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Home My WebLink AboutAS-825_9701_CA_LTRRPT_20230905_MW Abandon WithersRavenel Our People. Your Success. 115 MacKenan Drive | Cary, NC 27511 t: 919.469.3340 | f: 919.467.6008 | www.withersravenel.com | License No. F‐1479 Asheville | Cary | Charlotte | Greensboro | Lumberton | Pittsboro | Raleigh | Southern Pines | Wilmington September 5, 2023 State of North Carolina Department of Environmental Quality Federal & State Lead Program Division of Waste Management‐Underground Storage Tank Section 1646 Mail Service Center Raleigh, North Carolina 27699‐1646 Attn: Mr. Scott Ryals, P.E. Reference: Letter Report – Well Abandonments Valdese General Hospital 724/730 Malcom Boulevard Valdese, Burke County, North Carolina Groundwater Incident Number: 9701 UST Number: AS‐825 WR Project Number: 23‐0307‐FL Mr. Ryals, WithersRavenel, Inc. (WR) has prepared this Letter Report documenting the completion of well abandonment activities completed at the Valdese General Hospital site in Valdese, Burke County, North Carolina. Activities outlined herein were completed under NCDEQ Contract # N70522‐C, Task Authorization (TA) 01 for the site, issued by NCDEQ on August 3, 2023. WR mobilized to the site on August 31, 2023, to complete the abandonment of monitoring wells MW‐1 and MW‐A. The activities completed in association with this TA are discussed in the following paragraphs. Well Abandonments – MW‐1, MW‐A Prior to the abandonment of monitoring wells MW‐1 and MW‐A as described below; each well was gauged for Light Non‐Aqueous Phase Liquid (LNAPL) and depth to water using a decontaminated electronic oil/water interface meter. No LNAPL/free product was measured within the wells. Groundwater levels in the monitoring wells measured on August 31, 2023 are shown below: Well ID Depth to Groundwater (ft) Total Well Depth (ft) MW‐1 24.91 25 MW‐A 25.88 35.6 WithersRavenel Our People. Your Success. Valdese General Hospital Incident # 9701 WR Project # 23‐0307‐FL Letter Report – Well Abandonments September 2023 2 Following gauging, each monitoring well was abandoned through the emplacement of 3/8‐in dia. bentonite pellets to within 1‐ft of each wells’ top of casing (TOC). The remainder of each well was filled with neat cement grout extending out of the TOC filling the well manholes. The well abandonment record (NCDEQ GW‐30) is included as Attachment A, while field notes and site photos for completion of the activities are provided as Attachment B. WithersRavenel appreciates the opportunity to be of service to the Federal & State Lead Program. Should you have any questions regarding the attached, please do not hesitate to contact WithersRavenel at (919) 469‐3340. Cordially, WithersRavenel Kevin B. Buchanan G. Matthew James, P.G. Project Manager Director of Geosciences Enclosure(s): NCDEQ GW‐30 (Abandonment Record) Field Notes/Site Photos WithersRavenel Our People. Your Success. Valdese General Hospital Incident # 9701 WR Project # 23‐0307‐FL Letter Report – Well Abandonments September 2023 ATTACHMENT A NCDEQ GW‐30 WELL ABANDONMENT RECORD WELL ABANDONMENT RECORD Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016 1. Well Contractor Information: Well Contractor Name (or well owner personally abandoning well on his/her property) NC Well Contractor Certification Number Company Name 2. Well Construction Permit #: List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known 3. Well use (check well use): Water Supply Well: ƑAgricultural ƑMunicipal/Public ƑGeothermal (Heating/Cooling Supply)ƑResidential Water Supply (single) ƑIndustrial/Commercial ƑResidential Water Supply (shared) ƑIrrigation Non-Water Supply Well: ƑMonitoring ƑRecovery Injection Well: ƑAquifer Recharge ƑGroundwater Remediation ƑAquifer Storage and Recovery ƑSalinity Barrier ƑAquifer Test ƑStormwater Drainage ƑExperimental Technology ƑSubsidence Control ƑGeothermal (Closed Loop)ƑTracer ƑGeothermal (Heating/Cooling Return) ƑOther (explain under 7g) 4. Date well(s) abandoned: 5a. Well location: Facility/Owner Name Facility ID# (if applicable) County Parcel Identification No. (PIN) 5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field, one lat/long is sufficient) N W CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED 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. 6a. Well ID#: 6b. Total well depth: (ft.) 6c. Borehole diameter: (in.) 6d. Water level below ground surface: (ft.) 6e. Outer casing length (if known): (ft.) 6f. Inner casing/tubing length (if known): (ft.) 6g. Screen length (if known): (ft.) WELL ABANDONMENT DETAILS 7b. Approximate volume of water remaining in well(s):(gal.) FOR WATER SUPPLY WELLS ONLY: 7c. Type of disinfectant used: 7d. Amount of disinfectant used: 7e. Sealing materials used (check all that apply): Ƒ Neat Cement Grout Ƒ Bentonite Chips or Pellets Ƒ Sand Cement Grout Ƒ Dry Clay Ƒ Concrete Grout Ƒ Drill Cuttings Ƒ Specialty Grout Ƒ Gravel Ƒ Bentonite Slurry Ƒ Other (explain under 7g) 7f. For each material selected above, provide amount of materials used: 7g. Provide a brief description of the abandonment procedure: 8. Certification: Signature of Certified Well Contractor or Well Owner Date By signing this form, I hereby certify that the well(s) was (were) abandoned in 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. 9. Site diagram or additional well details: 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. SUBMITTAL INSTRUCTIONS 10a. For All Wells: Submit this form within 30 days of completion of well abandonment to the following: Division of Water Resources, Information Processing Unit, 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 abandonment to the following: Division of Water Resources, Underground Injection Control Program, 1636 Mail Service Center, Raleigh, NC 27699-1636 10c. For Water Supply & Injection Wells: In addition to sending the form to the address(es) above, also submit one copy of this form within 30 days of completion of well abandonment to the county health department of the county where abandoned. For Internal Use ONLY: George M. James 4164-C 7a. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of wells abandoned: WithersRavenel, Inc. N/A Bentonite Neat Cement ~# ~# 08//2023 Bentonite pellets gravity fed into wells to within one- foot of well's top-of-casing. Remainder of wells filled with neat cement extending above well's TOC and filling manholes.9DOGHVH*HQHUDO+RVSLWDO NCDEQTF# 0DOFRP%OYG9DOGHVH1& Physical Address, City, and Zip %XUNH °° MW-1,MW-$ 6 a Varies Varies 08/2023 WithersRavenel Our People. Your Success. Valdese General Hospital Incident # 9701 WR Project # 23‐0307‐FL Letter Report – Well Abandonments September 2023 ATTACHMENT B FIELD NOTES AND SITE PHOTOS WithersRavenel Our People. Your Success. Valdese General Hospital Incident # 9701 WR Project # 23‐0307‐FL Letter Report – Well Abandonments September 2023 PHOTO 1 MW‐1 PHOTO 2 MW‐1 FOLLOWING ABANDONMENT WithersRavenel Our People. Your Success. Valdese General Hospital Incident # 9701 WR Project # 23‐0307‐FL Letter Report – Well Abandonments September 2023 PHOTO 3 MW‐A PHOTO 4 MW‐A FOLLOWING ABANDONMENT