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Home My WebLink AboutHoke_Well Abandonment_20221118 (6) WELL ABANDONMENT RECORD For Internal Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILS i Matthew Steele 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 4548 A wells abandoned: (NC Well Contractor Certification Number 7b.Approximate volume of water i emaining in well(s): 1.80 (gal.) Geological Resources, Inc. FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: f 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: 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) N Concrete Grout ❑ Drill Cuttings ❑lrri ation ❑ Specialty Grout ❑Gravel Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g) s Monitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Rcmediation 5 Ibs of Concrete 69.2 Ibs of bentonite ❑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 �., -� E ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Pour a L i 4.Date well(s)abandoned: 09/26/2022 NOV i Q 2022 t 5a.Well location: `rtif;r��r Food Stop #1 00-0-0000026072 Facility/Owner Name Facility ID#(if applicable) 8.Certification: �G 513 West Prospect Avenue, Raeford, NC 9/29/2022 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Hoke 6943-4050-1071 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]at/long is sufficient) 9.Site diagram or additional well details: 34.9839694 N 79.2325333 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#: S P-1 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 43.24 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Infection Wells: In addition to sending the form to the address in 10a Un known 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: 32.21 (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): n/a (ft,) loc.For Water Supply&Iniecti I Wells: In addition to sending the form to the address(es)above,also submit one copy of this form within 30 days of completion of well abandonment to the county health department of the county where 6f.Inner casing/tubing length(if known): unknown (ft) abandoned. II 6g.Screen length(if known): unknown (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 Matthew Steele 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 4548 A wells abandoned: I NC Well Contractor Certification Number 7b.Approximate volume of water,;remaining in well(s): 0.22 (gal.) Geological Resources, Inc. FOR WATER SUPPLY WELLS,ONLY: Company Name 7c.Type of disinfectant used: 2.Well Construction Permit#: N/A List all applicable well construction permits(i.e.UIC,County,State, Variance,etc)if known 7d.Amount of disinfectant used:' 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ® Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay ❑Ind ustrial/Commercial ❑Residential Water Supply(shared) a Concrete Grout ❑ Drill Cuttings ❑Irri ation ❑ Specialty Grout ❑Gravel Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g) RMonitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation 5 Ibs of Concrete 32.11 Ibs of Bentonite ❑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 Pour ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) 4.Date well(s)abandoned. 09/26/2022 v t1 5a.Well location: Food Stop #1 00-0-0000026072 h;, r s"r�r`' S.Certification: rwi ?�"'�' Facility/Owner Name Facility m#(if applicable) 513 West Prospect Avenue, Raeford, NC 9/29/2022 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Hoke 6943-4050-1071 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 Sb.Latitude and longitude in degrees/minuteslEeconds or decimal degrees: and that a copy of this record has been provided to the well owner. (if well field,one lat/long is sufficient) 9.Site diagram or additional well details: 34.9839694 N 79.2325333 `,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. CONSTRUCTION DETAILS OF WELL(S)B+�ING ABANDONED SUBMITTAL INSTRUCTIONS Attach well cons7ruction 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 thisform within 30 days of completion of well 6a.Well ID#: SVE-1 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: (ft.) 24.70 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Infection Wells: In addition to sending the form to the address in 10a 6e.Borehole diameter: unknown (in) above, also submit one copy of this form within 30 days of completion of well abandonment to the following: 23.37 Division of Water Resources,U i nderground Injection Control Program, 6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636 I n/a 10c.For Water Supply&Infection 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 counity health department of the county where 6f.Inner casing/tubing length(if known): unknown (ft.) abandoned. 6g.Screen length(if known): unknown (ft) I I Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 f WELL ABANDONMENT RECORD For Internal Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILS Matthew Steele 7a.For Geoprobe/DPT or Closedi 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 4548 A wells abandoned: NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 1.34 (gal.) Geological Resources, Inc. FOR WATER SUPPLYWELLSONLY: Company Name 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: 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout C Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay ❑industrial/Commercial ❑Residential Water Supply(shared) a Concrete Grout ❑ Drill Cuttings ❑Irri ation ❑ Specialty Grout ❑Gravel Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g) ' RMonitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation 5 Ibs of Concrete 55.5 Ibs of Bentonite ❑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 Pour ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) 4.Date well(s)abandoned. 09/26/2022 5a.Well location: Food Stop #1 00-0-0000026072 ;,� lV��1l�' yjae�'JJL7 - Facility/Owner Name Facility ID#(if applicable) 8.Certification: i 513 West Prospect Avenue, Raeford, NC " 9/29/2022 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Hoke 6943-4050-1071 By signing this form, I hereby ceriify 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) i 9.Site diagram or additional well details: 34.9839694 N 79.2325333 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 constructioniabondonment,you can submit one form. 10a. For All Wells: Submit this:form within 30 days of completion of well 6a.Well ID#: T-1 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 42.66 00 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: unknown (in) above, also submit one copy of this form within 30 days of completion of well abandonment to the following: 34.42 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): n/a (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): 38 (ft.) abandoned. 6g.Screen length(if known): 5 (ft.) i Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016