Craven_Well Abandonment_20220907

A
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
L Well Contractor Information: WELL ABANDONMENT DETAILS
KENNY SARGENT 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) /'or multiple injection or non-taneir supply ere/tiv ONLY with the .tame
construction abandannient,you con submit one lbrnt.
A - 4226
7b.Approximate volume of wateriremaining in well(s): 2'S (gal.)
NC Well Contractor Certification Number _
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS'ONLY:
Company Name S_p 2022 7c.Type of disinfectant used:
2.Well Construction Permit#: �r O `t
/.i.,t all applicable hell construction permits(i.e.Counn',Slate.6ariattee.etc- il:(;aut,.c� (� l'
:n.•.•:•=tJ 7d.Amount of disinfectant used:
ltl'i ii ::d'r:
3.Well use(check well use): u "
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: If.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 4.0 GALLONS
❑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 ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
a.Date well(s)abandoned: 08/24/22
5a.Well location:
MCAS CHERRY POINT
Facility/Owner Name Facility IDti(ifapplicable) 8•Certification: _
100 ROOSEVELT BLVD HAVELOCK 28532 08/2S/22
Physical Address.City,and Zip Signature of Certified Well Contractor or,Well Owner Date
CRAVEN By signing this form. I hereby certify that the irell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0)00 or 2C.0200 Well Constnuction Standards
and that a copy of this record has been provided to the irell owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one tat/long is sufficient) 9.Site diagram or additional well details:
340 52' 43.88" N 760 54' 10.74" " You may use the back of this page to provide additional well site details or well
abandonment details. You may also6ttach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
:lunch it ell construction record(t)ilt arailable. l•or nnthiple injection or non-w0ter supply
ire/Lv ONLY frith thesatne consirucaooabondomnenf,you can submit oneJortre 10a. For All Wells: Submit this(form within 30 days of completion of well
6a.Well ID#:
OU 1-15GW02 abandonment to the following: i
Division of Water Quality,Information Processing Unit,
6b.Total well depth:
25.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
2.0 above.also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the followine:
6d.Water level below ground surface: 1 0.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
loc. For Water Supply& Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft. 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 crnum
6f.Inner casing/tubing length(if known): where abandoned.
(ft.)
I
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
i
r
I

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
KENNY SARGENT 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) l;or multiple h jection or non-water supphv we/tv ONLY with the scone
A - 4226 construction abandonment,you can submit one Jarm.
NC Well Contractor Certification i\umber
7b.Approximate volume of water'remaining in well(s): 2.5 (gal.)
'� C` rrH
GEOLOGIC EXPLORATION �^ c °°' FOR WATER SUPPLY WELLS ONLY:
ti•'-• � _
Company Name 2022 7c.Type of disinfectant used:
2.Well Construction Permit q: Sr P O 1!
List all applicable ire//c•oostruction permits(i.e.County,State. 1%ariance,etc flun7wn, Uni
_�A:._.,� ,.✓.:>: •�� 7d.Amount of disinfectant used: .
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑AgrlCultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: O Bentonite Slurry ❑Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 4.0 GALLONS
OAquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwvater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
d.Date well(s)abandoned: 08/24/22
5a.Well location:
MCAS CHERRY POINT
Facility/Owner Name Facility ID4(ifapplicable) 8•Certification: j
100 ROOSEVELT BLVD HAVELOCK 28532 08/25/22
Physical Address.City.and Zip Signature of Certified Well Contractor or Well Owner Date
CRAVEN By signing this form. I hereby certify that the ive(!(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with/SA NCAC 02C.01,,00 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the we!!owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field.one lat/long is sufficient) 9.Site diagram or additional well details:
340 52' 35.30" N, 760 54' 53.65" 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)iJ*arailable. I•'or multiple injection or min-crater supplt
trellvONLYfriththescone construction abandonment.You con submitonejorm. 10a. For All Wells: Submit this form within 30 days of completion of'well
Ga.Well ID#:
OU 1-15GW03 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 25.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
2.0 above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (itt•) abandonment to the following:
10.0 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.)
1636 Mail Service Center,Raleigh,NC 27699-1636
toe. For Water Supply& Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft•) the address(es) above, also submit lone copy of this form within 30 days of'
completion of well abandonment to the county health department of the county
6f.Inner casing/tubing length(if known): where abandoned.
(ft.) I;
4
6g.Screen length(if known): (ft.)
Fonn G W-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 201?
I

t
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
KEN NY SARGENT 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) 1;or multiple inyec•tion or non-iratei supply wells ONLY iriih the Name
c•onsiruction abandonment.You can subnili one,/orm.
A - 4226
7b.Approximate volume of water('remaining in well(s): 2"5
NC Well Conhactor Certification Number (gal.)
i.
GEOLOGIC EXPLORATION „.. FOR WATER SUPPLY WELLS'ONLY:
Company Name 16
�a. -F 7c.Type ofdisinfectant used:
2.Well Construction Permit#: _ 0, q
T
Lis'i al!npplicahle hell cun.ciruciion pennitc(i.e.County.SYaie, D �k"it �e,c •.) knuuvt
� � f�7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: .% 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: 91 Bentonite Slurry ❑ Other(explain under 7g)
Zl Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Agttiter Recharge ❑Groundwater Remediation 4.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Storm water Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE�PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 08/24/22
Sa.Well location:
MCAS CHERRY POINT
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
100 ROOSEVELT BLVD HAVELOCK 28532 ��� 08/25/22
Physical Address.City,and Zip Signature of Certified Well Contractor or Well Owner Date
i
CRAVEN By signing this form. !hereby certify that the wells) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
340 52' 48.48" N 760 54' 28.02" W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Anach❑•ell construction record(s)ijaroilable. hor multiple ityec•tion or non-water supply
hells ONLY iriih the same con.siruction abandonment,you con submit one Jornt. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
OU 1-15GW04 abandonment to the following:
Division of Water Quality,Information Processing knit,
25.0 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b. For Infection Wells: In addition to sending the form to the address in 10a
20 above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the
. following:
I,
10.0 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply& IniectionI Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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 count%
6f Inner casing/tubing length(if known): (ft.) where abandoned.
G
G
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Qualpty Revised\•larch 2013
Y

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
KENNY SARGENT 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) l'br mhdtiple infect/' or non-water supply wells ONLY with the .vunu-
A - 4226 cons(rnctiun abundunmeni,you con.suhnni vine f lrnh.
11
' r!:� 7b.Approximate volume of water remaining in well(s): 2'S (gal.)
NC Well Contractor Certification Number ���a.6 t_s'i
GEOLOGIC EXPLORATION . 2 FOR WATER SUPPLY WELLS ONLY:
�n n
Company Name J I V— `!r�7c.Type of disinfectant used: 1
2.Well Construction Permit#: - '`' '^,
l,iet ull applicable well'cnnctruction pernrity(i.e,CounOc St (e.6orianck. r.y�f/' tnu•n 7d.Amount of disinfectant used: 1
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑lrri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 4.0 GALLONS
❑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 ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Retum) ❑Other(explain under 7g)
4.Date well(s)abandoned: 08/24/22
5a.Well location:
MCAS CHERRY POINT
Facility/Owner Name Facility[DO(if applicable) 8•Certification:
100 ROOSEVELT BLVD HAVELOCK 28532 08/25/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
CRAVEN 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.0/00 or 2C.0200 Well Constniciion Standards
and that a copy of this record has been provided to the well owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field.one lat!long is sufficient) 9.Site diagram or additional well details:
340 52' 46.74" N 760 54' 14.85" " 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 SUMMITTAL INSTRUCTIONS
Attach well conv(ntction record(s)i%arailahle. lohr muHiple ihjection or non-water stlpph
we/lc Oh'/,Y wit((he.came constnuvimh abandnnnhent,you can suhmi(one%rIn Ion. For All Wells: Submit this!form within 30 days of completion of well
6a.Well ID#:
OU1-15GW05 abandonment to the following
Division of Water Quality,Information Processing knit,
6b.Total well depth: 25.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob. For Infection Wells: In addition to sending the form to the address in l0a
2,0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (1n.) abandonment to the following:
10.0 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Celnter,Raleigh,NC 27699-1636
loc. For Water Sungly& Infection Wells: In addition to sendine the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submitl one copy of this form within 30 days of
completion of well abandonment to the county health department of the cowry
where abandoned.
6f.Inner casing/tubing length(if known):
6g.Screen length(if known): (ft.
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
gr
fi

WELL ABANDONMENT RECORD For Internal Use ONLY: C
This form can be used for single or multiple wells
i
I.Well Contractor Information: WELL ABANDONMENT DETAILS
KENNY SARGENT 7a.Number of wells being abandoned: 1
Well Contractor Nmne(or well owner personally abandoning well on his/her property) Vor nntlliple injection or non-:rater supply wells ONLY with the .carve
construction abondomnent,eon can subm' one%rm.
A - 4226
NC Well Contractor Certification Number
7b.Approximate volume of water remaining in well(s): 2.5 (gal.)
`�i i
�5 �. sb
GEOLOGIC EXPLORATION �'y FOR WATER SUPPLY WELLS ONLY:
Company Name � b16'•
7c.Type of disinfectant used: j
2.Well Construction Permit#:
Lip all applicable yell construction permits(i.e.('ounty,Sate.Variance,,etc;.),jfit n)i� 7ti.Amount of disinfectant used:
.•�,••�i'rl n
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: i➢ Bentonite Slurry ❑ Other(explain under 70
ElMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 4.0 GALLONS
❑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 ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) ,
d.Date well(s)abandoned: 08/24/22
Sa.Well location:
MCAS CHERRY POINT
Facility/Owner Name Facility ID#(if applicable) g-Certification:
100 ROOSEVELT BLVD HAVELOCK 28532 08/25/22
Physical Address.City,and Zip Signature of Certified Well Contractor or Well Owner Date
CRAVEN By signing this form. 1 hereby certi�y that the wells) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
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:
340 52' 57.51" 760 54' 51.20" You may use the back of this page fo provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF NVELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
,•mach yell construction record(s)if mailable. Ivor rttuhiple b jerlion or non-wafer supply
vel/s ONLY with the saute constructionabantonntew,you can subunit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
OU 1-15GW06 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 25.0 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
2.0 above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
i
6d.Water level below ground surface: 10.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I0c. For Water Supply& IniectioI Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft') 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
i6f.Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Form G W-30 North Carolina Department of Environment and Natural Resources—Division or Water Quality Revised vlarch 201