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Home My WebLink AboutCumberland_Well Abandonment_20240429 (3) i WELL ABANDONMENT RECORD FDElntemalUse ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAt S Ken Dlediker, 7a:For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on his/her p'ropefty) well cotistructibn/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of n/a (federal employee) weds abandoned:1 II NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.) US Army Corp of Engineers, Savannah District FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: 2.Well Construction Permit#: List all applicable well construction permits(i.e.UIC County,State,Variance,etc.)tfknown 7d.Amount of disinfectant used: 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑MunicipaliPublic ❑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) ❑ Concrete Grout ❑ Drill Cuttings ❑Irri ation: ❑ Specialty Grout ❑Gravel. Non-Water Supply Well: ❑Bentonite Slurry 0 Other(explain under 7g) RMonitoring ❑Recovery Injection Well: 7E For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation 2 bag ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑Stormwater Drainage, ❑Experintental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure: OGeothermal.(Closed Loop) []Tracer ❑Geothermal(Heating/Cooling Return) ❑other(explain under 7g)- Bentonite chips poured into.borehole and,hydrated. 02/26/2024 TT,. :� 4.Date wells)abandoned: `6 �t�)� i �I 5a.Well location: i'APR .2 $ N US Army- Ft. LibertyUM _ Facility/Owner Name Facility ID# ifa applicable) 8.Certification tY C PP ) Gruber Rd and Lane St., Fort Liberty; 28307, DIEDIKEa.KENNETH.D.1607235984 13,E 04/23/2024 Physical Address;City,and Zip Signature of Certified Well Contractor of Well Owner Date Cumberland By signing this form, I 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 and that a copy of this record has been provided to the ivell 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:. 35.131075 N -78.957420 `1l, 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 SUBNIITTAL INSTRUCTIONS Attach well construction records)ifavailable.For multiple injection or non-water supply wells ONLY wiih the same comtructio»/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well 6a:Well ID#: MW86-3R abandonment to the following: Division of Water Resources,Information Processing Unit, 66.Total well depth: 35.5 (ft) 1617 Mail Service Center,Raleigh,NC 276994617 10b.For Infection Wells:. In addition to sending the form to the address in 10a 6c.Borehole diameter: 4.25 (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: 28.2. (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 tI i 6e.Outer casing length(if known): 35.5 (ft.) 10c.For Water Supply&Infection Wells: In addition to sending the form to the address(es)above,also submit oneicopy of this form within 30 days of completion of well.abandonment to the county health department of the county where 611,Inner casing/tubing length(if known); (ft.) abandoned. i 6g.Screen length(if known): 10 (ft.) Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 i ; WELL ABANDONMENT RECORD FDr Internal use ONLY:, 1.Well Contractor Information: WELL ABANDONMENT DETAILS' Ken Diediker 7&For Geoprobe/DPT or Closed-IJoop 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 n/a (federal employee wells abandoned:to NC Well Contractor Certification Number 7b.Approximate volume of water remaiiiing'in well(s): (gal.). US Army.Corp of Engineers, Savannah District. . FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: 2.Well Construction Permit#: List all applicable well construction permits(i.e.'UIC,County,State,Variance,elc.)jknown 7d.Amount of disinfectant used: 3.Well use(check well use): ' . Water Supply-Well: 7e.Sealing materials used.(check ail that apply): ❑Agricultural ❑Municipal/Public ❑Neat Cement Grout IN Bentonite 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 ❑hTi ation ❑ Specialty Grout ❑ Gravel Non-Water Supply Well: ❑Bentonite Slurry ❑ Other(explain under 7g) RMonitoring ❑Recovery Injection Well: 7E For each material selected above,provide amount of materials used: ❑AquiferRecharge ❑GroundwaterRemediation 1 bag*, ".'. ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test - ❑Stormwater Drainage; ❑Experimental Technology ❑Sub'sidence Control 7g.Provide a brief description of the abandonment procedure: . ❑Geothermal(Closed Loop) ❑Tracer - ❑Geotherinal(Heating/CoolingReturit) ❑Other(ezplain under 7g) Bentonite chips poured into borehole and hydrated.. 4.Date well(s)abandoned: 03/01/2024 _,r Sa.Well location: A S 2024 US Army-.Ft. Liberty t . . l'Il�ii+"Ti'%cii*.i i.:... .f,•i'.g.: s�t�r.�i Facility/Owner Name Facility ID#(if applicable) 8.Certification: Rock Merritt Ave. and Letterman Street, Fort Liberty; 28307 DIEDIKEFi.KENNE7H.D.7607235984/a mza.7,"�39« 04/16/2024 Physical Address;City,and Zip' Signature of Certified WeII Contractor or Well Owner- Date Cumberland By signing this form, I hereby certify that the ivell(s) tvas (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: (ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details: 35.1547996199 N 78.9989618703 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 wiih.the same constructionlabandonment,you can submit one form. ,r� 10a:'For All Wells: Submit this,form within 30 days of completion of well 6a.Well ID#: C(i 1—T Tu abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 45 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 .. 10b.For Iniection Wells:- In addition to sending the.form to the address in 10a 6c.Borehole"diameter: 2.25 (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• (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): ,50 (ft) ' ' 10c.For Water.Suooly&c 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. 23.32 andoned. 6E,Inner casingitubing length(if known); (ft.) ab 6g.Screen length(if known): 10 (ft.) , Form GW-30_ North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 . f i WELL ABANDONMENT RECORD LY: I +I I 1.Well Contractor Information: WELL ABANDONMENT DETAILS .Jack Kulaga 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 GNW-30 is needed.'Indicate TOTAL NUMBER of w n/a (federal employee) ells abandoned:10 to NC Well Contractor Certification Number 7b.Approximate volume of wate I remaining in well(s): (gal.) . US Army Corp of Engineers, Savannah District FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: 2.Well Construction Permit#: -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 11 Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑.Dry Clay ❑IndustrialUCommercial ❑Residential Water Supply(shared) ❑ Concrete Grout O Drill Cuttings ❑Irrigation ❑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 El Groundwater Remediation 1 bag ❑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) Bentonite chips poured into borehole and hydrated.. 4.Date well(s)abandoned. 11/14/2023 ; EE � r ' Ft i r r LJ 5a.Well location: APR 2 71 HN US Army-Ft. Liberty Facility/Owner Name Facility ID#(if applicable) 8.Certification: lint?h :.i i�C'C$a".�:� i?`i Gruber and Merill Street, Fort Liberty, 28307. (°""'"`"°°°" pIEDIKEfl.KENNETH.D.1607235984f�DlEDIIlFAI{ENNEI...IbC)93598� 04/15/2024 ��DaK29M00.15 16115 9-06'90• - Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Cumberland By signing this form, I hereby certify that the.well(s)•was (were) abandoned in County Parcel.ldentification No.(PIN) accordance with 15A NCAC 02C 10100 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: 35.1230718947- N -79.0031 1 91507. 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(Sl 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 farm. / J 10a. For All Wells: Submit this form within 30.days of completion of well 6a.Well ID#• 1�t V R-O 0�_ Y�" abandonment to the following: i I. Division of Water Resources,.Information Processing Unit, 6b.Total well depth: 50 (ft.) 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: 2.25 (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: 14.1 (ft) Division of Water Resources I Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): I 50 (ft.) lOc.For Water Sunuly&Iniectiori'Wells: Ifi 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. 6L Inner casing/tubing length(if known): (ft.) abandoned. 6g.Screen length(if known): 10 Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 1 1 WELL ABANDONMENT RECORD For Internal Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILSi I Kevin Moon 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: NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.) U.S. Army Corps of Engineers FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: 2.Well Construction Permit#: List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if!mown 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 G Bentonite Chips or Pellets ❑Geothermal(Hcating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings ❑Irri ation ❑ Specialty Grout ❑ Gravel Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g) RMonitoring ❑Recovery Injection Well: 7E For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation 1 bag ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑Stormwatcr 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) Bentonite chips poured into well and hydrated. I 4.Date well(s)abandoned: 03/20/2024 5a.Well location: ^~�'� �+� �..L.S U.S. Army- Fort Liberty APR T • 202 Facility/Owner Name Facility ID9(ifapplicable) 8.Certification: Knox Street and Woodruff St, Fort Liberty, 28307 znv, Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Cumberland By signing this form, I 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 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: (ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details: 35.15461 N -78.98523 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 constructionlabandonment,you can submit one form: 10a. For All Wells: Submit thisi form within 30 days of completion of well 6a.Well ID#• 69MW8 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 32.30 (ft) 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: 2 (in.) above,also submit one copy of this form within 30 days of completion of well abandonment to the following: 1 6d.Water level below ground surface: NA (ft-) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): 32.30 (ft.) loc.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 6E Inner casing/tubing length(if known): (ft.) abandoned. I 6g.Screen length(if known): 10 (ft.) i Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016