Gaston_Well Abandonment_20241022

, r
. 1 WELL ABANDONMENT RECORD
6 t.,r4 2c, North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#NCWC-4081C
I.WELL CONTRACTOR: 5. WELL DETAILS: I '
Norris Justin Love , a.Total Depth:32 13. Diameter:24� in.
Well Contractor(Individual)Name b.Water Level(Below Measuring Point): ft.
Love Well &Water Works, LLC Measuring point is 1 ft.above land surface.
Well Contractor Company Name
STREET ADDRESS 4109 Tarlton Mill Rd 6. CASING: Length Diameter
Marshville NC 28103 a.Casing Depth(if known): N/A ft. 24" in.
City or Town State Zip Code b.Casing Removed: ft. in.
(704 )-635-5755
Area code-Phone number 7. DISINFECTION: 1 Lb
2.WELL INFORMATION: _ (Amount of 65%-75%calcium hypochlorite used)
SITE WELL ID#(if applicable) 8. SEALING MATERIAL:
STATE WELL PERMIT#(if applicable) Neat Cement F Rand Cement
Cement lb. Cement lb.
COUNTY WELL PERMIT#(if applicable) Water gal. Water gal.
DWQ or OTHER PERMIT#(if applicable) Bentonite I .
WELL USE(Check applicable use): ❑ Monitoring ❑✓ Residential Bentonite lb. ,
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural Type:❑Slurry ❑Pellets, ' "`� �`""' "" 'f
Water gal: O C T 2 2 2024
❑ Recovery • ❑ Injection ❑ Irrigation
❑ Other :..:'. i-,-^:a-- i'
Other(list use) I rr'.:+ ` " ass`
Type material Fill dirt& Concrete D,'ct•;r'l'-:,3 3.WELL LOCATION: - Amount 10Yards Fill Dirt&2 Yards Concrete
COUNTYGaStOn QUADRANGLE NAME
NEAREST TOWN: 709 Queens Court Gastonia,NC 28052
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Filled with dirt up to 28ft& Poured concrete pad 2ft
(Street/Road Name,Number,Community,Subdivision,Lot No.,Parcel,Zip Code) below surface.
TOPOGRAPHIC/LAND SETTING:
❑Slope ❑Valley ❑Flat ❑Ridge❑Other 1I I
(Check appropriate setting)
10. WELL DIAGRAM:Draw&detailed sketch of the well on the back of this
LATITUDE May be in degrees, form showing total depth,depth and diameter of screens(if any)remaining
minutes,seconds,or in a
decimal format in the well,gravel interval,intervals of casing perforations,and depths and
LONGITUDE —— types of fill materials used.
Latitude/longitude source: ❑GPS ❑Topographic map• 10-9-24
(Location of well must be shown on a USGS topo map and 11. DATE WELL ABANDONED
attached to this form if not using GPS.) I DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
4a.FACILITY-The name of the business where the well is located.Complete 4a and4b. WITH 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF
(If a residential well,skip 4a;complete 4b,well owner information only.) THIS REC HAS BEEN PRO D TO THE WELL OWNER.
FACILITY ID#(if applicable)
10-9-24
NAME OF FACILITY SI TURE OF CERTIFIED WELL CONTRACTOR DATE
STREET ADDRESS
City or Town State . Zip Code SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who personally abandons his/her residential well
4b.CONTACT PERSON/WELL OWNER: in accordance with 15A NCAC 2C.0113i)
NAME Joseph Wilson
STREET ADDRESS7900 D Stevens Mill Rd,Matthews NC 28104 PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW 30
Attn:Information Management,1617 Mail Service Center—Raleigh,NC 27699-1617, Phone No.[phone] ext 568. Rev.5/06

► p, ! ,
WELL ABANDONIVI t 1 RECORD For Intemal Use ONO: '
92,1dPiller I
1.Well Cmitractor Information: WELL ABANDONMENT DETAILS '
44'g /9 r J 311 1 f 7a.For Geoprobe/DP-T or Closed-L lopi Geothermal Wells having the same
Well Contractor,lame(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 isIneeded. Indicate TOTAL NUMBER of
R. l� ' n- 4 wells abandoned: i I ,/
NC Well Cotntt{actolrlCertification Number 76.Approximate volume of water remainingi in well(s): �(, (gal.)
g I ciW/ 3I9,5 2 FOR WATER SUPPLY WELLS ONLY:
Company Nam¢ 7c.Type of disinfectant used: 1 I711
2.Well Construction Permit#: i 132 J I
List all applicable well construction permits(i.e.l UIC,County,State,Variance,etc)iflmown //��7d.Amount of disinfectant used: t%z.
3.Well use(check well use):
•
Water Supply Well: 7e.Sealing materials used(check all that apply)•
❑Agricultural 1 ❑Municipal/Public 0 Neat Cement Grout Kentonite Chips or Pellets
❑Geotherm l(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay 1
ndustrial/l ommercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑irrigation ' ❑ Specialty Grout 0 Gravel
Non-Water tupply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each materi I selected above,provide amount of materials used:
❑Aquifer Rtcharge OGroundwater Remediation es S 1/9.0 ag /b 1 , ei66
❑Aquifer Storage and Recovery ❑Salinity Barrier l /p gag, (✓°!!� �(/
0 Aquifer Test ' ❑Stormwater Drainage
❑Experime tal Technology ❑Subsidence Control •
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer /1 (A)// �I ��Ill
,/ T�
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g) L/✓-' �1 7�/,/� Il
y� ) A v P !f9-fir.-
4.Date well(s)abandoned: 1 r/' / Ail "`.
t t 0 : i# 1.5...;
5a.Well loc tion:
ail eP e' alY6'1 OCT � � �0?4
Facility/Owner ame Facility ID#(if applicable) 8.Certification: , , r fist?•
14 fly1� ' :.E. .- , ,-,
Physical Address,City,and Zip Sig afore of Ce ed Well Contractor or We 1 Owner Date
6 4Tdi1/
t By signing this form, I hereby cert that the well(s) was(were)?bandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
I 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 1
(if well field,or lat/long is sufficient) 9.Site diagram or additional well details:
-fir I i 39 N 91. AV/ 3 , W You may use the back of this page to provide additional well site details or well
l' abandonment details. You may also attach additional pages if necessary.
•CONSTRU("TION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well co,/traction 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 : abandonment to the II flowing: I,Division of Water Resources,Information Processing Unit,
6b.Total well depth: (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
1
10b.For Injection V'ells: In addition!to sending the form to the address in 10a
r.
6c.Borehole diameter: Z 4 (in.) above,also submit one copy of this fo1rm within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c.For Water Supply&Injection Wlls: In addition to sending the form to the
a�ing length(if known): (ft.)6e.Outer c address(es)above,also submit one copy)of this form within 30 days of completion
I of well abandonment to the county health department of the county where
6f.Inner casidig/tubing length(if known): - (ft.) abandoned.
I
6g.Screen length(if known): d (ft.) •
•
•
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources ReLlsed 2-22-2016
1
I

I ,
WELL ABANDONMENT RECORD For Internal Use ONLY:
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
WiII Keyes 7a.For Geoprobe/DPTorClosed-Lol plGeothermal Wells having the same
Well Contractor Namc(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-301 isIneeded. Indicate TOTAL NUMBER of
wells abandoned:
4220-A
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: NA
1
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc)if known NA
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 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustrial/Commcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑irrigation 0 Specialty Grout + 0 Gravel
Non-Water Supply Well: a Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ®Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
I -� o L+'S.., `. ,z, 11;.r La
4.Date well(s)abandoned: 8/14/24 'I 0 C T ?(i 74
5a.Well location:
I
Duke Energy I . - „ ..
D t i.c'::ij3
Facility/Owner Name Facility ID#(if applicable)
S.CertilIca'
Plant Allen Rd, Belmont, NC, 28012 9/9/24
Physical Address,City,and Zip ' afore rtified Well Contractor or Well Owner Date
Gaston - 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 1at/long is sufficient) 9.Site diagram or additional well details:
524126.596 N 1400089.219 Nr 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#: E D I abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter:4 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following: 1
1 1
6d.Water level below ground surface: 5 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (ft.) lOc.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): NA (ft.) abandoned. ,
6g.Screen length(if known): 20 (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 !
W i I I Keyes 7a.For Geoprobe/DPT or Closed-L lopl 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
4220—A wells abandoned: 1 1
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: NA'
2.Well Construction Permit#: NA
List all applicable xell construction permits(i.e.UIG County,State,Variance,etc.)if
A
7d.Amount of disinfectant used: l ,
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 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
0 Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: IN Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring URecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24 j �A_ ` _� ‘..2
`'' 1.....e"t�
5a Well location:
.
OCT 22, 20z4
•.
Duke Energy 1n:�.;, a.. . ..�.;„�•,,:
Facility/Owner Name Facility ID#(if applicable) 8.Certifcatlo • t ` "' ;;i'..
Plant Allen Rd, Belmont, NC, 28012 9/9/24
Physical Address,City,and Zip store of rtified Well Contractor or Well Owner Date
Gaston .
By signing this form, l 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:
524126.596 N 1400089.219 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 j
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#: ED- -C> abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in l0a
6e.Borehole diameter:4 (in.) above,also submit one copy of this!form within 30 days of completion of well
abandonment to the following: 1
5 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft) 1636 Mail Service Ceeter,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (fL) 10c.For Water Supply&In iectionWells: 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 easing/tubing length(if known): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Forth 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 ,
W i I I Keyes 7a.For Geoprobe/DPT or Closed-Llopl 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:
4220-A ! I NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
I.
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.NC,County.State,Variance,etc.)ifknoww
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
0 Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑IndustriallCommcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout , 0 Gravel
Non-Water Supply Well: II Bentonite Slurry , 0 Other(explain under 7g)
❑Monitoring (Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier .
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
1
4.Date well(s)abandoned: 8/14/24 p.-� n' k ,` ,x ' ' u9m
.� . .� ii.�.y .,
5a.Well location: r c� 2024
Duke Energy 11
Facility/Owner Name Facility TD#(if applicable) 8.Certifcation: 1G` F- c.7. ' r ;5 ';.
Plant Allen Rd, Belmont, NC, 28012 Da`'=19/9/24
Physical Address,City,and Zip S' re o 'fi e 1 Contractor or Well Owner Date
Gaston 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:
524126.596 N 1400089.219 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 ;
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#: ED abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (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: 4 (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 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): (ft.)
NA abandoned. !
6g.Screen length(if known): 20 (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: I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
W i II Keyes 7a.For Geoprobe/DPT or Closed-Lol p Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30I is Ineeded. Indicate TOTAL NUMBER ofwells abandoned:
4220-A I !. 5
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
P
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: NA,
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if know; 7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) CI Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation ❑ Specialty Grout 0 Gravel
Non-Water Supply Well: ® Bentonite Slurry 0 Other(explain under 7g)
:Monitoring (Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal i
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date wells)abandoned: 8/14/24 ~
OCT 2d2024
5a.Well location: ,
Duke Energy lri3:7 ;,-.-.,:.. JI::
Facility/Owner Name Facility ID#(if applicable) 8.Certification: Dz c a. `=`�
Plant Allen Rd, Belmont, NC, 28012 9/9/24
Physical Address,City,and Zip Si use of Certified Contractor or Well Owner Date
Gaston 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:
524126.596 N 1400089.219 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailahle.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#: E D- l abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (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:4 (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 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (ft.) 10c.For Water Supply&Iniectionl 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): NA (ft.)
abandoned
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
it

WELL ABANDONMENT RECORD For Internal Use ONLY: I
1
1.Well Contractor Information: WELL ABANDONMENT DETAILS
W i I I Keyes 7a.For GeoprobelDPT 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 I GW-30 i is needed. Indicate TOTAL NUMBER of
1 4220— wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water relmaining in well(s): 5 (gal.)
I
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name NA
7c.Type of disinfectant used:
•
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)rfknonn
7d.Amount of disinfectant used: NA
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) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 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 I 0 Other(explain under 7g)
❑Monitoring 'Recovery
Injection Well: 7f.For each material selected above;provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
Imo; -' i, ,{
4.Date well(s)abandoned: 8/14/24 '
OCT 222024
5a.Well location:
Duke Energy -: ...f. ''''':':.':".1;:"-,
Facility/Owner Name Facility ID#(if applicable) 8.Certification '• C.°` G i.;,''_3 03
Plant Allen Rd, Belmont, NC, 28012 9/9/24
Physical Address,City,and Zip Si re of Ce • We l Contractor or Well Owner Date
Gaston 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:
524126.596 N 1400089.219 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 1D#: ED- 5 abandonment to the following: ,
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (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: 4 (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 tn. Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
1
6e.Outer casing length(if known): 20 (ft,) 1Oc.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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (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
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
W i I I Keyes 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-3 i is needed. Indicate TOTAL NUMBER of
wells abandoned:
4220-A I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering• FOR WATER SUPPLY WELLS ONLY:
Company Name
I�' 7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(ke_UIC,County,State,Variance,eta)if known NA
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 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Indust ial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: Ill Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring URecoveiy
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
. m ems. 4,_,,1.,,a 'r'' 4..,1 J
4.Date well(s)abandoned: 8/14/24
5a.Well location: i OCT 2 2LOL4
Duke Energy il;°:,. IA;1-
Facility/Owner Name Facility ID#(if applicable) 8.Certifrcatio : 1 jj'ti ••._•"3C/0
Plant Allen Rd, Belmont, NC, 28012 9/9/24
Physical Address,City,and Zip Signature o Certified Well Contractor or Well Owner Date
Gaston 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:
524126.596 N 1400089.219 ,,1r 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 wit: ED— abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (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: 4 (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 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

lI
WELL ABANDONMENT RECORD For Internal Use ONLY: I I
1.Well Contractor Information: WELL ABANDONMENT DETAILS j
i
WI I I Keyes 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:
4220-A I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
I' •
Griffin Dewateri ng FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: NA
i
2.Well Construction Permit#: NA I
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known 7d.Amount of disinfectant used: 'A,VA
3.Well use(check well use): •
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
• Non-Water Supply Well: - IP Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring HRecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
0 Aquifer Recharge 0 Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) „
4.Date well(s)abandoned: 8/14/24
OCT 2d2024
5a.Well location:
Duke Energy 11-,,:-.;:,;.,.r "-r', u;:
6o
Facility/Owner Name Facility ID#(if applicable) S.Certification: i'v\,i: +_i::�
Plant Allen Rd, Belmont, NC, 28012 i 9/9/24
Physical Address,City,and Zip Si re of Certified Well Contractor or Well Owner Date
I
Gaston 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:
524126.596 N 1400089.219 �, 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 j
Attach well constructionrecord(s)ifavailable.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#: E D-7 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in IOa
6c.Borehole diameter:4 (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 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (ft.) 10c.For Water Supply&Iniection'Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): NA (ft.) abandoned. I
•
6g.Screen length(if(mown): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

I :
WELL ABANDONMENT RECORD For Internal Usc ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Will Keyes 7a.For Geoprobe/DPT or Closed-Loop p 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:
4220-A I I 5
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(Le.UIC,County,State.Variance,etc.)if known NA
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 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustrial/Commcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑irrigation - 0 Specialty Grout 0 Gravel
Non-Water Supply Well: II Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring IRecovery
Injection Well: 7f.For each material selected above provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery ID Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop). ❑Tracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24 '"•`•�', i F' ''1 '^L
5a.Well location: 1 O C T 2 d 2024
Duke Energy
:.ram �1-..r.�'v'�,-::'•r
Facility/Owner Name Facility ID#(if applicable) 8.Certification: Ir„�:r,r: .� ",;ilr
Plant Allen Rd, Belmont, NC, 28012 /9/24
Physical Address,City,and Zip Si re of Ce ed Well Contractor or Well Owner Date
Gaston
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:
524126.596 N 1400089.219 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,Q you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: E D- V abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (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:4 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following: iff
6d.Water level below ground surface: 5 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I'
6e.Outer casing length(if known): 20 (ft.) 10c.For Water Supply&IniectionWells: 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): NA (ft.) abandoned. ,
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

I
WELL ABANDONMENT RECORD For Internal Use ONLY: I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Will Keyes I
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
4220-A wells abandoned:
1 '
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
1
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name
t�I 7c.Type of disinfectant used: NA
2.Well Construction Permit it: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation ❑ Specialty Grout 1 0 Gravel
Non-Water Supply Well: IR Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
[Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control 1
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24 ;
�{,tiaw
5a.Well location: , OCT d 2024
Duke Energy
Facility/Owner Name Facility ID#(if applicable) 8.Certification: ;7 -.' r, '..1-: :
Plant Allen Rd, Belmont, NC, 28012 D.1".':c '� .'`, 9/9/24
Physical Address,City,and Zip Si a of Ce ' Well Contractor or Well Owner Date
Gaston
By signing this form, I hereby certifP 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 1at/long is sufficient) 9.Site diagram or additional well details:
524126.596 N 1400089.219 w You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailahle.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#: ED- q abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (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:4 (in.) above, also submit one copy of this'form within 30 days of completion of well
abandonment to the following:
5 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): 20 (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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
I '
'

1
WELL ABANDONMENT RECORD For lntemal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS I
W i l I Keyes 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
wells abandoned:
4220-A
7b.Approximate volume of water remaining in well(s): 5 (gal.)
NC Well Contractor Certification Number
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known NA
7d.Amount of disinfectant used:
3.Well use(check well use): '
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout ❑Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: a Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring IRecovery 1
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery ❑Salinity Barrier
I
❑Aquifer Test ❑Stormwater Drainage
I
0 Experimental Technology ❑Subsidence Control '
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
4.Date wells)abandoned: 8/14/24 `I.^� ' ' I`' '�' 3 5a.Well location: OC I ) 2 CUL4
Duke Energy . ,,.r:r.,wr.' 1:1
Ir.c:
Facility/Owner Name Facility ID#(if applicable) 8.Certification: [J'd4i:e.303�
Plant Allen Rd, Belmont, NC, 28012 ' 9/9/24
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Gaston I.
By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 1SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy r f 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:
524126.596 N 1400089.219 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 I.
ONLY with the same consnrrction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: E D- l lr O abandonment to the following:
i
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (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:4 (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 (ft,) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (ft.) 10c.For Water Supply&Iniectionl 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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources ( Revised 2-22-2016
1

is
WELL ABANDONMENT RECORD For Internal Use ONLY:
,
1.Well Contractor Information: WELL ABANDONMENT DETAILS I
Will Keyes 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-30 is'needed. Indicate TOTAL NUMBER of
wells abandoned:
4220-A I '
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gaL)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State.Variance,etc)if known NA
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 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustrial/Commcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: In Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring URecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
DAquifer Recharge ❑Groundwater Remediation 25 gal
DAquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
oGeothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24 ;r t ;r,_.. ', 'II:,
5a.Well location: OCT v 2 2024
Duke Energy
8.Certillcatio P-r�c:ii -,g'. ,'
Facility/Owner Name Facility1D#(ifapplicable) lrf, %'f '' '
Plant Allen Rd, Belmont, NC, 28012 �t`t,u.1�.�9/9/24
Physical Address,City,and Zip Si re of Certified Well Contractor or Well Owner Date
Gaston
By signing this form, 1 hereby certify that the well(s) was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15,4 NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this 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:
524126.596 N 1400089.219 `,tr 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 consul tation/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well 1D#: E D- l`+ abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter:4 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
r
6d.Water level below ground surface: 5 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (ft.) 10c.For Water Supply&IniectionWells: 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): NA (ft.) abandoned. I
6g.Screen length(if known): 20 (ft.)
1
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY: I
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Will Keyes 7a.For Geoprobe/DPT or Closed-L I p�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
4220—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water rel airing in well(s): 5 (gal.)
Griffin Dewateri ng FOR WATER SUPPLY WELLS ONLY: •
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknoww
7d.Amount of disinfectant used: NA
3.Well use(check well use): •
Water Supply Well: 7e.Sealing materials used(check allthat apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustrial/Commcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings .
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: I Bentonite Slurry 0 Other(explain under 7g)
:Monitoring !Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal !
❑Aquifer Storage and Recovery ❑Salinity Barrier 1
:Aquifer Test ❑Stormwater Drainage I
0 Experimental Technology 0 Subsidence Control '
7g.Provide a brief description of the abandonment procedure:
oGeothermal(Closed Loop) ❑Tracer Positive displacement via tremie pipe
OGeothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24 ,.'" z"_,,)t,.:,. ','y, -,
5a.Well location: 01..:I 2 6+ 2024
Duke Energy in.,,,r L ;
Facility/Owner Name Facility ID#(if applicable) 8.Certification: i ,ysue ':':! L!
Plant Allen Rd, Belmont, NC, 28012 - 9/9/24
Physical Address,City,and Zip Signature of Certifie Well Contractor or Well Owner Date
Gaston '
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 heel'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:
523678.701 N 1398900.252 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 j.
Attach well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the same constntction/abandonment you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: E D- 12. abandonment to the following: .
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 70 (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: 4 (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: 60 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (IL) 10e.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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (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
WillKeyes 7a.For Geoprobe/DPT or Closed-L I op Geothermal Wells having the same
Well Contractor Namc(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4220—A ' wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewateri ng FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
•
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if knonn
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
0 Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation ❑ Specialty Grout 0 Gravel
Non-Water Supply Well: PI Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring URecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stonnwater Drainage
❑Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24
OCT 2 ".3 29'/1
L.I
5a.Well location:
Duke Energy • :.41 t
Facility/Owner Name Facility ID#(if applicable)
8.Certification: D'a c..e; z 0
Plant Allen Rd, Belmont, NC, 28012 9/9/24
Physical Address,City,and Zip Signature of Certifie Well Contractor or Well Owner Date
Gaston
By signing this form, I hereby certi6,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:
523678.701 N 1398900.252 `i, 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. 1 Oa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: ED— 1`S abandonment to the following:
Division of Water Resources,Information Processing Unit,
1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: 70 (ft)
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter:4 (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:
60 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Ceiter,Raleigh,NC 27699-1636
20 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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources j Revised 2-22-2016

WELL ABANDONMENT RECORD /For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
•
Will Keyes 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-30 is;needed. Indicate TOTAL NUMBER of
4220-A wells abandoned: I i
1
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gaL)
Griffin Dewateri ng FOR WATER SUPPLY WELLS ONLY:
Company Name NA
7c.Type of disinfectant used:
2.Well Construction Permit#: NA '
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 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 0 Specialty Grout 0 Gravel
Non-Water Supply Well: a Bentonite Slurry 1. 0 Other(explain under 7g)
❑Monitoring ®Recovery ;'
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑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)
Positive displacement via tremie pipe
4.Date well(s)abandoned: 8/14/24
5a.Well location: ' OCT 2 v 2021
Duke Energy
Facility/Owner Name Facility TD#(if applicable) 8.Certification: !..._ •: ,_� ` t�.,,;,
Ire .�.._ . .;;; ��,�:.
Plant Allen Rd, Belmont, NC, 28012 1 D'I'l°2e-'3 9/9/24
Physical Address,City,and Zip Signature of Certi Well Contractor or Well Owner Date
Gaston 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 laUlong is sufficient) 9.Site diagram or additional well details: •
523678.701 N 1398900.252 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 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#: ED- y abandonment to the following: j
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 70 (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:4 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
60 Division of Water Resources,U uderground Injection Control Program,
6d.Water level below ground surface: (ft.)
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned.
i
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
i

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Will Keyes 7a.For Geoprobe/DPT or Closed-L I op 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
4220—A wells abandoned: i
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
0 Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: a Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring URecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal
[Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
OGeothermal(Heating/Cooling Return) .❑Other(explain under 7g) Positive displacement via tremie pipe
4.Date well 8/14/24s)abandoned:
5a.Well location: O C T 2 d 2024
Duke Energy
Facility/Owner Name Facility ID#(if applicable) S.Certification: "r�
Plant Allen Rd, Belmont, NC, 28012 E<Af-arin 9/9/24
Physical Address,City,and Zip Signature of Certifie Well Contractor or Well Owner Date
Gaston 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:
523678.701 N 1398900.252 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#: ED— %5 abandonment to the following:
Division of Water Resources,Information Processing Unit,
1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: 70 (it)
q 10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter:`t (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: 60 (ft,) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources ! Revised 2-22-2016

r
i .
WELL ABANDONMENT RECORD For Internal Use ONLY:
'
1.Well Contractor Information: WELL ABANDONMENT DETAILS
W i I I Keyes 7a.For Geoprobe/DPT or Closed-L I p'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:
4220-A
E
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc)iflaroan
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all;that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: C Bentonite Slurry j 0 Other(explain under 7g)
❑Monitoring ®Recovery I
Injection Well: 7f.For each material selected above;provide amount of materials used:
['Aquifer Recharge ❑Groundwater Remediation 49 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier i
❑Aquifer Test ❑Stormwater Drainage
•
•
0 Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Positive displaeement'via tremie pipe
4.Date well(s)abandoned: 8/14/24
h., :S '!fir 4.w-.
5a.Well location: OCT 2 /104
Duke Energy
Facility/Owner Name Facility TD#(if applicable) 8.Certification: ll;:�,,n7:..; ' ='r',�^,, -illy 11,r�.aa
Plant Allen Rd, Belmont, NC, 28012 ,.;.;.�' ".., 9/9/24
Physical Address,City,and Zip Signature of Certi e Well Contractor or Well Owner Date
Gaston
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:
523678.701 N 1398900.252 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailahle.For multiple injection or non-water supply wells
ONLY with the same construction/abandonment,you can submit one form. 1'
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: E D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 70 (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:4 (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: 60 (ft,) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources f Revised 2-22-2016

WELL ABANDONMENT RECORD For internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Will Keyes 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 i GW-30 is needed. Indicate TOTAL NUMBER of
4220—A wells abandoned: I i
lNC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewateri ng FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc)if known
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout I 0 Dry Clay
❑IndustriallCommcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: C Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring (Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal
❑Aquifer Storage and Recovery ❑Salinity Bather
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24
5a.Well location: '
Duke Energy _ v
Facility/Owner Name Facility ID#(if applicable) S.Certification: OCT 2 6+ 2024
Plant Allen Rd, Belmont, NC, 28012 g/19/24
Physical Address,City,and Zip Signature of Certifie Well Contractor or Well CIWrilr',z, - Date
Gaston 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 Iat/long is sufficient) 9.Site diagram or additional well details:
523678.701 N 1398900.252 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#: ED- `"l abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 70 (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: 4 (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: 60 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (ft.) 10c.For Water Supply&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): NA (ft.) abandoned.
6g.Screen length(if known): 20 (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
Will Keyes 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-30 is needed. Indicate TOTAL NUMBER of
4220-A wells abandoned:
I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation ❑ Specialty Grout 0 Gravel
Non-Water Supply Well: •Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring •Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24
5a.Well location: ; O C T 2 d 2024
Duke Energy ;
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
Plant Allen Rd, Belmont, NC, 28012 9/9/24
Physical Address,City,and Zip Signature of Certifi Well Contractor or Well Owner Date
Gaston
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 1at/long is sufficient) 9.Site diagram or additional well details:
523678.701 N 1398900.252 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.
ED- 1 O 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#. abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 70 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in l0a
above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: 4 (in.)
abandonment to the following:
6d.Water level below ground surface: 60 (ft,) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
1
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-2016

l
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Will Keyes 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 I GW-30 is needed. Indicate TOTAL NUMBER of
4220—A wells abandoned: I
NC Well Contractor Certification Number 7b.Approximate volume of water reil aining in well(s): 5 (gal.)
Griffin Dewateri n g FOR WATER SUPPLY WELLS ONLY:
Company Name NA
t�'
7c.Type of disinfectant used:
2.Well Construction Permit#: N A
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown
7d.Amount of disinfectant used: NA
3.Well use(check well use): i
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustrial/Commcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 1 0 Drill Cuttings
0 Irrigation 0 Specialty Grout 1 ❑Gravel
Non-Water Supply Well: IN Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ®Recovery
Injection Well: 7f.For each material selected above;provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal
❑Aquifer Storage and Recovery ❑Salinity Bather
I
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
OGeothermal(Heating/Cooling Return) 0 Other(explain under 7g)
t
8/14/24
4.Date well(s)abandoned: l `,,.,.k,-.;,Ir..,, :/ _,i
5a.Well location: !0 C T 2 d 2024
Duke Energy
S.Certification: P-.- _:,!--,; ',.W.
Facility/Owner Name FacilitylD#(ifapplicable) 1G`�:.:�:': •t�", ,
Plant Allen Rd, Belmont, NC, 28012 ry;�,." '` ` 9/9/24
Physical Address,City,and Zip Signature of Certi a Well Contractor or Well Owner Date
Gaston 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:
523678.701 N 1398900.252 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#: E D lot abandonment to the following: i
Division of Water Resources,Information Processing Unit,
70 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.) i
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter:4 (in.) above,also submit one copy of this lform within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 60 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
6e.Outer casing length(if known): 20 (ft.) 10c.For Water Supply&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copyy of this form within 30 days of completion
A' of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): N A (ft.) abandoned.
6g.Screen length(if known): 20 (ft)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources ` Revised 2-22-2016
.

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAIIJS
WillKeyes 7a.For GeoprobelDPT or Closed-Limp 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
4220-A wells abandoned: I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc)rfknoxn
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) .0 Sand Cement Grout . 0 Dry Clay
❑lndustrial/Commcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 1 0 Drill Cuttings
ID Irrigation ❑ Specialty Grout 1 0 Gravel ,
Non-Water Supply Well: • Bentonite Slurry I 0 Other(explain under 7g)
❑Monitoring •Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal
❑Aquifer Storage and Recovery ❑Salinity Barrier I
❑Aquifer Test ❑Stormwater Drainage i
0 Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Positive displacement via tremie pipe
4.Date well(s)abandoned: 8/14/24 ( •ti ••,;:h..r •,
5a.Well location: ' O C T 9. 2024
Duke Energy
8.Certification: - ''
Facility/Owner Name Facility ID#(if applicable) 1C1i:.:�•�••„••,-_ . _r<4. �all!!:
":':T• 'i:.
Plant Allen Rd, Belmont, NC, 28012 I 9/9/24
Physical Address,City,and Zip Signature of Certifie Well Contractor or Well Owner Date
Gaston
By signing this form, 1 hereb,v 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:
523678.701 N 1398900.252 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)((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#: ED-20 abandonment to the following: i
•
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 70 (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:4 (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:
60 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned.
6g.Screen length of known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
1 ;

WELL ABANDONMENT RECORD For internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
W i II Keyes 7a.For GeoprobelDPT 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-30 is;needed. Indicate TOTAL NUMBER of
4220—A wells abandoned: '
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)([know
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural . 0 Municipal/Public ❑Neat Cement Grout ' 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel •
Non-Water Supply Well: ! Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring !Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier '
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
OGeothermal(Heating/Cooling Return) 0 Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24 `� t;�?
5a.Well location: U`'I ZG`4
Duke Energy it ::: - ,ch
Facility/Owner Name Facility ID#(if applicable) 8.Certification: j 'jti, ply i
Plant Allen Rd, Belmont, NC, 28012 9/9/24
Physical Address,City,and Zip Signatu W re of Certi a ell Contractor or Well Owner Date
Gaston
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:
523678.701 N 1398900.252 `,t, 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
Attach well construction records)ifavailable.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#: E D 2 t abandonment to the following:
Division of Water Resources,Information Processing Unit,
1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: 70 (ft.)
1
10b.For Infection Wells: In addition to sending the form to the address in l0a
above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: 4 (in.)
abandonment to the following: j
6d.Water level below ground surface: 60 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Cei ter,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (ft.) 10c.For Water Supply&Iniection.Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6L Inner casing/tubing length(if known): NA (ft.) abandoned.
6g.Screen length(if known): 20 (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
Will Keyes 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-30 is needed. Indicate TOTAL NUMBER of
4220—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewate ri ng FOR WATER SUPPLY WELLS ONLY:
Company Name A
7c.Type of disinfectant used: N~
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State.Variance,etc.)rfknow:
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
0 Agricultural ❑Municipal/Public 0 Neat Cement Grout . 0 Bentonite Chips or I?ellets
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay
0 Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 1>! Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring (Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24
5a.Well location: ✓
Duke Energy O C 1; 2921
Facility/Owner Name Facility ID#(if applicable) 8.Certification: t lr�.
Plant Allen Rd, Belmont, NC, 28012 lI
D �;"-'":-�' 9/9/24
Physical Address,City,and Zip Signature of Certifie Well Contractor or Well Owner Date
Gaston 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 beefs provided to the well owner.
5b.Latitude,and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one 1at/long is sufficient) 9.Site diagram or additional well details:
523678.701 N 1398900.252 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)ifavailahle.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#.
ED-22 abandonment to the following:
Division of Water Resources,Information Processing Unit,
1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: 70 (fL)
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 4 (in.) above, also submit one copy of this;form within 30 days of completion of well
abandonment to the following:
60 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
20 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
NA abandoned
6f.Inner casing/tubing length(if known): (ft.) i
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources I Revised.2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Will Keyes 7a.For Geoprobe/DPT or Closed-Lo I p;Geothermal Wells having the same
Well Contractor Namc(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-301is needed. Indicate TOTAL NUMBER of
4220-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewateri ng FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if knows: NA
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 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑IndustriallCommcrcial ❑Residential Water Supply(shared) ❑Concrete Grout I 0 Drill Cuttings
❑Irrigation 0 Specialty Grout , 0 Gravel
Non-Water Supply Well: IN Bentonite Slurry j 0 Other(explain under 7g)
❑Monitoring URecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal
['Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24 i' In ii....
5a.Well location: i1 O C T 2 ! e024
Duke Energy
8.Certification: I ` - '--`•,ro`-. !-.i''S?sue
Facility/Owner Name Facility ID#(if applicable) hTi*s: - ='-� �„ � .�
Plant Allen Rd, Belmont, NC, 28012 ! •
9/9/24
Physical Address,City,and Zip Signature ofCerti Well Contractor or Well Owner Date
Gaston By signing this form, l 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:
523678.701 N 1398900.252 W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction recordist 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#: ED-2.2) abandonment to the following:
I
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 70 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
1
10b.For Iniection Wells: In addition to sending the form to the address in l0a
6c.Borehole diameter: 4 (in.) above,also submit one copy of this!form within 30 days of completion of well
abandonment to the following: i
i
6d.Water level below ground surface:
(jQ (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Ce i ter,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned. j, .
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources j ; Revised 2-22-2016
I

I
WELL ABANDONMENT RECORD For Internal Usc ONLY:
' 1.Well Contractor Information: WELL ABANDONMENT DETAILS
Wi II Keyes 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-30 isneeded. Indicate TOTAL NUMBER of'
4220-A wells abandoned: I
I
NC Well Contractor Certification Number 7b.Approximate volume of water rei aining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name n I
7c.Type of disinfectant used: N
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if knoun NA
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public ❑ Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: !Bentonite Slurry I 0 Other(explain under 7g)
❑Monitoring !Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
['Aquifer Recharge 0 Groundwater Remediation 49 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
OGeothermal(Heating/Cooling Return) 0 Other(explain under 7g)
4.Date well(s)abandoned: 1 ',.:,....,:,..:.,1_,:' V 4:,Li
5a.Well location: ' OCT 2 e 2024
;
Duke Energy _
Ir,`�,,,._...-.. ::""'"".2.','''..,:‘tit
Facility/Owner Name Facility ID#(if applicable) 8.Certification: I r -_
Plant Allen Rd, Belmont, NC, 28012 I 9/9/24
Physical Address,City,and Zip Signature of Certi a Well Contractor or Well Owner Date
Gaston By signing this form, 1 hereby certify that the we/i(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:
523678.701 N 1398900.252 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
Attach well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the same constntction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well 13)#: E D-24t abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 70 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
4above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) I
abandonment to the following:
I
60 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): 20 (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): NA (ft.) abandoned. ,
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

I
WELL ABANDONMENT RECORD For Internal Use ONLY: ,
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Wi I I Keyes 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 I GW-30 is needed. Indicate TOTAL NUMBER of'
4220-A wells abandoned: III
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
I
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)rfknoxn NA
7d.Amount of disinfectant used: I .
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 0 Dry Clay
0 Industrial/Commercial ❑Residential Watcr Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: El Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ®Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
Cl Experimental Technology ❑Subsidence Control '
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
,- . _ t> ' i'
s�
4.Date well(s) 8/14/24 abandoned: 0(:r2 ss 0 A
5a.Well location:
Duke Energy
Facility/Owner Name Facility ID#(if applicable)
S.Certification: Dijk,c'-31_0
Plant Allen Rd, Belmont, NC, 28012 . 9/9/24
Physical Address,City,and Zip Signature of Certi a Well Contractor or Well Owner Date
Gaston By signing this form, 1 hereby certifr 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:
523678.701 N 1398900.252 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 constntction/abandonment,you can submit one form.
2 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: E D_ abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 70 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
4 above,also submit one copy of this iform within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
60 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): 20 (ft) 10c.For Water Supply&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Will Keyes 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
4220—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water reinaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name •
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known NA
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all;that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 1 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout 1 0 Dry Clay
❑Industrial/Commcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: a Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring IRecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g) 11
4.Date well(s)abandoned: 8/14/24
OCT 2 '2 202-
5a.Well location:
Duke Energy 1 r:C „ , i,:..
Facility/Owner Name Facility TD#(if applicable) 8.Certification: I Q7`ci,6'_'st-.,
Plant Allen Rd, Belmont, NC, 28012 9/9/24
Physical Address,City,and Zip Signature of Certi a Well Contractor or Well Owner Date
Gaston 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 Alp 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:
523678.701 N 1398900.252 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
ONLY with the same construction/abandonment,you can submit one form.
ED-Z 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: abandonment to the following:
I
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 70 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the than to the address in l0a
4 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following: 1
I
6d.Water level below ground surface: 60 (ft,) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (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
Wi II Keyes 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 I GW-30 is needed. Indicate TOTAL NUMBER of
4220-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name NA
7c.Type of disinfectant used:
2.Well Construction Permit#: NA
List all applicable well construction permits(1*.e.UIC,County,State,Variance,etc.)if known
7d.Amount of disinfectant used: NA
3.Well use(check well use): 1
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustrial/Commcrcial ❑Residential Water Supply(shared) 0 Concrete Grout I 0 Drill Cuttings
❑Trrigation 0 Specialty Grout j 0 Gravel
Non-Water Supply Well: U Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring URecovery
Injection Well: 7f.For each material selected above;provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 49 gal ,
❑Aquifer Storage and Recovery ❑Salinity Barrier
i
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer Positive displacement via tremie pipe
OGeothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24 !OCT 2 d 2024
5a.Well location: It,aa,... r''r`'_ c '%o-
Duke Energy ' u:�-;,._ i1;3
Facility/Owner Name Facility ID#(if applicable) 8.Certification: J
Plant Allen Rd, Belmont, NC, 28012 i 9/9/24
Physical Address,City,and Zip Signature of Certi ie Well Contractor or Well Owner Date
Gaston By signing this form, I hereby certifjr 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:
523678.701 N 1398900.252 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
1
ONLY with the same construction/abandonment,you can submit one form.
Z� 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: E D abandonment to the following: ,
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 70 (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:4 (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: 60 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources ' Revised 2-22-2016

I
WELL ABANDONMENT RECORD For Internal Usc ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Will Keyes 7a.For Geoprobe/DPT or Closed-Lo I p Geothermal Wells having the same
Well Contractor Namc(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:
4220-A I ,
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS NA:
Company Name 7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if knorai
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all'that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
0 Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout i 0 Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: S Bentonite Slurry i 0 Other(explain under 7g)
:Monitoring PIRecovery
Injection Well: 7f.For each material selected above,'provide amount of materials used:
i.
❑Aquifer Recharge ❑Groundwater Remediation 49 gal i
❑Aquifer Storage and Recovery 0 Salinity Barrier
:Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24 °ti . ., ...-r_' a ,- ,.,
5a.Well location: •
0 C T 2 2 2024
Duke Energy
Facility/Owner Name Facility ID//(if applicable) 8.Certification: drg;m:,i.r r_
Plant Allen Rd, Belmont, NC, 28012 9/9/24
Physical Address,City,and Zip Signature of Certi a Well Contractor or Well Owner Date
Gaston .
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 latllong is sufficient) 9.Site diagram or additional well details:
523678.701 N 1398900.252 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 constn�tction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
IN:6a.Well I : ED- ` .8 abandonment to the following:
Division of Water Resources,Information Processing Unit,
1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: 70 (ft)
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter:4 (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: 60 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (ft.) 10c.For Water Supply&IniectioniWells: 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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources ; Revised 2-22-2016

r
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
i
WillKeyes 7a.For Geoprobe/DPT or Closed-L I op 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
4220—A wells abandoned: i
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known NA
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 SpecialtyGrout 0 Gravel
Non-Water Supply Well: I Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring (Recovery
Injection Well: 7f.For each material selected above;provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage i
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
I
;.
8/14/24 z;: -
4.Date well(s)abandoned: 1 '`°"' "' L.° 7`S• 3
5a.Well location: O L T 26+ 2024
Duke Energy
S.Certification: h;i�' ,.,..
Facility/Owner Name Facility iD#(if applicable) Ly'„t; S1_3
Plant Allen Rd, Belmont, NC, 28012 ! 9/9/24
Physical Address,City,and Zip Signature of Certi re Well Contractor or Well Owner Date
Gaston By signing this form, I hereby certi,/jr 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:
524126.596 N 1400089.219 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 constnrction/abandonment,you can submit one form.
�� 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: ED- abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
i
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 4 (in.) above,also submit one copy of this?form within 30 days of completion of well
abandonment to the following:
1
6d.Water level below ground surface: 5 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
i.
6e.Outer casing length(if known): 20 (ft.) 10c.For Water Supply&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS '
Will Keyes 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-30 is needed. Indicate TOTAL NUMBER of
4220—A wells abandoned: Ii
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
•
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name NA
7c.Type of disinfectant used:
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if knonii
7d.Amount of disinfectant used: NA
3.Well use(check well use): j
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout i 0 Dry Clay
❑IndustriaUCommercial ❑Residential Water Supply(shared) 0 Concrete Grout ❑Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: U Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring URecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
OGeothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24 ii lI,‘.2...„k._'+1.... +ae...), n'
5a.Well location: ; O C T 2 d 2024
Duke Energy _,-;:_, ,
Facility/Owner Name Facility TD#(if applicable) 8.Certification:
ri.:,;_.
Plant Allen Rd, Belmont, NC, 28012 19/9/24
•
Physical Address,City,and Zip Signature of Certifie Well Contractor or Well Owner Date
Gaston
By signing this form, I hereby certifir 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 c f 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:
524126.596 N 1400089.219 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 i
ONLY with the same construction/abandonment,you can submit one form.
�d 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well met: E D O abandonment to the following: I,
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wens: In addition to sending the form to the address in 10a
6c.Borehole diameter: 4 (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 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (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 DETAII:S
W I I I Keyes 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:
4220-A
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State.Variance,etc)ifknoxn
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
0 Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: II Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring BlRecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge 0 Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
0 Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24
5a.Well location: Q C I b Lo L
Duke Energy
Facility/Owner Name Facility iD#(if applicable) 8.Certification:
Plant Allen Rd, Belmont, NC, 28012 . 9/9/24
Physical Address,City,and Zip Signature of Certi a Well Contractor or Well Owner Date
Gaston By signing this form, /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:
524126.596 N 1400089.219 ,i, 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 m#: E abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in l0a
4 above,also submit one copy of this!form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
5 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
20l0c.For Water Supply&Iniection 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): NA (ft.)
abandoned.
6g.Screen length(if known): 20 (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:
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Wi II Keyes 7a.For Geoprobe/DPT or Closed-LI op 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
4220—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown NA
7d.Amount of disinfectant used: i
3.Well use(check well use): ,
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustriai/Commcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: s Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring IIIRecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge. ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
l-� - " ..s i.
8/14/24 n � . . .a „��°� ,
4.Date well(s)abandoned: I �,
OCT 2 2 2021
5a.Well location:
Duke Energy it,;�:,,....:: ::
Facility/Owner Name Facility TD#(if applicable) 8.Certification: I Di u"'`".`'u
Plant Allen Rd, Belmont, NC, 28012i �. 9/9/24
Physical Address,City,and Zip Si of Certi rW�y Well Contractor or Well Owner Date
Gaston I
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:
524126.596 N 1400089.219 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.
ED— 7� 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID# abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (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:4 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
5 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): 20 (ft.) 10c.For Water Supply&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): (ft.)
NA abandoned.
6g.Screen length of known): 20 (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
Will Keyes 7a.For Geoprobe/DPT or Closed-to'op Geothermal Wells having the same
Well Contractor Namc(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: I
4220-A I '
NC Well Contractor Certification Number 7b.Approximate volume of water remaining
maining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name NA
7c.Type of disinfectant used:
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.WC,County.State,Variance,etc)ifknown
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipallPublic 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) CI Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: II Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring •Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge 0 Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
. ` ,�5,,,., ``. .:,, . 1
8/14/24
4.Date well(s)abandoned: - T 9. '2, `�
274
5a.Well location: U
Duke Energy II-;:3;,,... .r=
Facility/Owner Name Facility ID#(if applicable) 8.Certifrcation: `� °:`: °�'�tj�
Plant Allen Rd, Belmont, NC, 28012
9/9/24
Physical Address,City,and Zip Signature of Certi a Well Contractor or Well Owner Date
Gaston 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:
524126.596 N 1400089.219 �, 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 scone construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: ED-�� abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter:4 (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 (ft,) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
6e.Outer casing length(if known): 20 (ft.) 10c.For Water Supply&Iniection'Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

1
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Will Keyes 7a.For Geoprobe/DPT or Closed-LI op 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
4220-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known NA
7d.Amount of disinfectant used: 1
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑IndustriaVCommcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: a Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ®Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal i
❑Aquifer Storage and Recovery ❑Salinity Barrier I .
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24
5a.Well location: O I-,I 2 2O24
Duke Energy ;-,_-.- �,r::.
S.Certification: h,` .— =' •J
Facility/Owner Name Facility ID#(if applicable) G�':��4
Plant Allen Rd, Belmont, NC, 28012 9/9/24
Physical Address,City,and Zip Signature of Certi t Well Contractor or Well Owner Date
Gaston 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 Iat/long is sufficient) 9.Site diagram or additional well details:
524126.596 N 1400089.219 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#: EDP'2)1-i abandonment to the following: I
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (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 4 (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 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned. 1
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
WillKeyes 7a.For Geoprobe/DPT or Closed-i op 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
4220—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State.Variance,etc.)if known
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustriaUCommercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 SpecialtyGrout ❑Gravel
Non-Water Supply Well: !Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring !Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal 1
❑Aquifer Storage and Recovery OSalinity Barrier
❑Aquifer Test ❑Stomiwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
oGeothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
8/14/24 t:.4 ,c °1 ',!".*:,.1.,:;
4.Date well(s)abandoned: � `L
5a.Well location: on- 9 2 2024
Duke Energy
Facility/Owner Name Facility ID#(if applicable) 8.Certification: I
Plant Allen Rd, Belmont, NC, 28012 . 9/9/24
Physical Address,City,and Zip Signature of Certi a Well Contractor or Well Owner Date
Gaston
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:
524126.596 N 1400089.219 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 1
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#: ED—--S5 abandonment to the following:
i
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (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:4 (in.) above, also submit one copy of this'form within 30 days of completion of well
abandonment to the following:
5 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): 20 (ft.) 10c.For Water Supply&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS j
Will Keyes 7a.For Geoprobe/DPT or Closed-Lo p 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
4220-A wells abandoned: I I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknoxm
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout i 0 Dry Clay
❑Industrial/Commcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout i 0 Gravel
Non-Water Supply Well: •Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring •Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier •
❑Aquifer Test ❑Stormwater Drainage '
I
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
r.
4.Date well(s)abandoned: 8/14/24 rn ,,i.-, w„ i..; 4).gi'...::, .
E 5a.Well location: 0 C T 2 2 2024
Duke Energy ,,
Facility/Owner Name Facility ID#(if applicable) 8.CertiTication: 11ii;;: :,..r.-^^" P-^� `':�:•$ 'n
Plant Allen Rd, Belmont, NC, 28012 9/9/24
Physical Address,City,and Zip Signature of Certi a Well Contractor or Well Owner Date
I
Gaston
By signing this form, I hereby certify that the well(s) was(were) abandoned in
County Parcel Identification No.(PIN) accordance with ISA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
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:
524126.596 N 1400089.219 `,ir 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#: E D- ✓C abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (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:4 (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 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,
ter,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned j
I
6g.Screen length(if known): 20 (ft.)
1
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources j Revised 2-22-2016
I

1
WELL ABANDONMENT RECORD For Internal Use ONLY:
i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Wi I I Keyes 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
4220-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water rI maining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name NA to
7c.Type of disinfectant used:
1
2.Well Construction Permit#: NA '
List all applicable}tell construction permits(i.e.UIC,County,State.Variance,etc)if known
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout I 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout ❑ Gravel
Non-Water Supply Well: a Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring PlRecovery '
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
i
❑Aquifer Storage and Recovery OSalinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer Positive displacement via tremie pipe
OGeothermal(Heating/Cooling Return) 0 Other(explain under 7g)
'
4.Date well(s)abandoned: 8/14/24 ti ° u
5a.Well location: ' OL I .i 2 LUL4
I
Duke Energy .. ,
:.1
11-flues..... �.;.. J-. s- '. Y7:(
Facility/Owner Name Facility ID#(if applicable) 8.Certification: ( 1,1<<c 3 C.-3
Plant Allen Rd, Belmont, NC, 28012 ,<A. . 9/9/24
Physical Address,City,and Zip Signature of Certi a Well Contractor or Well Owner Date
Gaston
By signing this form, /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:
524126.596 N 1400089.219 `,t, 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
Attach well construction record(s)ifavailahle.For multiple injection or non-water supply wells
ONLY with the sane construction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well DM:
ED-31- abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: 4 (in.)
abandonment to the following:
6d.Water level below ground surface: 5 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
i
1
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (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
Will Keyes 7a.For Geoprobe/DPT or Closed-hoop 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
422O—A wells abandoned:
7b.Approximate volume of water lemaining in well(s): 5
(gal.)
NC Well Contractor Certification Number ,
Griffin Dewateri ng FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State.Variance,etc.)if knolm
7d.Amount of disinfectant used: NA
3.Well use(check well use): '
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout I 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay
0 Industrial/Commercial ❑Residential Watcr Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: a Bentonite Slurry 1 0 Other(explain under 7g)
❑Monitoring IBRecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge El Groundwater Remediation 25 gal I
❑Aquifer Storage and Recovery ❑Salinity Barrier '
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control I
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
-
4.Date well(s) 8/14/24 abandoned: d .;‘R_,,,...,i,..:._; .`,, v..�. ..
5a.Well location: 0 r T `2G 24
Duke Energy 1 `'
Facility/Owner Name Facility lUff(if applicable) 8.Certif'ication: 1i_r.,F,-„`' : u
Plant Allen Rd, Belmont, NC, 28012 c=: CI. -r.� 9/9/24
Physical Address,City,and Zip Signature of Certi a Well Contractor or Well Owner Date
Gaston 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:
524126.596 N 1400089.219 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. 1
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
ED—�" abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (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:4 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
I.
I
6d.Water level below ground surface: 5 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (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: I,
1
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Will Keyes 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owncr personally abandoning well on his/her property) well construction/depth,only 1 GW-301is needed. Indicate TOTAL NUMBER of
4220-A wells abandoned:
NC Well Contractor Certification Number - 7b.Approximate volume of water I remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name NA q
7c.Type of disinfectant used:
2.Well Construction Permit#: NA I.
List all applicable well construction permits(Le.UIC,County,State.Variance,etc.)if knolm
7d.Amount of disinfectant used:
3.Well use(check well use):
1
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural 0 Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: III Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring (Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer Positive displacement via tremie pipe
OGeothermal(Heating/Cooling Return) 0 Other(explain under 7g)
4.Date well(s)abandoned: 1 8/14/24 Y4 i
- ,/ k,>,
5a.Well location: ; O C T 2 2 2024
Duke Energy
InfFacility/Owner Name Facility ID#(if applicable) 8.Certifrcation: .A;
Plant Allen Rd, Belmont, NC, 28012 . 9/9/24
Physical Address,City,and Zip Signature of Certi a Well Contractor or Well Owner Date
Gaston 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 t f 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:
524126.596 N 1400089.21 9 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#: E D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (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:4 (in.) above,also submit one copy of this:form within 30 days of completion of well
abandonment to the following: 1
6d.Water level below ground surface: 5 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Form GW-30 - North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
1
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Will Keyes
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
4220-A wells abandoned:
I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifkaom;
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 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 0 Other(explain under 7g)
❑Monitoring uRecovery ,
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage •
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
°Geothermal(Closed Loop) ❑Tracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
•
--,
4.Date well(s)abandoned: 8/14/24 I .,h.-n t.+' s .s, ,4, c,:;La'
5a.Well location: 1 O C T 2 2 2024
Duke Energy
Facility/Owner Name Facility TM(if applicable) S.Certification: iG`is =:_'+i
Plant Allen Rd, Belmont, NC, 28012 9/9/24
Physical Address,City,and Zip Signature of Certifie Well Contractor or Well Owner Date
Gaston
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:
524126.596 N 1400089.219 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
Attach well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the swine construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: E D- Lip abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: 4 (in.)
abandonment to the following:
5 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): 20 (ft.) 10c.For Water Supply&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): NA (ft.) abandoned.
6g.Screen length(if known): 20 (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: I
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Wi II Keyes 7a.For Geoprobe/DPT or Closed Loop Geothermal Wells having the same
Well Contractor Name(or well owncr personally abandoning well on his/her property) well construction/depth,only I GW j30,is needed. Indicate TOTAL NUMBER of
4220-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water(remaining in well(s): 5 (gal.)
Griffin Dewatering FOR WATER SUPPLY WELLS'ONLY:
NACompany Name
7c.Type of disinfectant used:
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e_UIC,County,State,Variance,etc.)iflmoxm NA
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/Commcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: Inn Bentonite Slurry 0 Other(explain under 7g)
OMonitoring PIRecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 25 gal
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stornwater Drainage
0 Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Positive displacement via tremie pipe
0 Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
;
4.Date well(s)abandoned: 8/14/24 e i C_h� ii..r: '4' u; i e; ,a
5a.Well location: 1, O C T 2 2 2024
Duke Energy
Facility/Owner Name Facility 11)11(if applicable) 8.Certification: _ „ s.:
Plant Allen Rd, Belmont, NC, 28012 . 9/9/24
Physical Address,City,and Zip Signature of Ce ti Well Contractor or Well Owner Date
Gaston
By signing this form, I hereby certify that the well(s) was(were) abandoned in
County Parcel Identification No.(PIN) 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.
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:
524126.596 N 1400089.219 `,l, You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
i
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#: ED- Li k abandonment to the following: .
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 35 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in l0a
6c.Borehole diameter: 4 (in.) above,also submit one copy of this torn within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 5 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
1
6e.Outer casing length(if known): 20 (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): NA (ft.) abandoned.
6g.Screen length(if known): 20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS ,
Will Keyes 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 GOO is needed. Indicate TOTAL NUMBER of
4220-A wells abandoned: I
1i i5
NC Well Contractor Certification Number 7b.Approximate volume of water iremaining in well(s): (gal.)
Griffin Dewateri ng FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: NA
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown
7d.Amount of disinfectant used: NA.
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
0 Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustrial/Commercial ❑Residcntiial Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: • @ Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring @Recovery '
Injection Well: 7f.For each material selected above,provide amount of materials used:
DAquifer Recharge ❑Groundwater Remediation 25 gal
DAquifer Storage and Recovery ❑Salinity Barrier
DAquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Positive displacement via tremie pipe
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
4.Date well(s)abandoned: 8/14/24 "a' -'' 1 ,,,d.-
5a.Well location: O C IT 3 b L u 4
Duke Energy lt,f - ..- ;i�u
Facility/Owner Name Facility iD/I(if applicable) 8.Certification: L'Idi,.1, ;J
Plant Allen Rd, Belmont, NC, 28012 , 9/9/24
Physical Address,City,and Zip gofertifte Well Contractor or Well Owner Date
Gaston
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:
524126.596 N 1400089.219 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#: ED 2., abandonment to the following:
Division of Water Resources,Information Processing Unit, •
1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: 35 (ft.)
10b.For Injection Wells: In addition to sending the form to the address in 10a
4 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: 5 (fr.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 20 (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 I health department of the county where
6f.Inner casing/tubing length(if known): NA (ft.) abandoned.
6g.Screen length of known):20 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016