Onslow_Well Abandonment_20241101

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Scott M. Werle `
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
wells abandoned:s(Five)
3344-A I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
ECS Southeast, LLC 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 a Neat Cement Grout a Bcntonite Chips or Pellets
❑Geothennal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout I ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bcntonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite — 10 Ibs
--_---OAquifer Storage-and-Recovery---- ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Neat Cement - 30 Ibs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothennal(Closed Loop) ❑Tracer Gravity feed bentonite from 15-5 ft bgs
❑Geothennal(Heating/Cooling Return) ❑Other(explain under 7g)
Pour neat cement from 5 ft bgs to surface
4.Date well(s)abandoned: 1 0/1 0/2024
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5a.Well location: NOV to m24
Wawa Lejeune NA
Facility/Owner Name Facility ID#(if applicable) 8.Cert' 'on: i. u
:..di:.
2155 Lejeune Blvd., Jacksonville, NC 28546 QN r `-"10/22/2024
Physical Address,City,and Zip Signature of Certified WelINydactor or Well Owner Date
Onslow NA By signing this jinn, 1 hereby cert(/ that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 IVell 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:
34.74069 N -77.36351 W You may use the back of this page!tot 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 conru•nctiou recortl(r)ifavailtrble. Fornutltiple injection ornon-watersapply wells
OA'ZY with the same conslt•uctiott/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW04, 05, 06,07, 08 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
I
10b.For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this four within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: 2.47 - 3.90 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.)
NA 10c.For Water Supply&Iniectio I 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 count health department of the county where
6f.Inner casing/tubing length(if known): 3 (ft.) abandoned.
6g.Screen length(if known): 12 (ft.)
Fenn GW-30 North Carolina Department of Environmental Quality-Division of Water Resources 1 Revised 2-22-2016