Durham_Well Abandonment_20240212

WELL ABANDONMENT RECORD For Internal Use ONLY:
•
1.Well Contractor Information: WELL ABANDONMENT DETAILS(
Nathaniel Newman 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
4630C wells abandoned: i
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#: '
List all applicable well construction permits(i.e.U/C,County,State,Variance,etc.)if known i
7d.Amount of disinfectant used: •
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout II Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry IN Other(explain under 7g)
IMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 16.67 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier t
❑Aquifer Test ❑Stormwater Drainage Concrete 16.67 lbs
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Hydrated bentonite used to fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024
bring opening to grade.
5a.Well location:
Barbara "Genia" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification: ;
601 Foster Street, Durham, NC 27701 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form. I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.01,00 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.002181 N -78.901839 W You may use the back of this page io provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply wells
ONLY with the same co,,str uctiomabandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: AS-1 abandonment to the following: i
Division of Water Resources,Information Processing Unit,
6b.Total well depth 13 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
I; .
6d.Water level below ground surface: 5.90 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I,
NA 10c.For Water Supply&Injection Wells: In addition to sending the form to the
6e.Outer casing length(if known): (ft.)
address(es)above,also submit one copy Eof this form within 30 days of completion
of well abandonment to the county I health department of the county where
6f.Inner casing/tubing length(if known): Unknown (ft.)
abandoned. �"y ;, � �
��v�`Crpp`�/' t
6g.Screen length(if known): Unknown (ft.) FEB 2 20�4
I
I71Ca,.iPS1 Prt3;
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources j t�e��' $3R vised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS1
Nathaniel Newman 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
4630C wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining aining in well(s): (gal.)
CATLIN Engineers and Scientists 'FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout • Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout • ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: ❑ Bentonite Slurry •Other(explain under 7g)
•Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 16.67 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Concrete 16.671bs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
Hydrated bentonite used to fill to -6 inches below
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024 bring opening to grade.
•
5a.Well location:
Barbara "Genic" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
601 Foster Street, Durham, NC 27701
2/2/2024 .---
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, 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.
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:
36.002181 N -78.901839 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 I
Attach Well construction record(s)ifavailable. For multiple injection or non-water supply wells ,
ONLY with the same construction/abandonment,you can submit one form.
10a. For,All Wells: Submit this form within 30 days of completion of well
6a.Well ID#• AS-OW-1 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 Injection 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!form within 30 days of completion of well
abandonment to the following:
i
6d.Water level below ground surface: 5.82 (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): UnKnOWn (ft) abandoned.
CI
fig.Screen length(if known): Unknown (ft.)
FEB ,'1 2 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Watotr nzehriez=n1 pror. unit Revised 2-22-2016
blitcytoo
1

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathaniel Newman 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
4630C wells abandoned: 1
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#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout • Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry R Other(explain under 7g)
•Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 16.67 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Concrete 16.671bs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the'abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Hydrated bentonite used to fill to -6 inches below
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024 bring opening to grade.
5a.Well location:
Barbara "Genic" Smith
Facility/Owner Name' Facility ID#(if applicable) 8.Certification:
601 Foster Street, Durham, NC 27701 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, 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.
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:
36.002181 N -78.901839 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 i
Attach well construction record(s)if available. For multiple injection or non-water supply wells i
ONLY with the sante construction abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: AS-OW-2 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 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 5.88 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Ce;ter,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 ti .county,.he department of the county where
g/ g length ) Unknown ( ) abandoned, et . ° _. ' j-„a /j` 1
6f.Inner casing/tubing (if known): ft. 1( L�i.i
Unknown FEB 'i 2 2024
6g.Screen length(if known): (ft.) I I
hiform4.i?ill PrricasoiN um
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
I

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathaniel Newman • 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 its needed. Indicate TOTAL NUMBER of
wells abandoned: I
4630C
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLI N Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: I
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout i' • Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irrigation ❑Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry • Other(explain under 7g)
•Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite ; . 50 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
Concrete 16.67 lbs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer
Hydrated bentonite used to fill to -6 inches below
❑Geothermal(Heating/Cooling Retum) ❑Other(explain under 7g)
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024 bring opening to grade.
5a.Well location:
i
Barbara "Genic" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification: � �yiiL"(/
601 Foster Street, Durham, NC 27701 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, 1 hereby certify that the well(s) was(were) abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/Iong is sufficient) i
9.Site diagram or additional well details:
36.002181 N -78.901839 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
i
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED
SUBMITTAL INSTRUCTIONS
Attach well construction record(s)([available.For multiple iple injection or non-w atersupply wells
ONLY with the same construclion'abandonment,you can submit one form. i.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 34 (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: I ,
i
a
6d.Water level below ground surface 16.26 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center;Raleigh,NC 27699-1636
NA IOc.For Water Supply&Injection Wells: In addition to sending the form to the
6e.Outer casing length(if known): (ft.)
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county�.,health department of the county where
abandoned. "�
6f.Inner casing/tubing length(if known): 4 (ft.) 6 , + ,,s
30
6g.Screen length(if known): (ft.) FEB 1 2 2024
htfer en,:err..:
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources „ be d�� Revised 2-22-2016
1

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS 1
Nathaniel Newman 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 deeded. Indicate TOTAL NUMBER of
4630C 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#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout ' II Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry • Other(explain under 7g)
•Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 25 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Concrete 16.67Ibs
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Retum) ❑Other(explain under 7g) Hydrated bentonite used.to fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024
bring opening to grade.
5a.Well location:
Barbara "Genic" Smith
Facility/Owner Name Facility ID#(if applicable) S.Certification: mcbtaL ' ��/ �A601 Foster Street, Durham, NC 27701 /l L"[ 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, I hereby certl6 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: t,
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.002181 N -78.901839 W You may use the back of this page to iprovide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable. For multiple injection or non-water supply weirs
ONLY with the same construction'abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID# Mw-2 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 form within 30 days of completion of well
abandonment to the following:
{
6d.Water level below ground surface 4.75 (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&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): 3 (ft.) abandoned.
6g.Screen length(if known): 12 (ft.) ; FEB 1 2 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Water ResourcesITIOWf7ltiiif it Pr"✓avigPyr Wed 2-22-2016
MICA OG

WELL ABANDONMENT RECORD For Internal Use ONLY:
•
1.Well Contractor Information: WELL ABANDONMENT DETAILS '
Nathaniel Newman 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:
4630C
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#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout 0 Dry Clay
0 Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irrigation 0 Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry C Other(explain under 7g)
IMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite 16.67 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Concrete •
81bs
•
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Hydrated bentonite used to fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024 bring opening to grade. '
5a.Well location:
Barbara "Genia" Smith ,
Facility/Owner Name Facility ID#(if applicable) 8.Certification: �%lG%�` O
601 Foster Street, Durham, NC 27701 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, I hereby certify'that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.002181 N -78.901839 You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply wells
ONLY with the same construction;abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-3 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 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 forrit within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 6.38 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
NA 10c.For Water Supply&Injection Wells: In addition to sending the form to the
6e.Outer casing length(if known): (ft.)
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county!.health department of the county where
6f.Inner casing/tubing length(if known): 3 (ft.) abandoned.
CIVC
6g.Screen length(if known): 1 1 (ft.) F EB I 2 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resottr a tg Unaevised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS!
Nathaniel Newman
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
4630C wells abandoned: i
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 j'
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc)if known I. '
7d.Amount of disinfectant used: I ,
3.Well use(check well use): 3
I
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout + • Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout i ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 1 0 Drill Cuttings
❑Irrigation 0 Specialty Grout j 0 Gravel
Non-Water Supply Well: ❑ Bentonite Slurry •Other(explain under 7g)
•Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 16.67 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Concrete 10Ibs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Hydrated bentonite used t0 fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024
bring opening to grade. i ,
5a.Well location:
Barbara "Genic" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
601 Foster Street, Durham, NC 27701 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, I hereby certify'that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: j
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.002181 N -78.901839 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
i
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS i
Attach well construction record(s)if available. For multiple injection or non-water supply wells ,
ONLY with the same construction.'abandonment,you can submit one form.
10a. For All Wells: Submit this form,within 30 days of completion of well
6a.Well ID#: MW-4 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 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:
i
6d.Water level below ground surface: 16.26 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,lRaleigh,NC 27699-1636
NA 1Oc.For Water Supply&Injection Wells: In addition to sending the form to the
6e.Outer casing length(if known): (ft.)
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county{6{health department of the county where
abandoned. I
6f.Inner casing/tubing length(if known): 3 (ft.) ,
6g.Screen length(if known): 1 1 (ft.)
F03 i 2 2024
I
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Reht UTALGye,a Pr . Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathaniel Newman • 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
4630C
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#:
List all applicable well construction permits(i.e.U/C,County,State,Variance,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
[Agricultural ❑Municipal/Public 0 Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
0 Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry a Other(explain under 7g)
IMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 45 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Concrete 16.671bs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Hydrated bentonite used to fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024 bring opening to grade.
5a.Well location:
Barbara "Genic" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
601 Foster Street, Durham, NC 27701 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, 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.
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:
36.002181 N -78.901839 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 constructionrecord(s)ifavailable. For multiple injection or non-water supply wells
ONLY with the same construciion'abandonnrent,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-5 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth 26 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection 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 form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface 5.71 (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): 11 (ft.) abandoned.
6g.Screen length(if known): 15 (ft.) FEB1. 2OZA
CD !r `t
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resource lrajeil 791T440,6yp;kikifDed 2-22-2016
i DWCYBOG

WELL ABANDONMENT RECORD Forintemal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathaniel Newman 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-3 0 is needed. Indicate TOTAL NUMBER of
4630C 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 ONL Y:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.U/C,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: _
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout 0 Dry Clay
0 Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑Irrigation _ ElSpecialty Grout 1 0 Gravel
Non-Water Supply Well: ❑Bentonite Slurry I Other(explain under 7g)
IMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 100 lbs
['Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Concrete 16.67 lbs
DExperimental Technology ❑Subsidence Control •
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Hydrated Bentonite used Ito fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Datewell(s)abandoned: 1/31/2024 bring opening to grade.
5a.Well location:
Barbara "Genic" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
601 Foster Street, Durham, NC 27701 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with I5A NCAC 02C.01001 or 2C.0200 Well Construction Standards
and,that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.002181 N -78.901839 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS •
Attach well construction record(s)ifavailable. For multiple injection or non-water supply wells
ONLY with the same construction•abandotmtent,you can submit one form.
10a. For All Wells: Submit this forM within 30 days of completion of well
6a.Well ID#: MW-6D abandonment to the following: . '
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 60 (ft.) 1617 Mail Service Centel.,Raleigh,NC 27699-1617
1,
• 10b.For Infection Wells: In additionito 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:
I .
28.27 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.)
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 34.5 (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): 55 (ft) abandoned. ['^y ,sI P M1
5
U I
6g.Screen length(if known): - (ft.) FE8 ,2 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Wat109/3!ftriliM PlP.a74141 y f Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY: '
1.Well Contractor Information: WELL ABANDONMENT DETAILSI
Nathaniel Newman 7a.For Geoprobe/DPT or Closed-Lo Ip 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
4630C wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining aining in well(s): (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name '
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout a Bentonite Chips s or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 1 0 Drill Cuttings
❑Irrigation 0 Specialty Grout ❑ Gravel
Non-Water Supply Well: 0 Bentonite Slurry II Other(explain under 7g)
(Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite 40 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Concrete . 16.671bs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer I
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Hydrated bentonite used;to fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024
bring opening to grade. I.
5a.Well location:
Barbara "Genia" Smith
I.
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
601 Foster Street, Durham, NC 27701 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100'or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one IaUlong is sufficient) 9.Site diagram or additional well details:
36.002181 N -78.901839 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable. For multiple injection or non-water supply wells
ONLY with the same construction abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-7 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 l0a
6c.Borehole diameter 8.25 (in) above, also submit one copy of this Rim within 30 days of completion of well
abandonment to the following:
10.45 Division of Water Resources,Undelrground Injection Control Program,
6d.Water level below ground surface: (ft.)
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 copyi of this form within 30 days of completion
of well abandonment to the county health department of the county where
1 0 abandoned.
6f.Inner casing/tubing length(if known): (ft.)
E> Ea
6g.Screen length(if known): 15 (ft.) FEB 12 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resttek°�" F3 Pr=zooktil UM Revised 2-22-2016
1 D*GissOG

WELL ABANDONMENT RECORD For Internal Use ONLY: i •
,
,
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathaniel Newman 7a.For Geoprobe/DPT or Closed-Lo Ip 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
4630C wells abandoned: 1 '
NC Well Contractor Certification Number 7b.Approximate volume of water re raining in well(s): (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.U/C,County,State,Variance,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout • 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 0 Drill Cuttings
❑Irrigation 0 Specialty Grout ! ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry • I Other(explain under 7g)
•Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 40 lbs
❑Aquifer Storage and Recovery ❑Sal inity Barrier
❑Aquifer Test ❑StormwaterDrainage Concrete 16.67Ibs
❑Experimental Technology ❑Subsidence Control ,
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Hydrated bentonite used,to fill to -6 inches below
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024 bring opening to grade. j
5a.Well location:
Barbara "Genic" Smith '
Facility/Owner Name Facility ID#(if applicable) 8.Certification: ��i�`�� �
601 Foster Street, Durham, NC 27701 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.002181 N -78.901839 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED
SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply wells
ONLY with the same construction'abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW 8 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 22 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition,to sending the form to the address in 10a
above, also submit one copyof this form within 30 days of completion of well
6c.Borehole diameter: 8.25 (in.) 1
abandonment to the following:
I' '
6d.Water level below ground surface 6.95 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
i,
NA 10c.For Water Supply&Injection Wells: In addition to sending the form to the
6e.Outer casing length(if known): (ft.)
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 7 (ft.) abandoned.
6g.Screen length(if known): (ft.)
FEB 2 2 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Rcsourceslt �,•1 t-tG^�?� R Revised 2-22-2016

WELL ABANDONMENT RECORD Forintemal Use ONLY: I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathaniel Newman 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
4630C wells abandoned: I
NC Well Contractor Certification Number 7b.Approximate volume of water re i aining in well(s):_ (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name •
7c.Type of disinfectant used: . .
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout C Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout 0 Dry Clay
0 Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout 0 Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: 0 Bentonite Slurry a Other(explain under 7g)
UMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 16.67 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Concrete 10Ibs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer I
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Hydrated bentonite usedjto fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024
bring opening to grade. '
5a.Well location:
Barbara "Genic" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
601 Foster Street, Durham, NC 27701 2/2/2024
•
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form. I hereby certifil that the well(s) was(were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100i or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: ; ,
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.002181 N -78.901839 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply wells
ONLY with the same construction'abandonment,you can submit one form.
10a. For All Wells: Submit this fonn within 30 days of completion of well
6a.Well ID#: M W 10 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 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:
5.94 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.)
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): 3 (ft.) abandoned. A ,.ram r•,.,.a .
6g.Screen length(if known): 1 (ft.) FEU r 2 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources I OW o 8e
.

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathaniel Newman 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-301is needed. Indicate TOTAL NUMBER of
4630C wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
I
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name 1 '
7c.Type of disinfectant used: I
2.Well Construction Permit#:
List's!!applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known I
7d.Amount of disinfectant used:
3.Well use(check well use): -
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout i I Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout ❑ Drill Cuttings
❑Irrigation 0 Specialty Grout ❑ Gravel
Non-Water Supply Well: 0 Bentonite Slurry I Other(explain under 7g)
•Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite ; 16.67 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
DAquifer Test ❑StormwaterDrainage Concrete ;, 10Ibs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Hydrated bentonite used to fill to -6 inches below
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024 bring opening to grade. 1
5a.Well location:
Barbara "Genia" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification: iiiittib6 4,70(ezii"
601 Foster Street, Durham, NC 27701
2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.002181 N -78.901839 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 I.
Attach well construction record(s)if available. For multiple injection or non-water supply wells I
ONLY with the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
M W 11 abandonment to the following:
Division of Water Resource ,Information Processing Unit,
6b.Total well depth: 13 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition.to sending the form to the address in l0a
above, also submit one copyof this form within 30 days of completion of well
6c.Borehole diameter: 8.25 (in.) 1
abandonment to the following:
i
6d.Water level below ground surface: 4.58 (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): 3 _ (ft.) abandoned.
0 . p -"!' Y A.
6g.Screen length(if known): 1 (ft.)
FEB ;I 2 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Water R [Lr�c�,. e��^7r Revised 2-22-2016

WELL ABANDONMENT RECORD Forintcrnal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS:
Nathaniel Newman 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-3 0 is needed. Indicate TOTAL NUMBER of
4630C wells abandoned: i
I '
NC Well Contractor Certification Number 7b.Approximate volume of water retraining in well(s): (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.U/C,County,State,Variance,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaVPublic 0 Neat Cement Grout II Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout ❑ Drill Cuttings
0 Irrigation ❑Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry e Other(explain under 7g)
(Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite 16.67 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Concrete 101bs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Hydrated bentonite used;to fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024 bring opening to grade.
5a.Well location:
Barbara "Genic" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
601 Foster Street, Durham, NC 27701 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, I hereby certify that the well(s) was(were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.002181 N -78.901839 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEiNG ABANDONED
SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available.For multiple injection or non-water supply wells
ONLY with the same construction abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-12 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 Injection Wells: In addition ito 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 7.98 (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): 3 ft. abandoned. i
v
6g.Screen length(if known): 10 (ft.) FEB 12 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resourcegjrrilii1P61 ,reXaegoiey Wised 2-22-2016
DWCEMOG

.
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathaniel Newman 7a.For Geoprobe/DPT or Closed-L4p 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
4630C wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
i' t
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: •
2.Well Construction Permit#:
List all applicable well construction permits(i.e.U/C,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: •
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all khat apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout •Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑Irrigation ❑ Specialty Grout 0 Gravel
Non-Water Supply Well: ❑ Bentonite Slurry •Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,;provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite 16.67 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Concrete 10 lbs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the:abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Retum) ❑Other(explain under 7g) Hydrated bentonite used to fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024 bring opening to grade.
5a.Well location:
Barbara "Genic" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification: ��l�/�� � ""' "
'
601 Foster Street, Durham, NC 27701 % i 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham . 0821990773 •
By signing this form, I hereby cert�,that the the//(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been:provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.002181 -78.901839 W You may use the back of this page to additional well site details or well
N
-- - -- abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply wells
ONLY with the same construction abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID# MW-13 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 Injection 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 form within 30 days of completion of well
abandonment to the following: l' i
5.94 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) ,
1636 Mail Service Cen ler;Raleigh,NC 27699-1636
NA 10c.For Water Supply&Injection Wells: In addition to sending the form to the
6e.Outer casing length(if known): (ft.)
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county'health department of the county where
abandoned.
6f.Inner casing/tubing length(if known): 3 (ft.) �+4 -w..
El-1VE3
6g.Screen length(if known): 1 (ft.)
FEB 1 2 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources iniera' aurrl p.;c i d 2-22-2016
DWOMOG
1

• 'WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS '
Nathaniel Newman 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-301is needed. Indicate TOTAL NUMBER of
4630C wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLI N Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: j
List all applicable well construction permits(i.e.UIC,County,Stale,Variance,etc.)if known
7d.Amount of disinfectant used: '
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
0 Agricultural ❑Municipal/Public ❑Neat Cement Grout • Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout ❑ Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: ❑ Bentonite Slurry A Other(explain under 7g)
•Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 16.67 lbs
[Aquifer Storage and Recovery ❑Salinity Barrier
[Aquifer Test ❑StormwaterDrainage Concrete 16.671bs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Hydrated bentonite used to fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024 -
bring opening to grade.
5a.Well location:
Barbara "Genia" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification: �� /� " '
601 Foster Street, Durham, NC 27701 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773 '
By signing this form• 1 hereby certify'that the well(s) was(were) abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.002181 N -78.901839 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)damnable. For multiple injection or non-staler supply wells
ONLY with the same construction,abandonnhent,you can submit one form.
10a. 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 Resource's,Information Processing Unit,
6b.Total well depth: 13 (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:
I
6d.Water level below ground surface: 5.06 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Centl r„Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 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
6f.Inner casing/tubing length(if known): 3 (ft.) abandoned.
6g.Screen length(if known): 1 0 (ft.) R
FEB 1'2 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources ti , Revised 2-22-2016
InfOriltiejen 7 f:.J. etAir4 UFA
DWW OG

I
I
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
'Nathaniel Newman
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-301 isineeded. Indicate TOTAL NUMBER of
4630C wells abandoned: I I
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#:
List all applicable well construction permits(i.e.UIC,County,Stale,Variance,etc)if known
7d.Amount of disinfectant used:
•
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout 'Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
0 Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout 0 Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry I Other(explain under 7g)
'Monitoring ❑Recovery
Injection Well: If.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 16.67 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier . •
❑Aquifer Test ❑Stormwater Drainage Concrete 10 lbs
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of thelabandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Hydrated bentonite used to fill to —6 inches below
land surface. Concrete was used to seal casing and
a.Date well(s)abandoned: 1/31/2024 bring opening to grade.
5a.Well location:
Barbara "Genic" Smith •
Facility/Owner Name Facility ID#(if applicable) 8.Certification: 4/tot/it n % ��/�v"'(/
601 Foster Street, Durham, NC 27701 t(f („// 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or We11 Owner Date
Durham 0821990773
By signing this form, 1 hereby certify:that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: '
(if well field,one lat/long is sufficient)
9.Site diagram or additional well details:
36.002181 N -78.901839 W You may use the back of this page to;provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-15 abandonment to the following:
i
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 5.67 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
i
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: 13 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Centi r,Raleigh,NC 27699-1636
•
NA 10c.For Water Supply&Injection Wells: In addition to sending the form to the
6e.Outer casing length(if known): (ft.) address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county`health department of the county where
3 abandoned.
6f.Inner casing/tubing length(if known): (ft.) i: ,i y r^;•)
6g.Screen length(if known): 1 (ft) ICB 1 2 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Water RcsoBOrmvAra Prw. ti""'Revised 2-22-2016
i

WELL ABANDONMENT RECORD For Internal Use ONLY: t
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathaniel Newman
7a.For Geoprobe/DPT or Closed-Loiopi 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 ismeeded. Indicate TOTAL NUMBER of
4630C wells abandoned: I
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#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public El Neat Cement Grout • Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout i ❑ Drill Cuttings
❑irrigation ❑Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑Bentonite Slurry I. Other(explain under 7g)
•Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite ', 16.67 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
El Aquifer Test ❑StormwaterDrainage Concrete 101bs
DExperimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Hydrated bentonite used,to fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024 bring opening to grade.
5a.Well location:
Barbara "Genic" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification: yi" �"'(/
601 Foster Street, Durham, NC 27701 • 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, 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.
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: .
36.002181 N -78.901839 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEiNG ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifmvailable. For multiple injection or non-na/er supply smells
ONLY with the sane construction'abandoninent,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MVV 16 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 injection 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 form within 30 days of completion of well
abandonment to the following: t
7.26 I
Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
i
6e.Outer casing length(if known): NA (ft.) lOc.For Water Supply&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy;of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 3 (ft.) abandoned.
10 L:.L., 1 V,E D
6g.Screen length(if known): (ft.)
FEB 1 22024
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
ifvfFifA'agi>;n r3rr,r qy .y UM
I

,
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathaniel Newman 7a.For Geoprobe/DPT or Closed-L lop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-3l is needed. Indicate TOTAL NUMBER of
4630C wells abandoned: 1I
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 1'
7c.Type of disinfectant used:
2.Well Construction Permit#: I
List all applicable well construction permits(i.e.U/C,County,State,Variance,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use): 1
Water Supply Well: 7e.Sealing materials used(check all that apply):
['Agricultural ❑Municipal/Public 0 Neat Cement Grout I • Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout I ! 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout , 0 Drill Cuttings
0 Irrigation 0 Specialty Grout j ' ❑Gravel
Non-Water Supply Well: 0 Bentonite Slurry IR Other(explain under 7g)
U Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite ;' ' 16.67 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Concrete 16.671bs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Hydrated bentonite used to fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024
bring opening to grade.
5a.Well location:
Barbara "Genic" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification: 1•
601 Foster Street, Durham, NC 27701 liato,,ddi
� 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.002,181 N -78.901839 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED ,
SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply wells
ONLY with the same construction'abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MVV 19 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 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:
I
6d.Water level below ground surface 6.81 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I .
fie.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 copyi 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.
i.
6g.Screen length(if known): 1 (ft.) r✓ f `� `
Ftti 1' 2 20Z4
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
DANCI 00
I .

r,
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathaniel Newman
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
4630C wells abandoned: I
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: I
•
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC County,Stale,Variance,etc.)if known I
7d.Amount of disinfectant used: I' •
3.Well use(check well use):
I
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural U Municipal/Pub lie ❑Neat Cement Grout IN Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout i ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout ❑ Drill Cuttings
❑Irrigation ❑ Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry I Other(explain under 7g)
SMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 16.67 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Concrete 16.67 lbs
❑Experimental Technology - ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Retum) ❑Other(explain under 7g) Hydrated bentonite used.to fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024 bring opening to grade. ,
5a.Well location: i
Barbara "Genia" Smith
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
601 Foster Street, Durham, NC 27701 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Durham 0821990773
By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) . accordance with I5A NCAC 02C.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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.002181 N -78.901839 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable. For multiple injection or non-water supply wells
ONLY with the same construction abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID# MW-20 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 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 fo'im within 30 days of completion of well
abandonment to the following:
6.30 Division of Water Resources,.Underground Injection Control Program,
6d.Water level below ground surface: (ft.)
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
abandoned.
6f.Inner casing/tubing length(if known): 3 (ft.) ��,��,-�.� .y1�j
E `�I� c7 G i
I-L.r
6g.Screen length(if known): 10 (ft.) .t8
12 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources €'t ' F'+1 P.r:^^: ,,ri Weed 2-22-2016
DwQtM'.

r i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Nathaniel Newman 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
4630C wells abandoned: 1 i
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
7c.Type of disinfectant used: ;_
2.Well Construction Permit#:
List all applicable well construction permits(i.e.U/C,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: I
3.Well use(check well use): 4
I
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 0 Dry Clay
❑IndustriallCommercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: ❑Bentonite Slurry • a Other(explain under 7g)
U Monitoring ['Recovery
Injection Well: 7f.For each material selected above,'provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 16.67 lbs
[Aquifer Storage and Recovery ❑Salinity Barrier
[Aquifer Test ❑StormwaterDrainage Concrete 16.671bs
•
['Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Hydrated bentonite used to fill to -6 inches below
land surface. Concrete was used to seal casing and
4.Date well(s)abandoned: 1/31/2024 bring opening to grade.
5a.Well location:
Barbara "Genic" Smith 1 f
Facility/Owner Name Facility ID#(if applicable) 8.Certification: /, t;-. �"'(/
601 Foster Street, Durham, NC 27701 2/2/2024
Physical Address,City,and Zip Signature of Certified Well Contractor-or Well Owner Date
Durham 0821990773 '
By signing this form• 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.
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:
36.002181 N -78.901839 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED
SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable.For multiple injection or non-si'aler supply wells
ONLY with the same constructiaz'abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-21 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 Injection 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 form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 7.65 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
NA 10c.For Water Supply&Injection Wells: In addition to sending the form to the
6e.Outer casing length(if known): (ft.) address(es)above,also submit one copylof 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. ; . . r
D
6g.Screen length(if known): 1 (ft.) f�EE 1 2 20Z4
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Relfdan' F+1-' .- r VIA Revised 2-22-2016

04
� . N
I .. . .
i
W
MW-18 A AktPill
a 1,000-
GAL.
® (CNL) r a it ""°°MW9J.; GASOLINE UST
1 MW-10
•
MW-11 ® ( 11
i ®MW-8 r
. MW-12 MW-4 mimes tot •
° MW-13 • ®
•• It
MW-17
i'•tlk(CNL) MW-14. • ®MW-3 ® MW-7
441
MW-15 0 MW-6D
s AS=1 C
`" AS-OW-1 V I 5,0400-GAL.
AS-OW-2 0 s� f GASOLINE USTs
LEGEND MW-16 MW-5
ioNMW=19 :• a
.
•
mii /4 v
Monitoring Well W W-1
2 ® '' ® M FORMER
® (Type III) MW-20 ••� M DISPENSER
® Abandoned Monitoring ►4 I`
ISLANDS
Well (Type II)
6,000-GAL.
Abandoned Monitoring HEATING ,
Well (Type III) CORPORATION ST OIL UST
O Abandoned Air
Sparge Well
0
Approximate Location
of Former UST System MI
0 Parcel Boundary I
4
l 1 ? Source:'Esri,Maxar,,Earthstar Geographics,a d the GG User Community
NOTES:
1. Well and tank locations were obtained from previous reports 50 25 0 50 100
prepared by other consultants and are approximate.
2. CNL=Could Not Locate I Feet
-PROJECT TITLE
FORMER NU-TREAD FIGURE
CATLIN S TIRE COMPANY SITE MAP
601 FOSTER STREET
DURHAM, NC 2
Engineers and Scientists
INCIDENT NO. .OB NO DATE SCA_E DRAWN BY CHECKED BY
33574 222017 FEB 2024 AS SHOVVN KMC/SJO