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Home My WebLink AboutBrunswick_Well Abandonment_20231006 t t • WELL ABANDONMENT RECORD For Internal Use ONLY: i • 1.Well Contractor Information: WELL ABANDONMENT DETAILS John E. Salmon 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 wells abandoned: I 3497 -A NC Well Contractor Certification Number . 7b.Approximate volume of water remaining in well(s): 33 (gal.) Applied Resource Management FOR WATER SUPPLY WELLS ONLY: Company Name HtH 7c.Type of disinfectant used: 2.Well Construction Permit#: List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known '16 oz 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 0 Neat Cement G t, , t$Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Go`"i �il t �r t;5„f r—fl ry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout /a 0 Drill Cuttings ❑Irrigation 0 Specialty Grout OCT `�0 20230 Gravel • Non-Water Supply Well: ❑Bentonite Sl ai pttb,er(explain under 7g) -XMonitoring ❑Recovery _ • � �t ;��r � '1 Injection Well: 7f.For each material selegrIfillfgnovide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation . 4 bags of bentonite chips ❑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 ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Dug 12" below grade and cut the casing. Then porued 16 oz of HtH and bentonite chips until 6" above 4.Date well(s)abandoned: 8/3/2023 . • grade. Then backfilled with soil. . . 5a.Well location: Island of Bald Head Facility/Owner Name Facility ID#(if applicable) 8.Certi cation: 5 Merchants Row, Bald Head Island NC 28461 An. (°-'c5a. rem 8/4/2023 Physical Address,City,and Zip Signa a of Certified Well Contractor or Well Owner Date Brunswick 2642J02302 By signing this form,I hereby certify that the well(s) was(were)abandoned in County Parcel Identification No.(PIN) accordance with ISA 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: 33 51 24 553 N -77 5858 685 w You may use the back of this page to provide additional well site details or well abandonment details. You may alsc1 attach additional pages if necessary. CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS Attach-well-onstrueliomrecord69-ifm'ailable.-For-mltipleinjeetionor-non-watersupplywells i _ _ 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#: #2 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 57 (ft.) • 1617 Mail Service Center,Raleigh,NC 27699-1617 tub.For Iniection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: 8 (in.) above, also submit one copy of this form within 30 days of completion of well abandonment to the following: 6 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): (ft.) 10c.For Water Supply&Iniection 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): 37 (ft.) abandoned. 6g.Screen length(if known): 20 (ft.) Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 WELL ABANDONMENT RECORD For Internal Use ONLY: I 1.Well Contractor Information: WELL ABANDONMENT DETAIILS John E. Salmon 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 1 30 is needed. Indicate TOTAL NUMBER of wells abandoned: 3497 -A 1 NC Well Contractor Certification Number 7b.Approximate volume of water!re'maining in well(s): 35 (gal.) Applied Resource Management - FOR WATER SUPPLYWELLS;ONLY: Company Name HtH , 7c.Type of disinfectant used: 2.Well Construction Permit#: List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known 16 oz 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 0 Neat Cement Grout-'F `i.,.. �t ,{jai`i nite Chips or Pellets bk (L.,yi t` n_ ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout `ry`Clay ❑Industrial/Commercial DResidential Water Supply(shared) 0 Concrete Grout O C T 0:b zon Drill Cuttings ❑Irrigation ❑ Specialty Grout ❑ Gravel Non-Water Supply Well: ❑Bentonite Slur4 2W2,--B' 1t:`s . tildth (explain under 70) . • 1Monitoring ORecovery 'Its:-a Injection Well: If.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation 4 bags of bentonite chips ❑Aquifer Storage and Recovery ❑Salinity Barrier , ❑Aquifer Test ❑Stormwater Drainage DExperimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer Dug 12" below grade and cut the casing. Then ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) pored 16 oz HtH. Then poured 4 bags of bentonite . 4.Date well(s)abandoned: 8/3/2023 chips 6" above casing.. • 5a.Well location: ,• Island of Bald Head • , Facility/Owner Name Facility ID#(if applicable) 8.Certi cation: 5 Merchants Row, Bald Head.Island NC 28461 i14, ( 5alo efrp • 8/3/2023 Physical Address,City,and Zip Signa e of Certified Well Contractor or Well Owner Date Brunswick 2642J02302 By signing this form, I hereby certify that the well(s)was(were) abandoned in County Parcel Identification No.(PIN) accordance with 15,4 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: 33 51 24 484 N -77 5858 495 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 SUBMITT-AL-INSTRUC-T-IONS' ' ,Iitacb-weldconslrueiion record(s)-IfovallabiePornmitiple-inlecrron or non-water supply wells - - - -- - ONLY with the.sane construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#: #1 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 58 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Injection Wells: In addition to sending the form to the address in I0a 6c.Borehole diameter: 8 (in.) above, also submit one copy of this form within 30 days of completion of well abandonment to the following: 6d.Water level below ground surface: 6 (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): (ft.) 10c.For Water Supply&Injection Wells: In addition to sending the fonn 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): 39 (ft.) abandoned. 6g.Screen length(if known): 20 (ft.) Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources) Revised 2-22-2016