recovery OSalinity Barrier
OAquifer Test OSmrmwater Drainage Concrete — 5lbs
OExperimental Technology OSubsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothemad(Closed Loop) OTmcer Well abandoned in place with hydrated bentonite
OGeothermal(Heatin Coolie Return) Collier(explain under? )
pellets to within 6 inches of surface and topped
4.Date well(s)abandoned: 12/14/2022 with concrete to existing grade.
5a.We6 location:
NCDEQ-Sawyer's Grocery 0-030022 �)
Fuility/Owner Name Facility ID#(if applicable) S.Certification:
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Washington NA By signing this form, 1 herebv certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or IC.0100 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:
(if well field,one lat/long is suffic'mo 9.Site diagram or additional well details:
35.866 N -76.725 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
Atmchwellconstrueto mord(s)rfuvailable. Formultiplerryectwnorrmn-matersupplvwells
ONLY with the same comirocnon ahumlonarml,you cnn.suhmrhone form.
10a. For All Webs: Submit this form within 30 days of completion of well
6a.Well lll#: DCW-1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 33'5 Ift t 1617 Mail Service Center,Raleigh,NC 27699-1617
10h. For Infection Wells: In addition to ending the form in the address in 10a
be.Borehole diameter: 12.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following.
6d.Water level below ground surface: 9.14 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6t.Outer easing length(if known): NA (ft) 10c.For Water Sootily Ar Injection Wells: In addition in sending the form to the
addre ts(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if know n): 28.5 Aft.) abandoned.
6g.Screen length(if know n): 5 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revved 2-22-2016

WELL ABANDONMENT RECORD For loos till Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 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 G W-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned.
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gaL)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name C:� L i 1^ 7e.Type of disinfectant used:
2.Well Construction Permit#: NA
Lest u(l uppbcubfewell congvuctian permits(i.e.(/lC,Cnw#ht$l�r, ri fkrmwn
77 7d.Amount of disinfectant used:
3.Well use(check well use): ,;,,,t?.C^.`Y 'A 11U"3
Water Supply Well: r,S'. 7e.Sealing materials used(check all that apply):
❑Agricultural OMunicipal/Public ❑ Neat Cement Grout III Bentanite Chips or Pellets
❑Crcothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Gout D Drill Cuttings
Dirrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well; ❑ Bentonite Slurry ■Other(explain under 7g)
[!Monitoring DReccvery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge OGroundwater Remediation Bentonite Pellets — 75 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test OStormwater Drainage Concrete — 5 Ibs
❑Expenmental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Well abandoned in place with hydrated bentonite
❑Geothermal(Heating/Cool Return) ❑Other(explain under? )
pellets to within 5 inches of surface and topped
4.Date well(s)abandoned: 12/13/2022 with concrete to existing grade.
58.wen location:
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owner Name Facility ON(if applicable) g.Certification: r�� , 1
1327 US Hwy 64 East, Plymouth, 27962 12/2y2022
Physical Address,City,and Zip Signorine of Certified Well Contractor or Well Owner Date
Washington NA 4v signing this farm, l hereby terrify 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.
56.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:
35.866 N -76.725 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
A!/ach weacartsnucuon recordlr)sJwudab(e. Formu(liple injection arson-xvhrsupply wet/s
ONL 1'wuh the same cominiruon abandonment you can submit one form.
IOa. For All Webs: Submit this form within 30 days of completion of well
6a.Weu ID#: MP-ID abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 60 (I.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For Iniection Wells: In addition to sending the form o the address in 10a
6c.Borehole diameter: 8.25 (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: 10.12 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (it) 10c.For Water Supply&Iniection Wells: In addition to sending the form m the
address(es)above,also submit one cop} of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 55 (ft.) abandoned.
6g.Screen length(if known): 5 (R.)
F.GW-30 North Carolina Department of Environmental Quality-Division of Witter Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 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
4330-B wells abandoned.
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name l,
y V E� V 7c.type of disinfectant used:
2.Well h Construction Permit q: NA L—
ED
List al/app"cable well conrrr s t on perm"'(/.I.(I1C CoartO,Stair,R"nsws,ele)r krro n
nr C 2 O't' 7d.Amount of disinfectant used:
3.Well am(check well use): f�
Water Supply Well: e.Sealing materials used(check all that apply):
OAgriculmral ❑Mum cipaVPubI&,s Qr30 ' ❑ Neat Cement Grout S Bentonite Chips or Pellets
DCrcothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
Dlnclustrial/Commereial OResidential Water Supply(shared) ❑Concrete Gout ❑ Drill Cuttings
01irrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry N Other(explain under 7g)
!!Monitoring DRecovery
Injection Well: 7C For each material selected above,provide amount of materials used:
❑Aquifer Recharge []Groundwater Remediation Bentonite Pellets — 25 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
[]Aquifer Test DStormwater Drainage Concrete — 5 Ibis
❑Experimental Technology DSubsidence Control 7g,Provide a brief description of The abandonment procedure:
[]Geothermal(Closed Lamp) OTracer Well abandoned in place with hydrated bentonite
DGeothermal(Hearing/Cooling Return) O/hher(explain under 7 )
pellets to within 6 inches of surface and topped
a.Dale well(s)abandoned: 12/13/2022
with concrete to existing grade.
So.Well location:
NCDEQ-Sawyer's Grocery 0-030022 ^
Facility/Owner Name Facility IDs(if applicable) 8.Certification: V fJ V
1327 US Hwy 64 East, Plymouth, 27962 �f«f///MMM���'����� 1y2y2p22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Washington NA
By signing this form, 1 hereby certify that the wells) was /were)abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one hulong is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 µ 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
Anuch well conrrrucnon record/r)Juvailub/e. F'ormulripfe mlecriaiwimn-xarerrupp[v welly
ONLY wnh the some consrrucnon ahamlunmenr.you con suhMraaeJbrm. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDO: MP-1 abandonment to the following
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the farm to the address in I0a
6c.Borehole diameter: 8'25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following
6d.Water level below ground surface: 9.55 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
NA 10c.For Water Supply&Injecton Wells: In addition to sending the form to the
tie Outer casing length Of known!: Ift.) address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 5 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revved 2-22-2016

WELL ABANDONMENT RECORD For Im final Use ONLY
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprolie/DPT or Closed-Loop Geothermal Wens having the same
Well Confader Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned
NC Well Comrades Certification Number 7b.Approximate volume ofwater remaining in well(s): (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: NA ...-n •d A 4(19Z
List a!l uppliauhle well ronsrrurnon pematr(i.e.(/IC.Counm,SI ,1 e. e n
7d.Amount of disinfectant used:
3.Well use(check well Use):
Water Supply Well: "' 7e.Sealing materials used(check all that apply):
OAgricultmal OMmicipal,Public ❑Neat Cement Grout N Benmmte Chips or Pellets
GGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
01ndirmial/Commercial DReside itial Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
Dirngation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Benmmte Slurry Ig Other(explain under 7g)
eMonitoring DRecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge OGroundwater Remediation Bentonite Pellets — 25 Ibs
OAquifer Storage and Recovery OSalmity,Been"
OAquifer Test OStormwater Drainage Topsoil — 5lbs
❑Experimental Technology OSubsidence Control 7g,Provide a brief description of the abandonment procedure:
DCreothermal(Closed Loop) OTracer
DCreothermal(Heatin(Heating/Cooling Return) o0ther(explain under7 ) ` 6" of well removed, remaining well abandoned
in place with hydrated bentonite pellets to within
4.Date wells)abandoned: 12/13/2022 4 inches of surface and topped with topsoil to
sec.Well location: existing grade.
NCDEQ-Sawyer's Grocery 0-030022
Facdlty/Owner Name Facility]DO(ifapplicable) S.Certification:
1327 US Hwy 64 East, Plymouth, 27962 LJvlf 12/22/2022
Physical Address,City,and Zip Sigmturc of Certified Well Conuacoor or Well Owner Date
Washington NA By signing this form, I hembv certify that the wells) was(were) abandoned in
County Parcel Identification No.(PIN) accordance with ISA NCAC 01C.0100 or IC.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:
(dwell field one lat/long is smficien) 9.Site diagram or additional well details:
35.866 N -76.725 W You may use the back of this page to provide additional well site details or well
abandonment derails. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Allah wel/camrrucnon record(sl rfmwdoble. Pormulnpleryecnon orrmn-wamrsuppfv wells
ONLY wnh the same consnncnon aham(onmeni you cansuhma onefo m. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MP-3 abandonment to the tollomsmg
Division of Mite Resources,Information Processing Unit,
6b.Total well depth: 15 (B.) 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: 8.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following.
6d.Water level below ground surface; 9.67 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
be.Outer casing length(if known): NA (ft.) 10c.For Water SUDDIv&Imecton 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
6L Inner casing/tubing length(if known): 5 (D) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GA-30 North Carelma Deparreent of Emtromnenbl Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7s.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on hlalber property) well construction/depth,only l GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned.
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and ScientistF, C E EVE FOR WATER SUPPLY WELLS ONLY:
Company Name p
NA t�rr 2 2 ZOLZ 7t-Type ofdisio@etant used:
2.Well Construction Permit N:
Lea al!nppbcable we!!eoresrruauan permitr 0.e.111C,Cowan',Shaw,Viwas F s(JC
IrA3rX- ,2-1 ,if 7d.Amount of disinfectant used:
3.Well use(check well use): "ap't7,;'30G
Water Supply Well: 7e.Sealing materials used(check all that apply):
[JAgricultural OMunicipaVPublic ❑Neat Cement Grout in Bentonite Chips or Pellets
OCseothermal(Heating/Cooling Supply) []Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑IndustnaVCommercial []Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
Chrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry in Other(explain under 7g)
eMonitoring ORecovery,
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge []Groundwater Remediation Bentonite Pellets — 25 lbs
❑Aquifer Storage and Recovery OSalmity Barrier
[]Aquifer Test OStormwater Drainage Concrete — 5lbs
❑Experimental Technology []Subsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer Well abandoned in place with hydrated bentonite
[]Geothermal(Heating/Cooling; Return) []Other(ex lain under 7 )
pellets to within 6 inches of surface and topped
4.Date well(s)abandoned: 12/14/2022 with concrete to existing grade.
5a.Wen location:
NCDEQ-Sawyers Grocery 0-030022
FacilitylOwner Name Facility IDh(if applicable) 8.Certification:
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Signature of Candied Well Contractor or Well Owner Date
Washington NA Be signing this form. 1 herebv cerrify that the well(s) was (were)abandoned in
County Parcel Identification No (PM) accordance with I SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one tailors is sufficient) 9.Site diagram or additional well details:
35.866 N —76.725 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 wellconsaactionrecnrd(s)efavailable.Farmultiplem)ectionornon-waiersupplvwells
ONLY with the same entvtractian ahandone em,you can suhma one ftrm.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Wtg IDO: MW-1 abandonment to the following
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (fl) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
be.Borehole diameter: 8.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
I d.Water level below ground surface: 9.01 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
be.Outer casing length lif known): NA (B) 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
6f.Inner casing/tubing length(if known): 3 ft.) abandoned.
6g.Screen length(if known): 12 (ft.)
Form GA-30North Carolina Department of Em irormenral Quality-Division of Water Resources Revved 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Wall Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Cloned-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 G W-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned'.
NC Well Contractm Certification Number 7b.Approximate volume of water remaining in wafts): (gal.)
CATLIN Engineers and ScienfV;-.0 ; tom V FOR WATER SUPPLY WELLS ONLY:
Company Name r r J 2o2Z
7t.Type of disinfecUot used:
2.Well Construction Permit#: NA I 2
Lim n11 opphcable well conso-uclion parmos(i.e.111C.Cow ',State.ibapn�,�44#l o,
fir,-ysi^'1 Yf 7d.Amount of disinfectant used:
}ftivs s-A��'50G
3.Well use(check well use): .+ �
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industiial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Doll Cuttings
0hrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry S Other(explain under 7g)
eMonimring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite Pellets - 25 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stomtwater Drainage Concrete - 5 Ibs
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geolhermal(Closed Loop) ❑Tracer
(Heating/Cooling❑Gcothermal Return) ❑Other(e lainunder7 ) Well abandoned in place with hydrated Bentonite
pellets to within 6 inches of surface and topped
4.Date well(s)abandoned: 12/13/2022 with concrete to existing grade.
5s.Well location:
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owror Name Fudity IDN(if applicable) S.Certification:� r� —(^yam/ /
1327 US Hwy 64 East, Plymouth, 27962 V�J-Jff�L�� 12/22/2022
Physical Address,City,and Zip Signature of Certified Well Contractor in Well Owner Date
Washington NA By signing this form, 1 herebv cent that the well(a) 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
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one letllong is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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
Aauch ae(l consbuclron record/s)frmuilable.FormuJliple mjediw or iron-amersrpp(v we!!s
ONLY with the same romm,,tron abar donmen1 you can submit one Jbrm.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-2 abandonment to the following
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 fit) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wefts: N addition to sending the form in the address in 10a
6c.Borehole diameter: 8.25 (in) above, also submit one copy of this form Within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 9.38 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 10c.For Water Suonly&Injection Well$: 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
61.Inner casing/tubing length(if known): 3 (ft.) abandoned.
6g.Screen length(if known): 12 (ft.)
Foot OW-30 North Carolina Depemnent of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD Far Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 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
4330-B wells abandoned
NC Well Contractor Ccmfi<atioo Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name ` („� 'Y ,/�,D 7e.Type of disinfectant used:
2.Well Construction Permit 0: NA f"e Zw Vmr, aµ
List all applicable well construction pennaa(i.e.111C.Cowrq%fal4'gpaaµRq.)ifinown
� Lu LL 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: `psGPA„yi^� ' ',, 7e.Seating materials used Icbeck all that apply):
00
OAgncultural OMuniciplivAbblc ❑Neat Cement Grout s Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) ORes chnatial Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Indtatrial/Commercial OResidential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
0brigation ❑ Specialty Grout ❑Gravel
Nan-Water Supply Welh ❑ Bentonite Slurry a Other(explain under 7g)
®Monitoring DRecovery
Injection Well: 7E For each material selected above,provide amount of materials used:
DAquifer Recharge OGroundwater Remediation Bentonite Pellets — 25 Ibs
OAquifer Storage and Recovery OSalinity Bauer
❑Aquifer Test OStormwater Drainage Topsoil — 5lbs
DExperimental Technology OSubsidence Control 7g,Provide a brief description of the abandonment procedure:
DGeothermal(Closed Loop) OTracer
(Heating/CoolingDCreothermal Return) OOther(explain under7 ) `t).$" of casing removed, remaining well
abandoned in place with hydrated bentonite
a.Dare well(a)abandoned: 12/13/2022 pellets to within 10" of surface and topped with
So.Well location: topsoil to existing grade.
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owner Name Facility IDk(ifapplkable) g•Certification: eb
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Signature of Certified Well Contractor m Well Owner time
Washington NA
By signing This form. 1 hereby certify that the weff(s) was(were)abandoned in
County Parcel Identification No.(PM) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Constrocnon Standards
and that a copy of this record has been provided to the well owner.
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one Iallong is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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 dnecessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach wellcomtructionrecord(s)tfuvailable Formultiplemjecnonornon-water.supplvwelk
ONLY with the same construction ahanlonmem..you can suhma one form.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDk: MW-3 abandonment to the following.
Division of Water Resources,Information Processing Unit,
61.Total well depth: 15 (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: 8.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following.
6d.Water level below ground surface: 9.65 lIt.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length lif known): NA Ift.) 10c.For Water Suooly&Infection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
61.Inner casing/tubing length(if known): 3 (ft.) abandoned.
6g.Screen length(if known): 12 (ft.)
Form GW-30 Nonh Carolina Department of Environmental Quality-Division of Water Resources Revved 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY.
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor-Nam,(or well owner personally abandoning well on hwlwr property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned
NC Wen Contractor Cemfiwnon Number 7b.Approaimsle volume of wafer remaining in well(s): (gal.)
CATLIN Engineers and Scientists r >u�y^ Q FOR WATER SUPPLY WELLS ONLY:
Company Name
0 �q 7<.Type of disinfectant used:2.Well Construction Permit#: NA 7 LD L
Li.st all applicable well construction permits Iic,UIC.Cot n ', ten.Fanance,erq�
err• 7d.Amount of disinfectant used:
3.Well use(check well on): , ;y-•,,� �'�
Water Supply Well: 7e.Sealing materials used(check all that apply):
OAgricultural OMunicipal/Public ❑New Cement Grout S Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) DResidential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
Olndustrial/Commercial DResidential Water Supply(shared) ❑Concrdc Grout ❑ Drill Cuttings
Ofirigation ❑Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑Bentonite Slurry S Other(explain under 7g)
eMonnoring DRecovery,
Injection Well: 7f.For each material selected above,provide amount of materials used:
OAquifer Recharge OGroundwaiter Remediation Bentonite Pellets — 25 Ibs
OAquifer Storage and Recovery OSalinity Barrier
DAquifer Test OStormwater Drainage Concrete — 5 Ibs
❑Experimental Technology OSubsiderea:Control
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Laop) OTracer Well abandoned in place with hydrated bentonite
DGeothermal(Hearin Conlin Return) OOther(explain under 7g)
pellets to within 4 inches of surface and topped
4.Date well(s)abandoned: 12/13/2022 with concrete to existing grade.
58.wee location:
NCDEQ-Sawyerrs Grocery 0-030022 � /)
Facility/Owner Name Facility IDN(if applicable) #.Certification:
1327 US Hwy 64 East, Plymouth, 27962 L>C/J/«f///���III���/ 12/22/2022
Physical Address,City,and Zip Sigmtnre ofCernfied Well Contractor or Well Owner Date
Washington NA By signing this form, I hereby certify that the well(s) was /were)abandoned in
County Pend Identificenon No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field one lar/long is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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 neccssary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Atmchwellcomimctimmrc rd(s)rfaradable. Formultiplenjection ornin-waler.ripply wells
ONLY with the same earran ramn ahondonment yaa can suhmit ono form.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-4 abandonment to the following'
Division of Water Resources,Information Processing Unit
6b.Total well depth: 15 (rt) 1617 Mail Service Center,Raleigh,NC 27699-1617
IOb. For loiectioo Wells: In addition to ending the form to the address in IOa
6c.Borehole diameter: 8.25 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 9.78 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (R) IOc.For Water Supply&Infection 51"ells: In addition to sending the form inthe
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 resume where
6L loner casing/tubing length(if known): 3 (R) abandoned
6g.Screen length(if known): 12 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Rmiud 2.22-2016

WELL ABANDONMENT RECORD For lnromal Use ONLY
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7s.For Geoprobc/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
4330-B wells abandoned.
NC well Condor Cendication Number 7b,Approximate volume of water remaining in we6(s): (gat)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
i S �!��s 7c.Type of disinfectant used:
2.Well Construction Permit 0: NA '�,a"r l• n9
Lesr all applicable well cons nsmon permus(I.c IBC C8wn0•,Slow.L'aYur(�, mown
nC(' 1+ t}ty( 7d.Amount of disinfectant used:
3.Well on(check well on): r„Oy AC-0
Water Supply Well: �Ctf„r{ t�y 7e.Sealing materials used(check all that apply):
❑Agricultural OMu&,ipaltPubTtc"ryry, 0 Neat Cement Grout C Bernonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
Olndusuial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
Okri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonile Slurry s Other(explain under 7g)
filMonitoring ORecovery
Injection Well: 7L For each material selected above,provide amount of materials used:
[]Aquifer Recharge []Groundwater Remediation Bentonite Pellets — 251bs
[]Aquifer Storage and Recovery []Salinity,Barrier
❑Aquifer Test []Stortnwater Drainage Concrete — 5lbs
❑Experimental Technology []Subsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) []Tracer
OGeothermal(Heming/Coolm Return) ❑OOter(explain under7 ) Well abandoned in place with hydrated bentonite
pellets to within 6 inches of surface and topped
4.Date events)abandoned: 12/14/2022 with concrete to existing grade.
So.We6 location:
NCDEQ-Sawyers Grocery 0-030022
Facility/Owner Name Facility ID#(ifappliceble) S.Certification: ^�
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Sigruture of Certified Well Contractor or Well Owner Date
Washington NA
By signing this form, /hereby certify that the wells) was(were) abandoned in
County Parcel Ideorifinnon No.(PIN) accordance with 15A NC4C 01C.0/00 or 1C.0100 Well Construction Standards
56.Latitude and longitude in degrees/minutes/seconds or decimal degree: and that a copy of this record has been provided to the well owner
(if well field,one Iaulong is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 K 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 W ELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Anachwellconrrrudinnreoord(r)r(madnble. Formwhrple m/ecrmn nrnon-waver rupply welts
ONLY wbM1 the same consrn¢rmn oMndunmenl.you can mhmu tine J run.
]On. For All Wells: Submit this form within 30 days of completion of well
6s.Well ID#: MW-5 abandonment to the following.
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 Lrt) 1617 Mail Service Center,Raleigh,NC 2 7 699-161 7
lob. For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 8.59 (ft) Division of Water Resources,I nderground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft) 10c.For Water Supply&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6L Inner casing/tubing length(if known): 3 (D) abandoned.
6g.Screen length(if known): 12 (D.)
F.GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Imernal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 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
4330-B wells abandoned.
NC Well Contractor Cconficanon Number 7b.Approsima to volume of w ater re maining in well(s): (gaL)
CATLIN Engineers and Scientists } FOR WATER SUPPLY WELLS ONLY:
Company Name .Y;....L.e a 1­07c.Type of disinfectant used:
2.Well Construction Permit#: N�A F.2
EQZZ
List aQ aWrcahle well comtiuctron permits fi.C.(IIC,Ct';,�lme.L'arunee,eM J fknown
ura 7d.Amount of disinfectant used:
3.Well use(check well toe): IfN'OGR"=-y,t_� � .M 9
Water Supply Well: 7e.Sealing materials used(check all that apply):
OAgncultural DMunicipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets
DCre rthermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
Olndustrial/Commercial DResidrntial Water Supply(shared) ❑Concrete Gout ❑ Drill Cuttings
01nagation ❑Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry Ill Other(explain under 7g)
IlMormtoring ORecovery
Injection Well: 7L For each material selected above,provide amount of materials used:
OAquifer Recharge OGroundwater Remediation Bentonite Pellets - 25 Ibs
OAquifer Storage and Recovery OSalinity Barrier
DAquifer Test OStormwater Drainage Concrete - 5lbs
❑Experimental Technology OSubsidmce Control 7g,Provide a brief description of the abandonment procedure:
OCreothermal(Closed Loop) OTracer Well abandoned in place with hydrated bentonite
OCreothermal(Heating/Cooling Return) OOther(explain under 7 )
pellets to within 4 inches of surface and topped
4.Date well(s)abandoned: 12/14/2022 with concrete to existing grade.
5a.Well location:
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owner Name Facility DO(if applicable) S.Certification:
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Signature of Certified Well Contractor of Well Owner Date
Washington NA By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Idennficanon No.(PIN) accordance with 15A NCAC 01C.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:
(if well field one latlong is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 W 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 WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Anach Hell construction record/s)fawilable. tormubiple m/ecsron or ran-wmersi pply we/Ls
OAZ}'wuh the same construction aMrWonmenq you urn suhmir onrJvm.
His. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDN: MW-7 abandonment to the following:
Division of W aler Resources,Information Processing Unit,
6b.Total well depth: 15 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 9.53 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
he.Outer casing length(if known): NA (ft.) His.For Water Suooly&Injectiou 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
M.Inner casing/tubing length(if known): 3 (B) abandoned.
6g.Screen length(if known): 12 (fk)
Farm GW-30 North Cemlina Department of Em'nomra:ntsl Quality-Division of Water Resources Re,ised 2-22-2016

WELL ABANDONMENT RECORD For lmemal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on ha/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientist (ty Ft FOR WATER SUPPLY WELLS ONLY:
CampanyName
NA _.. 9 ^0'1'1 7e•Type of disinfectant used:
2.Well Construction Permit N: f1C(� , L LL
Lies all applicable well conslructlon permits(i.e.UIC,County,S/ah,Variance,em)inkno
-ar..,.lyfitW� 6 7d.Amount of disinfectant used:
3.Well use(check well use): IfdJPT't^-u�
Water Supply Well: 7e.Sending materials used(check all that apply):
DAgricultural ❑MunicipaVPubhc ❑Neal Cement Grout S Bentonite Chips or Pellets
DCreothermal(Heating/Cooling Supply) DResidential Water Supply(single) ❑ Sand Cement Groin ❑ Dry Clay
❑Industrial/Commercial DResidential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
❑hri ation ❑ Specialty Grout ❑Gravel
Now-Water Supply Well: ❑Bentonite Slurry s Other(explain under 7g)
eMonitoring []Recovery,
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge nGroundwster Remediation Bentonite Pellets — 25 Ibs
❑Aquifer Storage and Recovery []Salinity Barrier
[]Aquifer Test nStormwater Drainage Concrete — 5 Ibs
❑Experimenral Technology []Subsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) []Tracer Well abandoned in place with hydrated bentonite
DGeothermal(Heating/Cooling Return) DOther(explain under 7 )
pellets to within 6 inches of surface and topped
4.Date well(s)abandoned: 12/14/2022 with concrete to existing grade.
St.Well location:
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owner Name Facility IDN(ifapphcable) S.Certification: �
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Signature ofCer ified Well Contractor or Well Owner Date
Washington NA By signing this form. 1 hereby certify that the wen(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
56.Latitude and longitude in degre<slminules/secmds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 W You may use the back of this page to provide additional well site details or well
abandonment derails. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(SI BEING ABANDONED SUBMITTAL INSTRUCTIONS
Anuc'h wellconehuction remrdlsl J,rvuilahle.Formulnple m/ectmn ornon-xmer ruppfv wells
ONL}'with the same con.rmm�m aAamlanmenr you can.wM1mit one/cam.
IOa. For All Wells: Submit this form within 30 days of completion of well
6s.Well IDN: MW-8 abandonment to the following.
Division of Water Resources,Information Processing Unit,
6b.Total„ell depth: 18 (D.) 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. 8.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 11.15 Ift.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 10c.For Water Supply&Iniecdoa Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 3 (ft.) abandoned.
6g.Screen length(if known): 15 (ft.)
Form GW30 North Carolina Department of Environmental Quality-Division of Water Resources Rcrised 1-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 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
4330-B wells abandoned.
s 7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Numbtt !1 qq ( It-�
L r eklh—
CATLIN Engineers and Scienti LAmount
UPPLY WELLS ONLY:
Company Name t-f, 2 fectant used:
2.Well Construction Permit 8: NA I%O'I
Liar all apphcable well corsowa on permit,(i.e.1/1C,Cqt„-.9'aaVA ��1ce„�.t,���known
�tjfU;'N isinfectant used:
3.Well use(check well on):
Water Supply Well: 7e.Seating materials used(check all that apply):
DAgicultural OMunicipal/Public ❑Neat Cement Grout s Bentonite Chips or Pellets
DCreothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑htdustrial/Commercial OResidential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
Ofirigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g)
IlMonitoring ORecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
DAquifer Recharge DGroundwiter Remediation Bentonite Pellets — 15 Ibs
DAquifer Storage and Recovery ❑Salinity Barrier
DAquifer Test OStormwater Drainage
OExperimental Technology OSubsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer ,
OGeothermal(Heating/Cooling Return) OOther(explain under 7g) 6 of well removed, remaining well abandoned in
place with hydrated bentonite pellets to existing
4.Date well(s)abandoned: 12/15/2022 grade.
5a.Well location:
NCDEQ-Sawyer's Grocery 0-030022 ^
Facility/Owner Name Facility ID#(if applicable) S.Certification: V
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Sigruture of Certified Well Contractor or Well Owner Date
Washington NA 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.
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one batons is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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
Armchwella trucrionre rd(s)fuvadable. Formultipletyecrionornon-anrersupptvwetts
ONLYwith the same construction bhandunmenq you con suhmil one/arm.
102. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDR: MW-11 abandonment to the following.
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 8 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob. For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 (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:
3.51 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
be.Outer casing length(if known): NA (R) 10c.For Water Supply&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of Well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 3 (ft.) abandoned.
6g.Screen length(if known): 5 (ft.)
Form GW-30 North Carolina Dep r ment of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD F.lmemal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 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
4330-B wells abandoned.
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
+.� 7c.Type of disinfectant used:
2.Well Construction Permit 0: NA r. 9 9n77
List all Ppbcab/e well ronstmclion permih(l.e.fllC,C'aunryt Sr ,7 ari v e ifknown
7d.Amount of disinfectant used:
3.Well use(check well we): �Jf1Y,+j�1
Water Supply Well: "' 7e.Sealing materials used(check all that apply):
[]Agricultural ❑Municipal/Public ❑Neat Cement Grout II Bentonite Chips or Pellets
OGeuthermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial []Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
Ofingation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ■Other(explain under 7g)
eMomitorng []Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
[]Aquifer Recharge OGroundwater Remediation Bentonite Pellets — 25 Ibs
❑Aquifer Storage and Recovery []Salinity Barrier
❑Aquifer Test OSmrmvvater Drainage Concrete — 5 Ibs
[]Experimental Technology []Subsidence Control 7g,Provide a brief description of the abandonment procedure:
OCaeothermal(Closed Loop) OTmcer
(Heating/CoolingOGeothermal Return) OOther(explain order7 ) —1.2' of well removed , remaning well abandoned in
place with hydrated bentonite pellets to within 1
e.Date well(a)abandoned: 12/14/2022 foot of surface and topped with concrete to existing
52.wen location: grade.
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owner Name Facility IDk(if applicable) S.Certification:
1327 US Hwy 64 East, Plymouth, 27962 V�J^I 12/22/2022
Physical Address,City,and Zip Signature of Ccmfied Well Contractor m Well Owner Date
Washington NA
By signing This form. /hereby certify that the well/sJ was(were) abandoned in
County Parcel Idemification No.(PIN) accordance with 15A NCAC 01C.0100 or 2C.0100 Well Construction Standards
and that a copy of this record has been provided io the well owner
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if ell field,one ha/long is sufficieno 9.Site diagram or additional well details:
35.866 N -76.725 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 WELLIS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Anuch wolfcamtruclion re<ordlal Javailrrhle. Formuhple rn/anion ninon-uurersvpply we/h
ONLY with the some nonce.........hemd nmia,,you can suhma one form.
IOa. For All W'eIB: Submit this form within 30 days of completion of well
6a.Well IDN: MW-12 abandonmem to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 12 (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: 8.25 (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: NM (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
be.Outer casing length(if known): NA (D) 10c'For Water Sunnly&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 3 (ft) abandoned.
6g.Screen length(if known): 9 (ft.)
I.GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revi"2.22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7s.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
4330-B wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gaL)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name �^
2.Well Construction Permit 0:
NA f i L�E t `� 7c.Type of disinfectant used:
List all applicable well torah action,permits fl.e.UIC,County•,SIpry�F(arlAre{1mi' an
1 j`-1. {{lI I�t 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: Irta-.`r' rt•i u�j+,w 7e.Sealing materials used(check all that apply):
[]Agricultural DMunicipal/Public ❑Neat Cement Grout O 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
01trigation Cl Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑Bentonite Slurry a Other(explain under 7g)
MMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
OAquifer Recharge []Groundwater Remediation Bentonite Pellets — 25 lbs
[]Aquifer Storage and Recovery []Salinity Barrier
DAquifer Test DStormwater Drainage Concrete — 5Ibis
[]Experimental Technology OSubsidence Control
7g.Provide a brief description of the abandonment procedure:
OGcothermal(Closed Loop) OTracer Well abandoned in place with hydrated bentonite
[]Geothermal(Heating/Cooling Return) []Other(explain under 7g)
pellets to within 6 inches of surface and topped
4.Date well(s)abandoned: 12/14/2022 with concrete to existing grade.
5s.Well location:
NCDEQ-Sawyer's Grocery 0-030022
Fscflity/Owner Name Facility ID#(Ifappheable) 8•Certification: �
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,sad Zip Signature of Certified Well Contractor m Well Owner Date
Washington NA
BY signing this farm, 1 hereby certify that the well(s)was(were)abandoned in
County Parcel Identification No (PIN) accordance with 15A NCAC 62C.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:
(if ell field,one Iat/long is sufferers) 9.Site diagram or additional well details:
35.866 N -76.725 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach wellconstruction recordfs)ifavailable. Formalliple injection or non-waler.supp/v wells
ONL}'with the same caumrclian ahandunmenl,you can suhmil one form.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDN: MW-13 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 18 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 (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: 10.78 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer easing length(if known): NA (ft.) 10c.For Water Sunnly&Injectou Wells: In addition tosending 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 ci sing/tubing length(if known): 3 ft.) abandoned.
6g.Screen length(if known): 15 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Recised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Cloud-Loop Geothermal Wells having the same
Well Contractor Name(or well owner perscrully abandoning well on limber property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned
NC Well Contractor Cenificame Number 7b.Approximate volume of water remaining in wel(s): (gal.)
CATLIN Engineers and .Scientists FAmont
UPPLY WELLS ONLY:
Company Name •'" ' ..+
4'..- q disinfectant used:
2.Well Construction Permit#: NA _ 7 2 7n^ 2L
/wrl ul/uppinn6fe well cortuructian permitr(i.e.(//C.Countyt imz.rleJ ifMown
rlY9W'/3 VO.Lisinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Seating materials used(check all that apply):
OAgricultural OMunicipaUPublic ❑Neal Cement Grout O Bentonite Chips or Pellets
GCxothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial OResidential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
Olrngation ❑ Specialty Grout ❑Grovel
Non-Water Supply Well: ❑ Bentonite Slurry a Other(explain under 7g)
■Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
OAquifer Recharge OGroundwater Remediation Bentonite Pellets — 75 Ibs
OAquifer Storage and Recovery OSalmity Banner
OAquifer Test OSlorm eater Drainage Concrete — 5 lbs
OExpenmentel Technology OSubsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTractt Well abandoned in place with hydrated bentonite
OGeothermal(Healing/Cooling Return) OOther( lain under 7g)
pellets to within 6 inches of surface and topped
4.Date well(s)abandoned: 12/13/2022 with concrete to existing grade.
5a.Well location:
NCDEQ-Sawyer's Grocery 0-030022 � �)
Facdiry/Owner Nano Facility ID#(ofapplicable) g.Certification: r���/—//
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,Cory,and Zip Signature ofCemfied Well Contractor or Well Owner Date
Washington NA
By signing this form, I hereby certify that the wells) was /were) abandoned in
County Parcel lderrification No(PM) accordance with I5A NCAC 02C.0I00 or 2C.0100 Well Construction Standards
and thar a copy of this record has been provided to the well owner.
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field,one lathing is sufficien0 9.Site diagram or additional well details:
35.866 N -76.725 N 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
Atmch x'rll consnucuon records)jmadubfe. FormWlipfe ryernon or non-xorrrrryrpfv wells
ONLY with Ac same comoroonon alrandomnam,you oan.mM1mrr nne jorm.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-14 abandonment to the following.
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 13 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
10.25 above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following.
6d.Warr level below ground surface: 9.05 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (R) 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 ofcomplelion
of well abandonment to the counq health department of the county where
6f.Inner casing/tubing length(if known): 3 (D) abandoned.
6g.Screen length(if known): 10 (ft.)
Fom,Gw-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD Forin¢malU.ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7s.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Nam(or well owner personally abandoning well on his/her property) well construction/depth,only 1 G W-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned
NC Wen Contractor certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and .SCIentIS�S a_ _^� FOR WATER SUPPLY WELLS ONLY:
Company Name , 1..., a s b--
� � 7e.Type of disinfectant used:
2.Well Construction Permit A: NA nCf 9. 9 7077
Lta all upphc,rb(e ,It conarruonon permla 0.a 111C.Coway,Shoe.Ibnann,escl ifirnown
7d.Amount of disinfectant used:
3.Well use(check well use): It6i.fPl;yi^n +ark= •'�('
Water Supply Well: 7e.Sealing materials used(check all that apply):
DAgdcuitural ❑Municipal/Pubhe ❑Neat Cement Grout s Bentonite Chips or Pellets
DGeothermal(Heating/Cooling Supply) OReside itial Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑IndustriaUCommercial DResidential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
Ohrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry a Other(explain under 7g)
IlMonitoring ORecovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge OGroundwater Remediation Bentonite Pellets - 25 Ibs
❑Aquifer Stooge and Recovery ❑Salinity Barrier
OAquifer Test OStormwatef Drainage Concrete - 5lbs
❑Experimental Technology OSubsidence Control
7g.Provide■brief description of the abandonment procedure:
DGeotheraral(Closed Loop) CTmcer Well abandoned in place with hydrated bentonite
DCaeothermal(Hearin Cooling Return) DOther(explain under 7g)
pellets to within 6 inches of surface and topped
4.Date well(s)abandoned: 12/13/2022 with concrete to existing grade.
5a.Wen location:
NCDEQ-Sawyers Grocery 0-030022
Facilay'Owncr Name Facility IDa(dapplicable) g.Certification: �
1327 US Hwy 64 East, Plymouth, 27962 V ((f 12/22/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Dam
Washington NA Br signing this farm, I hereby cernify that the wells/ was(were)abandoned in
Comrty Parcel ldennfication No (PIN) accordance with 15A NCAC 02C.0/00 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
56.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:
35.866 N 76.725 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
Anuch xr(l constraclion remrJlsL/avmlub(e. pormu(tiple mjecuan ur non-w arcs supply wells
ONLY with the same you urn sehmlt one/rm.
10s. For All Wells: Submit this form within 30 days of completion of will
fia.WeDIDO: MW-15 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total,,ell depth: 13 (n.) 1617 Mail Service Center,Raleigh,NC 27699-1617
Uns. For Infection Wells: In addition to sending the form to the address in Inn
6c.Borehole diameter: 8.25 (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: NM (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA Ift.) 10c.For Water Supply&Infection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form Within 30 days of completion
of well abandonment to the county health department of the county where
61.Inner casing/tubing length(if known): 3 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Fare GW-30 North Carolina Deterrence,of EnvirommaW Quality-Division of Water Resources Retired 2-22-2016

WELL ABANDONMENT RECORD Far Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his her propeny) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned.
NC Well Contractor Certification Number .-�(n '\ / �7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientist�v t a `j FOR WATER SUPPLY WELLS ONLY:
Company Name ncr, 7c.Type of disinfectant used:
2.W'ell Construction Permit#: NAra Uri I
Ltsr al(apphcah/e xe!!construction permits(i.e.WC.C'au"I_** "r/ atci mown
,� 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
OAgicultural ❑Municipai/Public ❑Neat Cement Grout N Bemtmute Chips or Pellets
OGeothermal(Heating/Coohng Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
Olndustrial/Commental OResidential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
01trigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bemmnite Slurry ❑ Other(explain under 7g)
lManiuring ORecovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge []Groundwater Remediation Bentonite Pellets — 25 Ibs
❑Aquifer Storage and Recovery []Salinity Barrier
[]Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure.
OGcothermal(Closed Loop) OTracer
(Heating/CoolingDGeothermal Return) []Other(explain under7 ) Well abandoned in place with hydrated bentonite
pellets to existing grade.
4.Date well(s)abandoned: 12/14/2022
5a.Well location:
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owwr Name Facility ID#(if applicable) h.Certification:
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Signature of('enified Well Contractor or Well Owner Date
Washington NA By signing this form. I hereby certify that the well/s) was(were/abandoned in
County Parcel Idermfi,m is No.(PM) accordance with l SA NCAC 62C.0100 or IC.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:
(if well field,one fat/long is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 W You may use the back of this page toprovide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLIS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Anuoh well construction reoordtsl/mndable. Formulnp(e inlerrom or nnn-woterstpply wells
ONLY wlth the same constn¢uun ohondomr,ri..ynu non suhma onr/ivm.
IOa. For All Wells: Submit this farm within 30 days of completion of well
6a.Well ID#: MW-19 abandonment to the following.
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 20 (D.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob. For Infection Wells: In addition to sending the form to the address in IOa
6c.Borehole diameter: 8.25 (in) above, also submit one copy of this farm within 30 days of completion of well
abandonment to the following.
6d.Water level below ground surface: NM (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (D) 10c.For Witter Supply&Infection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 5 (D) abandoned.
6g.Screen length(if known): 15 ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Imcml Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning w 11 on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned
NC Well Contractor Certification Number 7Is.Approximate volume of water remaining in well(s): (Kai.)
CATLIN Engineers and Scienti9ts; -,s FOR WATER SUPPLY WELLS ONLY:
Company Name rt Or1�
NA nc f 2 G L 7<•Type of disinfectant used:
2.Well Construction Permit N: •+—''
Lrsr a!!app!cable well comtruemon permia lr,e (llC Coamp,Store,{orla .efyL�`Ir m
7d.Amount of disinfectant used:
3.Well use(check well oat): (M "AlsxL
Water Supply Well: 7e.Senfing materials used(check all that apply):
OAgricultural 0Municipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets
OGembermal(Heating/Cooling Supply) OResidenual Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial OResidential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
Obligation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
011.%lomtoring ORecovery
Injection Well: 7E For each material selected above,provide amount of materials used:
OAquifer Recharge OGroundwater Remediaticn Bentonite Pellets — 40 lbs
OAquifer Storage and Recovery OSalinity Barrier
OAquifer Test OStormwater Drainage
❑Experimental Technology OSubsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTmcer
OGeothermal(Heatin Conlin Return) OGther(explain under7 ) Stick-up removed and remaining well abandoned in
place with hydrated bentonite pellets to existing
4.Date wells)abandoned: 12/14/2022
grade.
52.Well location:
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owner Name Facility IDa(if applicable) S.Certification:
1327 US Hwy 64 East, Plymouth, 27962 LI L��r 12/22/2022
Physical Address,City,and Zip Signature ofCenified Well Contractor or Well Owner Date
Washington NA
B},signing this form, !hereby certify that the wells/ was (were) abandoned in
County Parcel Identification No.(PIN) accordance with!SA NCAC 02C.0100 or 1C.0100 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:
(if well field one Iat/long o sufficienq 9.Site diagram or additional well details:
35.866 N -76.725 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
Anachwe!lconslractro rrr,ordls)(fo ad b1,. Forma/Irp/e mlecuon or nnn-water supply we/tr
ONLY with the same eonsrnrrnr,n ahanJourn.•nr.vmr can suhmtt one form_
IOa. For All Wells: Submit this form within 30 days of completion of will
6a.Well 1Dk: MW-20 abandonment to the following.
Division of Water Resources,Information Processing Unit,
6b.lbtal well depth: 20 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For Injection Wells: In addition to sending the form to the address in l0a
61.Borehole diameter:
$.25 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following.
6d.\\a ter level below ground surface: 9.98 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
be.Outer casing length(if known): NA (ff) 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
of.Inner casinWtubing length(if known): 5 (R) abandoned.
6g.Screen length(if known): 15 Ift.)
Form GW-30 North Cerchru Department of Environmental Quality-Division of Water Resources Raised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 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
4330-B wells abandoned:
NC Well Connector Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientists— ,'z-•� t FOR WATER SUPPLY WELLS ONLY:
Company Name awe
7c.Type of disinfectant used:
2.Well Construction Permit N: NA QCf 2 2 2022
List al!pphcable well constrac(tan permilr(t.e.UIC,Cca ny 7sarc.]brans,,era)ijemmvn
U0 7d.Amount of disinfectant used:
3.Well am(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
OAgricultural OMunicipaVPublic ❑ Neat Cement Grout s Bentonite Chips or Pellets
ClGeothermal(Heating/Coomig Supply) OResidential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑lndustrial/Commercial OResidential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
0hrigation ❑Specialty Grout ❑ Gravel
Noo-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
SMonittering ORecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge OGroundwater Remediation Bentonite Pellets - 40 lbs
CAquifer Storage and Recovery ❑Salinity Barrier
OAquifer Test OSburnwater Drainage
OExperimental Technology CSubsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer
OGeothermal(Heating/Cooling Return) OOther(explain under7 ) Stick-up removed and remaining well abandoned in
place with hydrated bentonite pellets to existing
4.Date Willis)abandoned: 12/14/2022
grade.
Sa.Wen location:
NCDEQ-Sawyer's Grocery 0-030022 � /)
Facility/Owner Name Facility IDN(if applicable) g.Certification:
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Washington NA By signing(his form. I hereby cerliify that the wellts)was(were) abandoned in
County Parcel Idermficatron 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:
(if well field,one let/long is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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 B necessary.
CONSTRUCTION DETAILS OF WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Altmhwel(construcaan.odisl Juvailable. Farmulliple injecfian arnon-walrr supply welt
ONLi'with thr same comtmcnan alwmjanmenl,yuu can suhmu one Jurm.
[Oz. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDN: MW-22 abandonment to the following
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 25 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Injettion Wells: in addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 (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: N M (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
be.Outer casing length(if known): NA (D) 10c.For Water Suonly&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 10 (ft) abandoned.
6g.Screen length(if known): 15 Ift.)
I.GW-30 North Carolina Deparnnent of Environmental Quality-Dnision of Water Resources Revised 2-11-2016

WELL ABANDONMENT RECORD For lmemal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Corurador Noma(orwell owner personally abaad.mog well on h-,hrr property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned:
NC Well Contmclor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientist �` n �� FOR WATER SUPPLY WELLS ONLY:
Company Name
L 7c.Type of disinfectant used:
2.Well Construction Permit 8: NA n_r 2 J 2022
Lnu all applicable.,It.,.,,.a permit./ie.111C,Counq,Stan. Parlarwe.etc.)tJeaown
Ur Wd.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Seating materials used(check all that apply):
OAgncultural OMunicipaMblic ❑Neat Cement Grout a Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) []Residential Water Supply(single) ❑Sand Cement Grow ❑ Dry Clay
❑Industrial/Commercial OResidential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
offfigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g)
I'Momtortng ORecovery
Injection Well: 7L For each material selected above,provide amount of materials used:
❑Aquifer Recharge DGroundwater Remediation Bentonite Pellets — 25 lbs
❑Aquifer Storage and Recovery OSalinity Barrier
DAquifer Test []Stormwater Drainage
OExperimental Technology []Subsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTsacer
OGeothermal(Heatin(Heating/Cooling Return) oOther(explain under7 ) Stick-up removed and remaining well abandoned in
place with hydrated bentonite pellets to existing
4.Date well(s)abandoned: 12/15/2022
grade.
52.Well location:
NCDEQ-Sawyers Grocery 0-030022
Facility/Owur Name Facility IDanfapplkable) S.Certification:
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Uam
Washington NA
BY signing this form. /hereby cent that the wefl(s) was (were) abandoned in
County Parcel Idemdieation No.(PIN) re"ordance 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.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one Iallong is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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 WELLIS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Anachwellconstmcuonrecord(,)tfawa b/e. Formulttpletnjecitonornon-wntersupplvwelly
ONLY with the same comnuct oe obanch nrnenr,you can nelaut one form.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-26 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 25 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 (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: NM fft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) IOU For Water Surely&lniectiou 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): 15 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Camlwa 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
Corey D. Futral 7s.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his'ber property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned
NC Well Contractor Cemfication Number 7b.Approximate volume of water remaining in ssell(s): (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company NameY.---
i 7c.Type of disinfectant used:
2.WellConstruction Permit M: NA ,. 0 t3 7n97
Lot all applcable well onion,"co penes(tt WC.Ccwali.SI ,�,[a ion . )r wn
l; 7fi.Amouat of disinfectant used:
3.Well use check well on): '^''.'-, 9
Water Supply Well: " 7e.Seating materials used(check all that apply):
OAgncultural OMunicipal/Pubhc ❑Neat Cement Grout s Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial OResidential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑lrti ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry e Other(explain under 7g)
FlMonitming ORecovery
Injection Well: 7f.For each material selected abo,'e,provide amount of materials used:
OAquifer Recharge OGroundwater Remediation Bentonite Pellets - 50 Ibs
❑Aquifer Storage and Recovery OSahnity Barrier
CAquifer Test ❑Stormwater Drainage Concrete - 5 Ibs
OExpenmenud Technology ❑Subsidence Control 7g Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTraeer Well abandoned in place with hydrated bentonite
OGeothermal(Heating/Cooling Return) OOther(ex lain under 7 )
pellets to withing 4" of surface and topped with
4.Date well(s)abandoned: 12/15/2022 concrete to existing grade. Well shield put back
52.well location: in place.
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owner Name Facility IDM(if applicable) S.Certification:
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Signature ofCertificd Well Contractor or Well Owner Date
Washington NA Br signing this fore. 1 herebr certify that the well(s) was in-ere)abandoned in
County Parcel Identification No.(PIN) accordance with 15A NC4C 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
56.Latitude and longitude in degrees/minutes/seconds or detimaldegrees:
(if well field,one latIong is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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
Auachwellca is tionrec rd(sltf vailable. Formvluple injection ornon-waternpp(v wells
ONLY with the some construction ahamlomnene you can submit one form.
IOa. For All Wells: Submit this forth within 30 days of completion of well
6a.Well ID0: MW-27 abandonment to the fallowing:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 27 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For Infection Wells: In addition to sending the farm to the address in 10a
6e.Borehole diameter: 8.25 (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: NM (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
on.Outer casing length(if known): NA (ft.) 10c.For Water Surely&Inieefton 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
61.loner casing/tubing length(if known): 17 (ff.) abandoned.
6g.Screen length(if known): 10 (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
Corey D. Futral 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
4330-B wells abandoned.
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gat)
CATLIN Engineers and Scientists r ( FOR WATER SUPPLY WELLS ONLY:
Company Name `'�' - s
ss-^ qqq�q 7c.Type of disinfectant used:
2.Well Construction Permit M: NA ... '. 9. �OCL
Una!/upplrca6lr we!l connrxebon permits(i.e(//C.Co goonce,ekj ifkrmw
' ,.yra1�.7 Urif 7d.Amount of disinfectant used:
3.Well use(check well ose): Imp;fY(r'«:s „ .'3,0G
Water Supply Well: 7e.Sealing materials used(check all that apply):
DAgncultural DMunicipai/Public ❑ Neat Cement Grout a Bentonite Chips or Pellets
OCreuthermal(Heating/Cooling Supply) OResidentud Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial DResidential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
0hrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry a Other(explain under 7g)
eMonitoring ORecovery
Injection Well: 7f.For each material selected abme provide amount of materials used:
DAquifer Recharge DGroundwater Remediation Bentonite Pellets — 501bs
❑Aquifer Storage and Recovery OSalmity Barrier
❑Aquifer Test ❑Stormwater Drainage Topsoil — 51bs
DExperimental Technology OSubsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer
DGeothermal(Heatin Coolin Return) DOther(explain under 7 ) Stick-up removed and remaining well abandoned in place
with hydrated bentonite pellets to withing 6"of surface
4.Date well(s)abandoned: 12/15/2022
and topped with topsoil to existing grade.
Sm.We"location:
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owner Name Facility ID#(ifsppi.eble) 8.Certification:
1327 US Hwy 64 East, Plymouth, 27962 ffff//II���� 12/22/2022
Physical Address,(ii .and 7, SignatureofCenified Well Contractor or Well Owner Date
Washington NA By signing this form. I hembv certify that the well(s) was (were) abandoned in
County Parccl Idemification 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.
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one lavlong is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 W You ma}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 xe/l consnucnon recnrJlsL{nvaduh(e. Farmulnp(e mpnwn or nun-wmersupp/v we!!s
ONLY with the same umsrn.arum.ham/onrnenr,you non.ruhmrrnne form.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDh: M W-30 abandonment to the following.
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 27 (R.) 1617 Mail Service Center,Raleigh,NC 27699-1617
IOb.For Infection Wells: In addition to sending the form to the address in IOa
6c.Borehole diameter: 8.25 (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: 13.73 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699.1636
6e.Outer casing length(if known): NA (D) IOc.For Water Supply&Injectiou 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
61.Inner casing/tubing length(if known): 17 (R) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Depznment of Emirommemal Quality-Division of Water Resources Revved 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral Is.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 l GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned.
NC Well Contractor Cenification Number V f - 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and ScientistsR="c El V — OR WATER SUPPLY WELLS ONLY:
Company Name Orr(` 2 2 2022 7c.Type of disinfectant used:
2.Well Construction Permit B: NA
J_..
LvtaHrpbcabkwell emutruaron Person(i.e.111C.Court xxL4t�,�fMlrq?t�:jy�o.waU
`'flsvt 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural DMunicipal/Public ❑Neat Cement Grout s Bentonite Chips in Pellets
DGeothermal(Henting/Cooling Supply) GResidential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial GResidential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
11hrigation ❑ Specialty Grout ❑Gravel
Nan-Wafer Supply Well: ❑ Bentonite Slurry a Other(explain under 7g)
1111\1onaoring GRecoverc
Injection Well: 7E For each material selected above,t rm'idt amount of materials used:
DAquifer Recharge GGroundwater Remediation Bentonite Pellets - 50 Ibs
DAquifer Storage and Recovery ❑Salinity Barrier
DAquifer Test ❑Stormwater Drainage Concrete - 5lbs
❑Experimental Technology OSubsidence Control 7g,Provide a brief description of the abandonment procedure:
GGeothermal(Closed Loop) OTracer Well abandoned in place with hydrated bentonite
GGeothermal(Heating/Cooling Return) Glhher(explain under 7g)
pellets to withing 4" of surface and topped with
4.Date well(s)abandoned: 12/15/2022 concrete to existing grade. Well shield put back
sa.Well location: in place.
NCDEQ-Sawyer's Grocery 0-030022 ^
Facility/Owner Name Facility ID#(ifapplicable) g•Certification: V
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Washington NA
By signing this form, !hereby certify that the well(s) was (were)abandoned in
County Parcel Identification No.(PrN) accordance with 15A NCAC 02C.0l00 or 2C.0200 Well Construction Standards
and that a cape of this record has been provided to the well owner.
Sit.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
rfwell field,one Iat/long is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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
Anachwellconsimctionrecoa((s)Jmatluhle. Formuiliples yecnonormn-xarersippWwelis
ONLY with the same couhuction ahumlonmem,yen can.suhmis one form.
IOa. For All Wells: Submit this form within 30 days of completion of will
Is.Well IDN: MW-31 abandonment to the following'.
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 29 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iajection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8'25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following'.
6d.Water level below ground surface: 11.00 (fL) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (R) 10c.For Water Sunoly&lntection Wells: In addition to sending the form to the
address(es)above,also submit one copy ofthis form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 14 (D) abandoned.
6g.Screen length(if known): 15 (ft)
Fonn G W 30 North Carolina Depsmnent of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For latenad Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on tue ur property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned.
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
i
CATLIN Engineers and Scientists , f OR WATER SUPPLY WELLS ONLY:
Company Name � rr O��Q L 7c.Type of disinfectant used:
2.Well Construction Permit N: NA —'
Lista/l applicable well construction pert,(i.e.1/IC,Cnamr.Slam,BiY, ryp rf a DO
lfsiOf3cf-' 7d.Amount of disinfectant used:
3.Well use(check well on): 'DIN SrJU
Water Supply Well: 7e.Seating materials used(check all that apply):
DAgricullural OMunicipal/Public ❑ Neat Cement Grout @ Bentonite Chips or Pellets
[]Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑fndustrial/Commercial CResidential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
Okrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry @ Other(explain under 7g)
@Monitoring []Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
OAquifer Recharge OGmundwater Remediation Bentonite Pellets — 50 Ibs
[]Aquifer Storage and Recovery OSalinity Banner
[]Aquifer Test OStormwater Drainage Concrete — 5lbs
[]Experimental Technology []Subsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) []Tracer Well abandoned in place with hydrated Bentonite
[]Geothermal(Heatin Conlin Return) []Other(ex lain under 7g)
pellets to withing 4" of surface and topped with
4.Date well(s)abandoned: 12/15/2022 concrete to existing grade. Well shield put back
Sm.Well location: in place.
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owmr Name Facility ID#(if applicable) S.Certification: ^��y—/ /
1327 US Hwy 64 East, Plymouth, 27962 12/22�2022
Physical Address,City,end Zip Signature of Courtier]Well Contractor or Well Owner Dam
Washington NA 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 IC.0200 Well Construction Standards
and that a copy of this record has been provided to the we//owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one let/long is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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
Anachnellconsiructionrecord(s)ifmailable. Formullipleinjectionornon-n'atersupplyw lh
ONLY with the some comrn,csian aharu/mm�enr,you can sahmli one form.
IOa. For All Wells: Submit this farm within 30 days of completion of well
6a.Well ID#: MW-32 abandonment to the following
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 28 (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: 8.25 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Neater level below ground surface: 9.52 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
be.fluter casing length(if known): NA fry) 10c.For Water Supply&lotteries Wells: In addition to sending the form 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
6L Inner casing/tubing length(if known): 13 fry) abandoned.
6g.Screen length(if known): 15 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For,lnhmal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7m.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
4330-B wells abandoned'.
NC Well Contractor Com&mirm Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientists q '�. FOR WATER SUPPLY WELLS ONLY:
Company Name ae a rs 7c.Type of disinfectant used:
2.Well Construction Permit#: NA r r` 7 r�9, 11
List all applicable well consmucam permas(i.e.(I/C Cmor) a�;'Variance,o�tc)adr�' (
�rnCer""� 7d.Amount of disinfectant used:
3.Well use(check well me):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural OMunicipal/Public ❑Neat Cement Grout Ill Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial OResidential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
Chrigation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry @ Other(explain under 7g)
@Monitoring ORecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
OAquifer Recharge OGroundwater Remediation Bentonite Pellets — 50 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
OAquifer Test OStormwater Drainage Concrete — 5lbs
OExperimental Technology OSubsidence Control 7g Provide a brief description of the abandonment procedure:
OCaeothermal(Closed Loop) OTracer Well abandoned in place with hydrated bentonite
OCreothermal (Heating/Cooling Return) OOther(explain under 7 )
pellets to withing 6" of surface and topped with
4.Date well(s)abandoned: 12/15/2022 concrete to existing grade. Well shield put back
Sm.Well location: in place.
NCDEQ-Sawyer's Grocery 0-030022
Facilty/Owner Name Facility lD#(if applicable) 8.Certification:
V.
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Data
Washington NA By signing this form t hereby certify that the well(s) was (were) abandoned in
County Parcel Idene fication No.(PM) accordance with 15A NC4C 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
56.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:
35.866 N -76.725 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 consmucaon mcordW ifom luble. Formultiple overruns orsan-water supply wells
ONLY with the same,a aln aran aham/onoeni,you can suhon one form.
IOa. For All Wells: Submit this form within 30 days of completion of well
62.WeB ID#: M W-33 abandonment to the following.
Division of Water Resources,Information Processing Unit,
6b.Tool well depth: 30 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10h. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 (in) above, also submit one copy of this form within 30 days of completion of Well
abandonment to the following:
6d.Water level below ground surface: 9'22 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length lit known): NA (R) 10c.For Water Supply&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 15 (R) abandoned.
6g.Screen length(if known): 15 ft.)
Form OW-30 North Carolina Deparunent 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
Corey D. Futral 7a.For Geoprobe/DPT or Cloud-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on hivber property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientists _ 1Yu FOR WATER SUPPLY WELLS ONLY:
Company Name
NA 22 7c.Type of disinfectant used:
2.Well Construction Permit A: � L�
Lrst d(uppl¢uh(r well consrrvnion permits(i.e.11/C,C. :f ariam.'e,etc 1 f/u�nsy��
p;!�7 7d.Amount of disinfectant used:
3.Well use(check well use): �:r„g'1-•f, ;�"�'v
Water Supply Well: 7e.Sealing materials used(check all that apply):
DAgricultural OMunicipal/Pubhc ❑Neat Cement Grout III Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial DResidential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
Ohnigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentomte Slurry Il Other(explain under 7g)
IlMonitoring DRecovery
Injection Well: 7L For each material selected above,provide amount of materials used:
❑Aquifer Recharge OGrounlwater Remediation Bentonite Pellets - 50 Ibs
DAquifer Storage and Recovery DSalinity Banner
OAquifer Test OStormwater Drainage Concrete - 5lbs
[]Experimental Technology OSubsidence Control
7g.Provide a brief description of the abandonment procedure:
OGeathermal(Closed Loop) OTmcer Well abandoned in place with hydrated bentonite
OGeothermal(Heating/Cooling Return) 00ther(explain under 7g)
pellets to withing 4" of surface and topped with
4.Date well(s)abandoned: 12/15/2022 concrete to existing grade.
5a.Well location:
NCDEQ-Sawyer's Grocery 0-030022
Facility/tTvner Nara Facility[Do(.fapplicable) 8.Cerocation: ^�
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Lp Signature ofCemfied Well Contractor or Well Owner Date
Washington NA
Br signing this form, !hereby certify that the well/sJ was/were)abandoned in
County Pared Idemnificanon 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 aawer.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficicnp 9.Site diagram or additional well details:
35.866 N -76.725 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 W ELLIS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Alsoch well construction ecord(V fava,Wfe. Formu(tiptem/ecit normm-wuterauppfvwells
ONLI'wuh the same consinmrron ahamlonrnem.ymr can.mhmn one form.
IOa. For All Wells: Submit this form within 30 days of completion of well
fia.Well IDs: MW-34 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 30 (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.
8.25 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the follow"ng.
6d.Water level below ground surface: 7.85 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 10c.For Water Supply&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form Within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casing/tubing length(if known): 15 (ft.) abandoned.
6g.Screen length(if known): 15 (ft)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2.22-2016

WELL ABANDONMENT RECORD For lam ool U.ONLY
L Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7s.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
4330-B wells abandoned:
NC Well Contractor Certification Number y_.. 7b.Approximate volume of water remaining in well(s): (gaL)
CATLIN Engineers and Scientist;Fc7:10Ei'v'E FOR WATER SUPPLY WELLS ONLY:
Company Name 2 2 7e.Type of disinfectant used:
qq
n
2.Well Construction Permit III: NA r r ZULL
List all applkable well con...non persons(i.e.ULC,Coun,,Slow.Vniris-ftrlfffible+�' 7d.Amount Of disinfectant n30d'
IftiJ ^,Yil"1/ OG
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
OAgricultund ❑MunicipabPublic ❑Neat Cement Grout 9 Bentonite Chips or Pellets
OGeothennal(Heating/Cooling Supply) DResidential Water Supply(single) ❑ Sand Cement Grote ❑ Dry Clay
❑industrial/Commercial OResidential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
01ringation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry N Other(explain under 7g)
!!Monitoring ORecovery
Injection Well: 7E For each material selected above,provide amount of materials used:
OAquifer Recharge OGroundwater Remediation Bentonite Pellets — 50 Ibs
❑Aquifer Storage and Recovery OSahnity Banner
DAquifer Test OStormwater Drainage Concrete — 5 Ibs
DExperimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
DGeothermal(Closed Loop) DTracer Well abandoned in place with hydrated bentonite
OGeothermal(Heating/Cooling; Return) OOther(explain under 7g)
pellets to withing 6" of surface and topped with
4.Date well(s)abandoned: 12/15/2022 concrete to existing grade. Well shield put back
SR.Wear location: in place.
NCDEQ-Sawyer's Grocery 0-030022
Fatdity/Owner Name Facility IDa(ifapplicable) S.Certification:� lJ0L444rrLL��// 12/22/2022
1327 US Hwy 64 East, Plymouth, 27962 lJ
Physical Address,City,and Zip SignaNre of Certified Well Contractor or Well Owner Dam
Washington NA
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.0100 Well Construction Standards
and that a copy of this retard has been provided to the well owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one laulong is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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
Altachaellconstruetionrecord(s)(/m ailable. Formultiplemjec"onornon-wmarsupplvwells
ONLY wub the same construction ahandunrnen(you can suhmit one Jorm.
IOa. For All Wells: Submit this form within 30 days of completion of well
Is.Well ID#: MW-35 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 28 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in Loa
6c.Borehole diameter.
8.25 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following.
6d.Water level below ground surface: 8.87 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (fi) 10c.For Water Supply&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form Within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 13 (ft.) abandoned.
6g.Screen length(if known): 15 (ft)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD Few lmerrW Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Conaador Name for well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned.
,^. r'-\ .j 7b.Approximate volume of water remaining in webs al.
NC Well Contractor Cemfication Number _C - , r 'N PP g O'_(gal.)
CATLIN Engineers and Scienti�th �V FOR WATER SUPPLY WELLS ONLY:
Company Name nr r
2.Well Construction Permit 8:
NA 7c.Type of disinfectant used:
Lsr all applmable wr0 cmanucnon permrn(t.e. ULC.C(gs40o .,TpnQ¢'F'.04 tJknown
7d.Amount of disinfectant used:
3.Well use(check well Use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
OAgncultural ❑Municipal/Public ❑Neat Cement Grout S Bentnrttte Chips or Pellets
OCseothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
Olndasbtal/Commercial OResidential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
Ofirrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry In Other(explain under 7g)
SMonitoring ORecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
OAquifer Recharge OGroundwater Remediation Bentonite Pellets - 25 Ibs
❑Aquifer Storage and Recovery OSahnity Barrier
OAquifer Test OStormwater Drainage Concrete - 4000 lbs
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer
OGeothermal(Heating/CoolingReturn) OOther(explain under 7 ) " 0.8' of well removed, remaining well abandoned in
place with hydrated bentonite pellets to top of well.
4.Date well(s)abandoned: 12/13/2022 Vault box concreted in place to existing grade.
So.Well location:
NCDEQ-SaWyer's Grocery 0-030022
Facility/Owner Name Facility IDa(depplicable) 8.Certification: 17 ^'It
1327 US Hwy 64 East, Plymouth, 27962 1�LJ1«lfN���� 12/22/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Washington NA 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 Consinrction Standards
and that a copy of this record bar been provided to the well owner
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field,one let/long is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 W, 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 WELLIS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Atl chvellconstrucnanreconlrslr/o,adable. Formalliple,Neurionornon-wmerstpplvwells
ONLY with the same consarannn ahondonrneni.you can soh m,one form.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDN: SP-1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (It.) 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: 8'25 (in.) above,also submit one copy of this form within 30 days of completion of well
Abandonment to the following.
6d.Water level below ground surface 8.57 1fe) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA /D) l0c.For Witter Supply&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 5 (R) abandoned.
6g.Screen length(if known): 10 (ft)
Farm G W-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
Corey D. Futral 7s.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner penomlly abandoman,well on his/her property) well ctmstruclion/depth,only I G W-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned:
NC Well Contractor Cenifietiumi Number 71L Approximate volume of water remaining in weB(s): (gaL)
CATLIN Engineers and Scientists r . FOR WATER SUPPLY WELLS ONLY:
Company Name !�
C '�tv ( 7a.Type of disinfectant used:
2.Well Construction Permit it: NA 4 9 902L
Lrsr u!l applkuble xe(l consnucaan pmmits(i.e.(I/C,Couotr,M bdand,.e/rfbmwn
3.Well use(check well use): ,�,,,�?!:%fir'••r
Ul{A 7d.Amount of disinfectant used:
Water Supply Well: ' ri•' ' 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipamblic ❑Neat Cement Grout Ill Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑htdustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
Ellnigatuoin ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry III Other(explain under 7g)
eMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Caoundwater Remediation Bentonite Pellets — 25 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
71Aquifer Test ❑Stirmwater Drainage Concrete — 4000 Ibs
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Imp) ❑Tracer
❑Geothermal(Heatin Coolie Return) ❑Other(explain under7g) •`t).8' of well removed, remaining well abandoned in
place with hydrated bentonite pellets to top of well.
a.Datewell(s)abandoned: 12/13/2022 Vault box concreted in place to existing grade.
Sa.Well location:
NCDEQ-Sawyer's Grocery 0-030022
Facihty,Ownwr Name Fuihty ID-0fapplicable) 8.Certification: V�
1327 US Hwy 64 East, Plymouth, 27962 V 12/22/2022
Physical Address,City,and Zip Signature of Cerofied Well Contractor or Well Owner Data
Washington NA By signing this form, I hereby terrify that the wells) was(were)abandoned in
County Parcel Idemificatron 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.
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field,one Iatdong is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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 xe!/construction recorrl/sl dmuilublr. Formuluplr ryenion ornon-xmersupp(v xe/lr
ONLY with the same con.rrnmrmn ahoadonmem,you can.n,hmrr one form.
Ills. For All Wells: Submit this form within 30 days of completion of well
6a.WeB IDN: SP-2 abandonment to the following.
Division of Water Resources,Information Processing Unit,
61L.total well dep(h: 15 (R-) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
be.Borehole diameter: 8.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following.
6d.Water level below ground surface: 8.90 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (B) 10c.For Water Supply&[election 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
61.Inner casing/tubing length(if known): 5 (B) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For low=]Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Connaaor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I G W-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned.
NC Well Contractor Certification Number i 7b.Approximate volume of water remaining in well(s): (gaL)
CATLIN Engineers and Scientists �yt~r y FOR WATER SUPPLY WELLS ONLY:
f 2 20'E�
Company Name
7c.Type of disinfectant used:
2.WellConstruction Permit M: NA
(wsrul(apphuahle well.1ritnonpersurslire.1/IC,Cowory.$Imtr.ka(a(7ree;r krwwn
3.Well use(checkweB use):
1m°�,��l70(34 7d.Amount of disinfectant used:
Water Supply Well: 7e.Seating materials used(check all that apply):
❑Agricultural OMunicipal/Public ❑Neat Cement Grout 11 Bentonite Chips or Pellets
[]Geothermal(Heating/Cooling Supply) []Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
Olndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
0hrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry Ill Other(explain under 7g)
eMonitoring []Recovery
Injection Well: 711.For each material selected above,provide amount of materials used:
[]Aquifer Recharge OGroundwater Remediation Bentonite Pellets — 25 lbs
[]Aquifer Storage and Recovery []Salinity Bamer
[]Aquifer Test OStormwater Drainage Concrete —4000 Ibis
❑Experimental Technology []Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) []Tracer
[]Geothermal(Heating/CoolingRehm) OOBrer(explain under 7g) " 1' of well removed, remaining well abandoned in
place with hydrated bentonite pellets to top of well.
4.Date well(s)abandoned: 12/13/2022 Vault box concreted in place to existing grade.
5a.Well location:
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owner Name Facility IDa(ifapplwable) B•Certifitation: �
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Sigum:ofCenified Well Ccu actor or Well Owner Date
Washington NA
By signing this form, I hereby certify that the wells) was (were)abandoned in
Canary Parcel IdeNificruirn No.(PIN) accordance with/SA 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 latnong is sufficient) 9.Site diagram or additional well details:
35.666 N -76.725 µ, 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
Anach we/l construction rcaordtrl jmailable Formuhiple mjenron or rron-wulersupp(v weltr
BNLf wnM1 the some com/mmm�aham/anrnenL You can.mhaa1 ore f rm.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDd: SP-3 abandonment to the following.
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Intection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following
6d.Water level below ground surface: 9.46 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (R) 10c.For Water Supply&Intection 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 casingAubing length(if known): 5 (R) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-12-2016

WELL ABANDONMENT RECORD For Interim]Use ONLY:
1.Well Contractor Information: R'ELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Commerce Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned.
NC Well Contractor Certification Number 7b.Approaimate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientist3 ` 'tWr t._ l _ FOR WATER SUPPLY WELLS ONLY:
Company Name n y b q 2022 7<.Type of disinfectant used:
2.Well Construction Permit 8: NA
J_r �
List u!(upph.ble well construcaoa permae(re,111C,CoffWc ari(oj2{;vys f'.
bA,'CISOG 7d.Amount of disinfectant used:
3.Well use(check well on):
Water Supply Well: 7e.Sealing materials used(check all that apply):
ElAgricultural OMunicipaltPublic ❑ Neat Cement Grout III Bentonite Chips or Pellets
Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial OResidental Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
Obligation ❑ Specialty Grout O Gravel
Non-Water Supply Well: ❑ Bentonite Slurry S Other(explain under 7g)
SMonitoring ORecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
[]Aquifer Recharge []Groundwater Remediation Bentonite Pellets — 25 lbs
OAquifer Storage and Recovery OSalinity Banner
DAquifer Test OStormwater Drainage Concrete —40001bs
OExperimenlal Technology []Subsidence Control 7g.Provide a brief description of the abandonment procedure:
[]Geothermal(Closed loop) OTracer
0.$' of well removed, remaining well abandoned in
[]Geothermal Heating/Conlin Return) []Other(ex lain under 7g)
place with hydrated bentonite pellets to top of well.
4.Date well(s)abandoned: 12/13/2022 Vault box concreted in place to existing grade.
5s.Well location:
NCDEQ-Sawyers Grocery 0-030022
Facility/Owner Name Facility lD4(if applicable) 8.Certification: �
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and hp Signature of Certified Well Contractor er Well Owner Date
Washington NA By signing this form, I hereby certify that the well(s)was(were)abandoned in
Corny Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0/00 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field one lat/long is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 N 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 WELLIS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Atmd well conmrvcnon record/r)Juvuilable. f'ormuh p/e m�ecnon or ton-wolersupply we!!s
!)h'L)'with the some caralrucliun a6mWonment.ymt can.mhmu one/onto.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDk: SP-4 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.ToW w ell depth: 15 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For Infection Wells: In addition to sending the form to the address in l0a
6c.Borehole diameter.
$.25 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following.
6d.Water level below ground surface: 9.11 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer easing length(if(mown): NA (D) 10c.For Water Supply&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casing/tubing length(if know n): 5 (R) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22.2016

WELL ABANDONMENT RECORD For lateral Use ONLY
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7s.For Geoprobe/DPr or Closed-Loop Geothermal Wells having the same
Well Contractor Nam(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gaL)
CATLIN Engineers and Scientists FOR WAT:disinfectant
UPPLY WELLS ONLY:
Company Name [' ... r 7e.Type of used:
2.Well Construction Permit#: NA
Dr,allopphaable well contou,ums permas ide.111C,Covnp a ,C a awnIJ� 7d.Amouoisinfectant used:
3.Well use(check well use): ,._.v?r 'i'
Water Supply Well; - ri`,• 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout a Bentonite 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
01ringation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentontte Slurry Ig Other(explain under 7g)
eMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
OAquifer Recharge OGroundwiter Remediation Bentonite Pellets — 25 lbs
OAquifer Storage and Recovery ❑Salinity Banter
OAquifer Test ❑Stormwater Drainage Concrete —4000 lbs
OExperimental Technology []Subsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) CTracer -- 1r of well removed, remaining well abandoned in
OCreothermal(Heating/CoolingReturn) OOther(explain under 7g)
place with hydrated bentonite pellets to top of well.
a.Date well(s)abandoned: 12/13/2022
Vault box concreted in place to existing grade.
5a.Well location:
NCDEQ-Sawyers Grocery 0-030022
Facility/Owner Name F.Aity IDk(ifapplicable) S.Certification: —/^T'f /
1327 US Hwy 64 East, Plymouth, 27962Vflf��� 12/22/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Washington NA By signing this farm, I hereby certify that the wells) was(were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0/00 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
56.Latitude and longitude in degrees/miuules/seconds or decimal degrees:
(if well field,one lat4ong is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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 aellconstruction recordis)ifawslable. Formultiple injection or iron-water.srypply wells
ONLY with the same co otrucimn abate mnent.ym,can sahmlt one farm.
10a. For All Wells: Submit this farm within 30 days of completion of well
6a.Well ID#: SP-5 abandonment to the following
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft.) 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: 8.25 (in) above, also submit one copy of this forth Within 30 days of completion of well
abandonment to the following:
lid.Water level below ground surface: 9.64 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 10c.For Water Supply At lniectioo 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
6t Inner casing/tubing length(if known): 5 (ry) abandoned.
6g.Screen length(if known): 10 Ift.)
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
Corey D. Futral 7s.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the scone
Well Contractor Name(or well owner personally abandoning well on his/her property) well etmstrnetion/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned
f r`y :
NC WellContractor Certification Number y.; 'Y;,ti.�l li^' SM qqq 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientists prf 2 2QLL 1 FOR WATER SUPPLY WELLS ONLY:
Company Name —15C 7c Type of disinfectant used:
-1 i
2.Well Construction Permit p: NA cP..• �!�'
Lost all applicable well cimsrrucaon permits(i.e.(/IC,Coun,,Stall,f"ar ante,etc)iflatown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Seating materials used(check all that apply):
DAgricultural OMunicipatlPublic ❑ Neat Cement Grout III Bemonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) []Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑lndustrial/Commercial []Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
Olin lion ❑Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry III Other(explain under 7g)
■Monitoring []Recovery
Injection Well: 7L For each material selected above,provide amount of materials used:
[]Aquifer Recharge OGroundwater Remediation Bentonite Pellets — 25 Ibis
OAquifm Storage and Recovery []Salinity,Barrier
[]Aquifer Test OStormwater Drainage Concrete — 4000 Ibs
❑Experimental Technology OSubsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) []Tracer OGeothermal(Heating/Cooling Return) OOther(explain under7 ) — , of well removed, remaining well abandoned in
place with hydrated bentonite pellets to top of well.
4.Date well(s)abandoned: 12/13/2022
Vault box concreted in place to existing grade.
Sa.well location:
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owner Name Facility ID#(if applicable) S.Certification:
1327 US Hwy 64 East, Plymouth, 27962 12�22�2p22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Washington NA By signing this form, I hereby certfy that the well(s) was (were) abandoned in
County Parcel Idernification No.(PIN) accordance with 15A NCAC 01C.0100 or 2C.0100 Well Construction Standards
and that a copy of this record has been provided to the well owner
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one Isola,u suf Scan) 9.Site diagram or additional well details:
35.866 N -76.725 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
Aumhwellcomtm tionrecord(s)fmailable.Formultiple injection or non-watersuppfv wells
ONLY with the same corurra ma,ahandomacm you aow mbmit one form.
His. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDk: SP-6 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter. 8.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 9.49 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 10c.For Water Supply&Injection Wells; In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 5 (D) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Interest Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 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.
4330-B a.i
NC Well Contractor Cenification Number �Cr t x] 1-ib.Approximate volume of water remaining in well(s): (gat.)
r r
CATLIN Engineers and Scientists ` '" , on2l FORWATERSUPPLY WELLS ONLY:
Company Name n_ l
�\ TE7 Type of disinfectant used:
r,, pr'J'�'•
2.Well Construction Permit q: NA ^-
L.,all applicable well mmaoct rr permus(i.e.111C,,Countyt\ .'lbria(�A,.,'eW'1' nown
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 N Bentonite Chips or Pellets
DGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Groin ❑ Dry Clay
❑Industrial/Commercial DResidential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
Olrngation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry a Other(explain under 7g)
SMonitoring ORecovery
Injection Well: 711 For each material selected above,provide amount of materials used:
OAquifer Recharge DGroundwater Remediation Bentonite Pellets — 25 Ibs
OAquifer Storage and Recovery OSalinity Barrier
OAquifer Test OStormwater Drainage
Concrete — 40001bs
DExperimental Technology OSubsidence Control 7g,Provide a brief description of the abandonment procedure:
DGeothermal(Closed Loop) OTmcer
OGeothermal(Hemin Conlin Return) OOther(explain under7 ) 'r 0.8' of well removed, remaining well abandoned in
place with hydrated bentonite pellets to top of well.
4.Date well(s)abandoned: 12/13/2022 Vault box concreted in place to existing grade.
5a.Well location:
NCDEQ-Sawyers Grocery 0-030022
Facility/Owner Name Facility]DO(if applicable) g.Certification: ✓�(
1327 US Hwy 64 East, Plymouth, 27962 IJ 12/22/2022
Physical Address,City,and Zip Signature of Carolled Well Contractor or Well Owner Dare
Washington NA 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 Construcron 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:
35.866 N -76.725 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
Anmhwellcorulructionrecord(s)rif~table.Formulaple injection ornon-matersapply wells
ONLY wish the.same construction ahamlonsnen(you can sohmit one form.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDA: SP-7 abandonment to the following.
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form in the address in 10a
6c.Borehole diameter: 8.25 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
bd.Water level below ground surface: 9'1 3 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-I636
6e.Outer casing length(if known): NA (ft) lee.For Water Supply At lidecton Wells: In addition in sending the form in 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
61.Inner casing/tubing length(if known): 5 (ft.) abandoned.
IF Screen length(if knownl: 10 (ft.)
Form GW-30 North Carolina Deparnnent of Environmental Quality-Division of Water Resources Revised 2.22-2016

WELL ABANDONMENT RECORD For Internal On ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on huther property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4330-B N: f hi wells abandoned.
NC Well Contractor Certification Number T�4`�'�`' 7R Approximate volume of water remaining in well(s):_(gal.)
e 2022
CATLIN Engineers and Scientists nCf 2 � FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: NA
Lirt all applicable well construction perm a ti.e.WC,Canty.Slaty, ;"'riance,ele:)i/known
7d.Amount of disinfectant used:
3.Well use(check well an):
Water Supply Well: 7e.Sealing materials used(check all that apply):
OAgnculmral OMunicipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets
OCseothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
Olrrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry Ill Other(explain under 7g)
!'Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
DAquifer Recharge IlGroundwater Remediation Bentonite Pellets — 25 lbs
DAquifer Storage and Recovery OSalinity Barrier
DAquifer Test ❑Stormwater Drainage Concrete —4000 lbs
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
OCseothermal(Closed Loop) OTracer
OGeothermal(Heating/Coolin Return) OOther(explain under7 ) 0.8' of well removed, remaining well abandoned in
place with hydrated bentonite pellets to top of well.
4.Date well(s)abandoned: 12/1 3/2022
Vault box concreted in place to existing grade.
58.Well location:
NCDEQ-Sawyer's Grocery 0-030022
Fwiity/Owner Name Facility ID#(if applicable) S.Certification:
1327 US Hwy 64 East, Plymouth, 27962 �2�22�2p22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Dare
Washington NA By signing this form. I hereby terrify that the wellisj was fa-ere) abandoned in
County Parcel Ideraification No(PIN) accordance with I5A NCAC 02C.0/00 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well turner
56.Latitude and longitude is degreeslminules/seconds or decimal degrees:
(if well field,one letting is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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
Anachwellc m,rucrionmcardlr/ff v table. Formultiple injection or non-watersapply welly
ONLY with the same conrwetum abawknrn ta,you can submit one form.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: SP-8 abandonment to the following
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (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: 8.25 (in) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 9.26 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (D) 10c.For Water Supply&lnjection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 5 (R) abandoned.
6g.Screen length(if known): 10 ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD Far hocand Use ONLY
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 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
4330-B
wells abandoned.
,.�\--a
NC Well Contractor Certification Number ,i'' `' 1�'' 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientjs . a q FOR WATER SUPPLY WELLS ONLY:
Company Name 1 1 s q b
nc(' Y �VP� 7e Type of disinfectant used:
2.Well Construction Permit k: NA
Liv all applicahle well canvrucoan permits(ix.1/1C,Cmmot State,iartArk awn
tJ�l 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
[]Agricultural OMunicipal/Public ❑Neat Cement Grout Ill Bemmonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) (]Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑lndtmtrial/Commercial []Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
LlIrrigation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry III Other(explain under 7g)
IlMonitoring ORecovery
Injection Well: 7E For each material selected above,provide amount of materials used:
[]Aquifer Recharge []Groundwater Remediation Bentonite Pellets — 25 lbs
OAquifer Storage and Recovery []Salinity Barrier
[]Aquifer Test OStonnwater Drainage Concrete --4000 Ibs
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer
(Heating/CoolingOGeothermal Return) OOther(explain under7 ) " 1, of well removed, remaining well abandoned in
place with hydrated bentonite pellets to top of well.
4.Datewell(s)abandoned: 12/14/2022 Vault box concreted in place to existing grade.
5a.Well location:
NCDEQ-Sawyer's Grocery 0-030022
Facility/Owner Name Facility IDh(if applicable) S.Certification:
1327 US Hwy 64 East, Plymouth, 27962 1�LJ)144MM����� 12/22/2022
Physical Address,City,and Zip Signature of Certified Well Contractor o,Well Owner Date
Washington NA
By signing this farm, 1 hereby certify that The well(s) was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
Sb.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:
35.866 N -76.725 N 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(SI BEING ABANDONED SUBMITTAL INSTRUCTIONS
Atlmch well consnunron recorrt/s/Jwui(uhle.Formubiple lnjee'aon ninon-xmer supply wells
ONLY with the same construction ahand nrnent,you can suhmit one Jorm.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.We61D0: SP-9 abandonment to the following.
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 fin.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 9.31 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (R) 10c.For Water Supply&Infection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
611 Inner casing/tubing length(if known): 5 (ft.) abandoned.
6g.Screen length(if known): 10 (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
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on ho her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned.
NC Well Contractor Certification Number s t" 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scien • s + it FORWATER SUPPLYWELLSONLY:
Company Name q r1
(. 7e Type of disinfectant used:
2.Well Construction Permit 0: NA or_-• .' 2
Lai al!appGcuble well consI.,noo permas tie.111C,County,&atr,f�r�< iJ known
• � 7d.Amount of disinfectant used:
3.Well use(check well use): I)tw �ae;p:'
Water Supply Well: 7e.Seating materials used(check all that apply):
[]Agricultural OMunicipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets
[]Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial OResidential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
Obingation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry Ill Other(explain under 7g)
IlMonitoring 011ecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
[]Aquifer Recharge []Groundwater Remedimion Bentonite Pellets — 25 Ibs
[]Aquifer Storage and Recovery OSalinity Banner
Concrete —40001bs
[]Aquifer Test OStorma wter Drainage
OExperimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) []Tracer — 8" of well removed, remaining well abandoned in
OCreothermal (Heating/Cooling Rehm) []Other(explain under 7g)
place with hydrated bentonite pellets to top of well.
4.Datewell(s)abandoned: 12/14/2022 Vault box concreted in place to existing grade.
5s.Well location:
NCDEQ-Sawyees Grocery 0-030022
Facility/Owner Name Facility[DO(if applicable) S.t ertification: �
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Washington NA By signing this form, 1 hereby certify that the well(s) was(were)abandoned in
County Parccl 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.
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one lat/Iong is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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
Anuch well construction recoN(sJ Juvuiluble. For multiple mjectian or rmn-xasersupply wells
ONLY with the same construction ahandomnem,you canxubmir oneform. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDd: S P-10 abandonment to the following.
Division of Water Resources,Information Processing Unit,
66.Total well depth: 15 Ifs) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For tntecfion Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
fill.Water level below ground surface: 9.38 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA Ifs) 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
6L Inner casing/tubing length(if known): 5 (ft.) abandoned
6g.Screen length(if known): 10 (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
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contactor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned.
NC Well Contractor Ccmficabon Number 3 9 '—, 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientists,NA -_
^ et 5J FOR WATER SUPPLY WELLS ONLY:
r .
Company Name Y'E`..� �O^'1
l.L
2.Well Construction Permit 0: C` 7e Type of disinfectant used:p
List all L"Itcable we//c Iruramn permits(i.e.111C.County.Stlde,Foramen,;tc
7d.Amount of disinfectant used:
3.Well ase(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
OAgricultural OMunicipdVPublic ❑Neat Cement Grout O Bentonite Chips or Pellets
OGeothermal(Heating/Co fling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial OResidential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
11fingation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonile Slurry a Other(explain under 7g)
IlMonitming ORecovery
Injection Well: 7L For each material selected above,provide amount of materials used:
OAquifer Recharge OGroundwater Remediation Bentonite Pellets — 75 lbs
OAquifer Storage and Recovery OSalmity Barrier
OAquifer Test OStornwater Drainage Concrete — 5Ibs
OExperimental Technology ❑Subsidence Control
7g.Provide n brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTmcer
` 4" of well removed, remaining well abandoned
OGeothermal(Heatin Conlin Return) OOther(explain under7 )
in place with hydrated bentonite pellets to within
4.Date well(s)abandoned: 12/13/2022 6 inches of surface and topped with concrete to
52.Well location: existing grade.
NCDEO-Sawyers Grocery 0-030022
Facility/Owner Name Facility IDN ofapplicable) S.Certification:
1327 US Hwy 64 East, Plymouth, 27962 12/22/2022
Phy.iul Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Washington NA
By signing this farm. I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with I5A 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 laulong is sufficient) 9.Site diagram or additional well details:
35.866 N -76.725 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 weft camtrucaon recardlrl(Im'mluhle. Formu/npfe mlernan tar non-watrrsuppfy wells
ONLY with the same comm¢non ohoml mmem.you ran.mhmo one farm.
IOa. For All Wells: Submit this form within 30 does of completion of well
6a.Well ID0: VE-4 abandonment to the following.
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 13 (fL) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in Ills
6c.Borehole diameter: 10.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 9.37 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (D) 10c.For Witter Supply&lnieetion Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 3 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Farm GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2.22-2016

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Monitoring Well (DMW-30 F�
(Type II) .- Js�
® Abandoned Monitoring
Well (Type II)
® Destroyed Monitoring r` ^t
Well (Type II)
Abandoned Monitoring
Well (Type III)
Active Non-Potable MWA7 t
Water Supply Well (CNL)
° Inactive Potable L, '. .
Water Supply Well •
Approximate Location r.
of Former UST Basin
Parcel Boundary
a c a d Use Co nib
NOTES:
1.Well and UST locations were obtained from previous 180 90 0 180 360
reports prepared by other consultants and are approximate. Feet
2. CNL=Could Not Locate
ERWKT ME FIGURE
CATLIN SAWYER'S GROCERY SITE MAP—
1327 US HWY 64 E EXTENT OF MONITORING WELLS
PLYMOUTH, NC
Engineers and Scientists
t:GOalT NO. .108 N0. WiE SOME p.AXN BM�Cmo By IGACI
12442 221264 DEC 2022 AS SHOWN IOMCISJO