Carteret_Well Abandonment_20230315

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WELL ABANDONMENT RECORD For Internal Use ONLY: •
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Lawrence D. Opper 7a.Number of wells being abandoned: 7
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water supply wells ONLY with the same
construction/abandonment,you can submit one form.
NC 3322-A 0
^ A P 1 7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
Regional Probing Services MAR 1 L 5 9093 FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.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 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout ❑ Drill Cuttings
❑Irrigation 0 Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
11Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge 0 Groundwater Remediation Bentonite Chips:1.6 lbs/ft(56 lbs/well)
❑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 Filled/hydrated from bottom-up. Capped with concrete.
❑Geothermal(Heating/Cooling Retum) ❑Other(explain under 7g)
MW-1R(15'), MW-2R(15'), MW-5(14'), MW-6(15'), MW-7(15')
4.Date well(s)abandoned: 1/20/2023 MW-8 (15'), MW-9 (15')
5a.Well location:
H&D Express
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
' 3439 Highway 24, Newport Lawrence Oppep „ -- 2/17/2023
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Carteret By signing this form, 1 hereby certt&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:
34.71994359 76.95718 You may use the back of this page to provide additional well site details or well
N W 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# See 7g abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth 14-15 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
lOb.For Injection Wells: In addition to sending the form to the address in 10a
well dia: 2 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: approx 7.85-10.65(ft) Division of Water Quality,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
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
where abandoned.
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): 10 (ft.) •
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013