MO-4731_15803_CA_WR_20230912_Well Abandonment

CES Group Engineers, LLP
IMPROVING. PROTECTING. RESTORING.

CHARLOTTE, NC
3525 Whitehall Park Drive, Suite 150
Charlotte, NC 28273

COLUMBIA, SC
1411 Gervais Street, Suite 140
Columbia, SC 29201

www.ces-group.net

September 12, 2023

Scott Ryals, PE
Environmental Engineer
North Carolina Department of Environmental Quality
DWM UST Section
1646 Mail Service Center
Raleigh, North Carolina 27699-1646

RE: Well Abandonment Report
Bost Realty
Incident No.: 15803
UST ID No.: MO-4731
Facility ID No.: N/A
806 S Main Street
Kannapolis, Cabarrus County, North Carolina 28081

Dear Mr. Ryals:

CES Group Engineers, LLP (CES), while under contract with the North Carolina Department of
Environmental Quality (NCDEQ), Contract No.: N042023, executed on February 24, 2023, is
submitting this Well Abandonment Report to you electronically via email.

The subject site is located at 806 S Main Street, in a commercial and residential area of
Kannapolis, Cabarrus County, North Carolina, as depicted on Figure 1.

On August 30, 2023, one groundwater monitoring well, MW-1, with a well depth totaling 32-feet,
as depicted on Figure 2, was abandoned by Daniel Summers of Carolina Soil Investigations,
LLC, Olin, NC, a North Carolina Certified Well Contractor (License Number 2579-A). Photographs
of the abandoned monitoring well are attached in Appendix A.

The one monitoring well was abandoned by pouring tremie grout into the well casing to a depth
of approximately 6-inches below grade, then completing the abandonment with neat cement to
grade, including filling in the well vault, securing the well by placing the well cover back on the
well vault, and then bolting the well cover tight.

A copy of the well abandonment record is included in Appendix B.

CES Group Engineers, LLP
IMPROVING. PROTECTING. RESTORING.
The performed work was authorized by NCDEQ Task Authorization (TA) #02, approved on August
17, 2023. Should you have any questions in regards to this submittal, please do not hesitate to
contact me at [phone].

Regards,

Greg Hans, PMP
Environmental Division Manager

Enclosures: Figure 1 – Site Location Map
Figure 2 – Site Plan
Appendix A – Photographic Log
Appendix B – Well Abandonment Record

FIGURES

^_
SITE LOCATION
Figure 1Site Location MapFormer Bost Realty806 South Main StreetKannapolis, Cabarrus County, North CarolinaDrawn on: 6/12/2023
Drawn by: Amy Schmidt
Reviewed by: Greg Hans
3525 Whitehall Park DriveSuite 150Charlotte, North Carolina 28273T: 704-489-1500www.ces-group.net³
0 2,000 4,000 6,000 8,0001,000
FEET
REFERENCE:USGS The National Map: National Boundaries Dataset, 3DEP Elevation Program, Geographic Names Information System,National Hydrography Dataset, National Land Cover Database, National Structures Dataset, and National TransportationDataset; USGS Global Ecosystems; U.S. Census Bureau TIGER/Line data; USFS Road Data; Natural Earth Data; U.S.Department of State Humanitarian Information Unit; and NOAA National Centers for Environmental Information, U.S.Coastal Relief Model. Data refreshed April, 2023.
CES Project No. 8149.0523E
DRAWN BY: BN
CHECKED BY: GH
PROJECT NUMBER:
8149.0523E
DRAWING TITLE:
SHEET NUMBER:
SEAL:PROJECT DESCRIPTION:Site PlanCES GROUP ENGINEERS, LLP
NC FIRM LICENSE #F-1240 3525 WHITEHALL PARK DRIVESUITE 150CHARLOTTE, NC 28273T 704. 489.1500
www.ces-group.net
DATE: 06/29/2023
SCALE : 1" = 20'

APPENDIX A

PHOTOGRAPHIC LOG

Monitoring Well MW-1 Abandoned

AddiƟonal view of Monitoring Well MW-1 Abandoned

APPENDIX B

WELL ABANDONMENT RECORDS

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:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply)□Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
□Irrigation
Non-Water Supply Well:
□Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stormwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop)□Tracer
□Geothermal (Heating/Cooling Return) □Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
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
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:
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):
□Neat Cement Grout □Bentonite Chips or Pellets
□Sand Cement Grout □Dry Clay
□Concrete Grout □Drill Cuttings
□Specialty Grout □Gravel
□Bentonite Slurry □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:
WM0301285