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Home My WebLink AboutRutherford_Well Abandonment_20240325 WELL A11AN'ONIVIEN'1' RECORD '. For Internal Use ONLY: ' 1.Well Contractor/information: WELL ABANDONMENT DETAILS ' im'v i 0/// A+ 'r- elf.). Z2/- 7a.For Geoprobe/DPT or Closeii-Loop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning NveII t his/her property) well construction:•depth,only I GW-30 is needed. Indicate TOTAL NUMBER of 7 •4 wells abandoned: 1 NC Well Contractor Certification Number /J . 7b.Approximate volume of water remaining in well(s): 3. (gal.) `�,� ��l/��o a,Arse-Ars ZI-1 - FQR WATER SUPPLY WEI.I!S ONLY: • - Company Name • r '^ • 7c.Type of disinfectant used:/ 2.Well Construction Permit#: l ,0 M O)0 0 SeS List all applicable well constructionpermits(i.e. UIC.County.State. Variance.etc.)if known I r 7d.Amount of disinfectant used: i - • 3.Well use(check well use): 1 - i Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public 0 Neat Cement Grout ' 1LBcntonitc Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout i• : 0 Dry Clay • ❑Industrial%Commercial ' '0 Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings ❑In•igation ❑ Specialty Groin i. 0 Gravel . Non-Water-W/� SupplyWell: 0 Bentonite Slurry 0 Other(explain under 7g) •1314 itoring ❑Recovery f . Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge' ❑Groundwater Remediation /3 �i �r. ,{e h/lei 6. '-1 /aL5 ❑Aquifer Storage and Recovery ❑Salinity Barrier DAquifer Test ❑Stormwater Drainage ❑Experimental Technology ❑Subsidence Control - • I • 7g.Provide a brief description of the abandonment procedure: ❑Geothemtal(Closed Loop) ETracer C7Geothennal(Heating/Cooling Return) ❑Other(explain under 7g) Scr.e. e.,4 C A-es`A11 re, , Cl s--6v►-el'•,o! e • • 6.tt e,k,4-C4- tvi/c bd ev ,.�;'/�j el/R/7 4.Date well(s)abandoned: 2 -��iZ4/ • bw /relei-C ! ci ;s•/bw 5ra0, 1 / 0ZW� 6-Jf cV C- 5a.Well location: 0 1Gvitt li�5 , 4!r vv u a�1 T Sinr•�4w ife /�.-//S , Facility Owner Name Facility lD (if applicable) 8.Certification: 1, /q r SP,:4, e$f�eef��,-�.�.c Jirc Z�1da /47 ,___714./... .a0,4 2- �.21 Physical Address.__/ City.and Zip ure Well Contractor or Well Date fiU 7�hekr U r 152 76.S9 Sz-oS By signing this/brat, 1 hereby c•e•li/j• that the u•e1/(s) was in•ere') abandoned in County Parcel Identification No.(PIN) accordance with 15.4 NCAC 02C 10100 or 2C.0200 well Construction Standards • and that a copy of itti.s record has been provided to the well owner. . - 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I' (il'well field.one lat:long isss/ufiiicient) ) 9.Site diagram or additional well details: . 35. S S q L[ (7 N e/- q L9 Li g W You may use the back of this page to provide additional well site detail;or well abandonment details. You may also attach additional pages if'nucssar. j CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS[ :wac•h well commie/ion record/xi if a railable. For multiple injection or non-water.snpplr wells - ONLY with the saute construction abandnnnteni.you gran submit one jihm. I, _ 10a. For All Wells: Submit this form within 30 days of completion of well S 6a.Well ID#: AG-- 0 -•''" ' i 1' Fb{a ndonment to the following: r L.,Li'E,.. # .( r„_, tt • . Division of Water Resources,Information-Processing Unit, MAR 6b.Total well'depth: -CO (ft.) e 2024 1617 Mail Service Center,Raleigh:NC 27699-1617 In•brirca:.'z ?r77.1).:'%2 IAA.For Injection Wells: in addition to sending the form to the address in I0a .,-. -a . 6c.Borehole diameter:• �'Z (in.) 1 %=''�'{' above, also submit one copy of Ihis1 form within 30 days of completion of well abandonment to the following: 6d.Water level below ground surface: '? 3-J{ (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): ells: In addition to sending the form to the address(es)above,also submit one,cgpy of this form within 30 days of completion . of well abandonment to the coitnfy health department of the county where 6f.inner casing/tubing length(if known): Lje•. (ft.) abandoned. • 6g.Screen length(if known): 1 P (ft.) - . - ' . - .. _ ,., ,. .,...._.... ,,,_.....o.,....,...., Re%ised 2-2 -20t(, WELL ABANIONIVIEN 1 RECORD For Internal Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILS ' V` i/I1O-� ,'ram i Ler/y 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 l GW-30:is needed. Indicate TOTAL NUMBER of wells abandoned: / ! 7� ii NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.) 6r FOR WATER SUPPLY WELLS ONLY: Company Name t' ' > 7c.Type of disinfectant used: W 2.Well Construction Permit#: ill `0 D 0 �(q 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 cntonitc Chips or Pellets ❑Geothennal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings ❑Irrigation ❑ Specialty Grout , ❑ Gravel Non-Wier Supply Well: ❑ Bentonite Slurry .I 0 Other(explain under 7g) . 171,0fonitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation ,�?eN4-0•v/e I fle: ;, d £ /, '_: • ❑Aquifer Storage and Recovery ❑Salinity Barrier IJ i, ' ❑Aquifer Test ❑Stormwater Drainage l' • ❑Experimental Technology ❑Subsidence Control 1 7g.Provide a brief description of the abandonment procedure: OGeothennal(Closed Loop) ❑Tracer A ____L/� I k OrCkale ❑Geothennal(Heating/Cooling Retum) ❑Other(explain under 7g) SCrCeJv Cu-.T0"J v'er*"aved Gt.ba.n,cto"0-6.0- cvif die t,'/-o,;/-c /0 ellel-.r 4.Date well(s)abandoned: 2--2-1-21-f q ` 5a.Well location: • Facility/Owner Name Facility ID#(if applicable) 8.Certification: /4"�,i"V l e- t SP„ d�/e,/lob 2S D /(/.„‘„(1. 3,1d___: „..:;(6 1'2 F`z Y . Physical Address,City,and Zip Signature of Certified Well Contractor or Well Date /ewfz et- FD rA /5z712 5-2 0S By signing this form, I hereby certlifj, that the well(.) 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: 3 5- 3 'q (y N g/o 7O 7 i.1 I W You may use the back of this page provide additional well site details or well / L l abandonment details. You may alsoi attach additional pages if necessary. CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS Attach well construction record(,)ijarailable..For multiple injection or non-water supply wells i. ONLY with the same construction/abandonment,you call submit one,form. f� L ,. 10a. For All Wells: Submit this form within 30 days of completion of well Pl 6a.Well ID#: be` / .._ e-"-, . ;..r f t.��^,,:�1 abandonment to the following: (' � `�'�" £ �"i is Division of Water Resources,Information Processing Unit, J 6b.Total well depth: D (ft.) MAR 2 5 2024 1617 Mail Service Center,Raleigh,NC 27699-1617 ' 10b.For Injection Wells: In addition to sending the form to the address in 10a 2.5 IDi'')r'""''n r.r7.:53C4^`'i UlOibove, also submit one copy of this form within 30 days of completion of well 6c.Borehole diameter: (in.) Dtt` Oin'jG abandonment to the following: I ; 6d.Water level below ground surface: (ft.) 3Division 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 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): il/ 0 (ft.) abandoned. •6g.Screen length(if known): t, (ft.) Form G W-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016. WELL ABANJUINIMLIN'I' RF4CUKD For Internal Use ONLY: -- 1.Well Contractor Information: WELL ABANDONMENT DETAILS - !� i7/ r^ h'- it)t in k e•- y 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 3 -7G A- wells abandoned: / 1 NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.) /44 e,#-' ,A.fV; e-6 w J,- e,,, FOR WATER SUPPLY WELLS OILY: Company Name • / f a 7c.Type of disinfectant used: , LA-� 2.Well Construction Permit#: en 6/O b. / List all applicable well construction permits(i.e. U/C,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 i�Bentonitc Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout 0 Drill Cuttings ' ❑Irrigation 0 Specialty Grout ❑ Gravel Non- ater Supply Well: ❑ Bentonite Sluny 0 Other(explain under 7g) N. onttoring ❑Recovery injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation �e, 'v' e��eJ�e I. j /,Fjia s L� 1 • , ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑Stonmwater Drainage i ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer i ❑Geothern,al(Heating/Cooling Return) ❑Other(explain under 7g) S- rCe nr ez.viek Ca--r..^ r vr^a Ad r-e, D /-e_ a.. FJa-keto.c. Q. 4.Date well(s)-abandoned: ' 2 Z- 2_ / 11-edL,[[ �� /f�N•i /el/c-s /1R'7'l✓d eb-'L`-A.k7 .r/O W 5a.Well location: jr o-v,Y7 f/uu., affer Ce.1CoI6,kk-1 1,,,,c,„., Facility/Owner Name Facility iDll(if applicable) 8.Certification: 1 II/ Sp;;("4_4_1 e S/r-ee 1 j ,-,./I /e,NC 2ViG° �,„--jG� 2 — Z k- 2`/ Physical Address,City,and Zip / Signature of Certified Well Contractor or Well Owner Date gv j 4er FO f-� /j 52" /q b s�2_b� By signing this./hrnt, I hereby certify that the well(s) was (were) abandoned in County Parcel Identification No.(PIN) accordance with 114 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: 3 5. 3 S 7 L/4 N — g I- 7 Z 1 Li 1 W You may use the back of this page'to provide additional well site details or well 1 abandonment details. You may also,attach additional pages if necessary. 1 CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS Attach Well construction record(%)iiifavailable.For multiple injection ornon-u•aier supply wells ONLY with the sane construction/abandonment,you can submit one form. i 10a. For All Wells: Submit this form within 30 days of completion of well C / abandonment to the following: . 6a.Well 110: ^.-. , r .-A.._i `r2f4.ra.: 3 Division of Water Resources,Information Processing Unit, 6b.Total well depth: G v (ft.) MAR 1617 Mail Service Center,Raleigh,NC 27699-1617 2 �� cu 10b.For Injection Wells: In addition to sending the form to the address in 10a 2 - 5 inic,fG:i;:k.,?1 ?r', above also submit one copy of this form within 30 days of completion of well 6c.Borehole diameter: (in. �,;. ;,, ""''1 2bandonment to the following: 6d.Water level below ground surface: 3 7 (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service C Inter,Raleigh,NC 27699-1636 IOc.For Water Supply&Injection 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 f of well abandonment to the county health department of the county where 6f.inner casing/tubing length(if known): 3 b (ft.) abandoned. 6g.Screen length(if known): I b (ft.) , Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources 1 Revised 2-22-2016