Craven_Well Abandonment_20240403 (8)

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
i
William J. Miller 7a.Number of wells being abandoned: N/A
Well Contractor Name(or well owner personally abandoning well on his/her property) For muhiple h jection or non-water supply hells ONLY,rith the scone
construction/abandonment,you consubmit one form.
2927A
NC Well Contractor Certification Number 7b.Approximate volume ofwater remaining in well(s): N/A (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: N/A
2.Well Construction Permit#: N/A
List all applicable,rell permits(i.e.County,State,Variance,IDjection,etc.)ifknoum 7d.Amount of disinfectant used: N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout 0Bentonite 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
❑Irrigation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
■Monitoring ❑Recovery
Injection Well: 7L For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite Pellets +/-5 lbs.
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Heating/CoolingReturn) ❑Other(explain under 7g) All well materials r6moved from boring then backfilled
with bentonite pellets for+/-0.5 feet below land surface.
4.Date well(s)abandoned: 12/19/2023
5a.Well Location:
PIE-PS
Facility/Owner Name FacilityDA(ifapplicable) g•Certification:
PIT 4,Havelock, NC 28532 —�" - January 22.2024
Physical Address,City,and Zip Signature of Certified Well.06titractor or Well Owner Date
CRAVEN By signing thisforni 1 hereby cert)5,that the well(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C 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 IatAong is sufficient) 9.Site diagram or additional well details:
34.90897654 N -76.89023757 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 it jeclion or non-water supply
well 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#: P4-TW26 abandonment to the following:
ka L. $ V t--'�-° Division of Water Resources,Information Processing Unit,
6b.Total well depth: 12 (ft.) 20Z4 1617 Mail Service Center,Raleigh,NC 27699-1617
APR v 10b.For Injection Wells: In addition to sending the form to the address in
6c.Borehole diameter: 2 (In.) tn,`.:rlTxki= �`" S�' y Uri 10a above,also submit one copy of this form within 30 days of completion
U.tFu of well abandonment to the following:
6d.Water level below ground surface: 4(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 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
6f.Inner casing/tubing length(if known): 2 (ft.) county where abandoned.
6g.Screen length(if known): 10 (ft.)
\2023\223060-PIE-PS-CHERRY POINT-DELINEATION,WELL INSTALL ABANDONMENT AND INJECTION PROJECfS\PIT 4-PHASE 11 LNAPL DELINEATION\FIELD ITEMS\223060_PIT4_CHERRYPOINT.GPJ
Adapted from NCDENR-DWR Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013

ENVIRONMENTAL,CIVIL
GEOTECHNICAL �1�TLI
WELL LOG NLtrrington,Raleigh,Washington, 1�
Charleston Engineers and Scientists
zzaoso SHEET 1 OF 1
Wilrringtan,NC
PROJECT NO.: 223060 STATE: NC I COUNTY: CRAVEN LOCATION: Havelock
PROJECT: PIT 4 - PIT 5 area aboard MCAS Cherry LOGGED BY: Ashley Jessen WELL ID:
Point DRILLER: William J. Miller P4-TW26
NORTHING: 428524 1 EASTING: 2632459 CREW: S j Chasteen
SYSTEM: NCSP NAD 83 USft DRILL MACHINE: Power Probe T.O.C.ELEV.: 23.46
VERT.DATUM: NAVD88 USft METHOD: DPT 0 HOUR DTW: 8.4 1 TOTAL DEPTH: 12.0
START DATE: 11/28/23 END DATE: 11/28/23 124 HOUR DTW: 11.0 WELL DEPTH: 12.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPm) s G DEPTH DESCRIPTION ELEVATION DETAIL
3.0
0.0 Land Surface 20.5 0.0
0.0 (SM)-Tan to light brown,Silty,0.to f.SAND. Red a -
Direct staining. No HCO o
Push 56.3 M
I U
y
2.0 2.0 18.5 2.0- -
SAA
Direct Push 44.4 M -
4.0 4.0 16.5
(SP)-Tan,v.f.to f.SAND. Slight HCO
Direct 37.2 W
Push '
6.0
6.0 14.5
SAA o a
Direct Push 37 0 W
I U)r _
= U _
-fn
$.0 8.0 12.5 _
SAA
Direct W
Push 36.9
10.0 10.0 10.5
SAA
Direct 340 W
.
Push -
12.0 -
2.o 12.0 8.5 12.0 12.0
BORING TERMINATED AT ELEVATION 8.5 ft
LL
i
Stratigraphy color(LOG)represents inferred stratum
permeability as follows:
■ VERY LOW 0 MEDIUM 0' VERY HIGH
■ LOW 0 HIGH
Native Backrill jI