FA-202_6361_CA_LTRRPT_20220202_Well_Abandonment

220 Old Dairy Road
Wilmington, NC 28405
[phone]
www.CatlinUSA.com
Wilmington, NC | Raleigh, NC | Washington, NC | Atlanta, GA

ENVIRONMENTAL | CIVIL | GEOTECHNICAL

Wilmington, NC | Raleigh, NC | Washington, NC | Atlanta, GA | Charleston, SC

February 2, 2023 North Carolina Department of Environmental Quality Division of Waste Management
UST Section Attn: Mr. Scott Ryals 1646 Mail Service Center Raleigh, NC 27699-1646 Re: Letter Report – Well Abandonment Bass Country Store 8440 NC 27 East Coats, NC 27521 Incident Number: 6361 Risk Classification: Undetermined CATLIN Project No. 221267
Dear Mr. Ryals,

CATLIN Engineers and Scientists (CATLIN) is pleased to provide you with this letter report documenting well abandonment field activities performed in general accordance with CATLIN proposal number 221267.02P, prepared January 12, 2023. Services were authorized by the North Carolina Department of Environmental Quality (NCDEQ) Task Authorization (TA) #02, accepted January 13, 2023, and Contract Number N122019D. The approved scope of services for this Task Authorization included:
• Abandon one (1) monitoring well (MW-01); and
• Prepare a letter report documenting the site activities.
Monitoring Well Abandonment On January 23, 2023, CATLIN personnel mobilized to the site and abandoned monitoring well MW-01. Well construction and abandonment procedure information for the well is provided in the table below:
Well ID Well Type Well Depth (feet) Well Diameter (inches) Abandonment Procedure
MW-01 Shallow 18.0 2.0 Pad and outer metal shield removed
Monitoring well MW-01 was abandoned under the direct supervision of a North Carolina Certified Well Contractor (CWC) according to guidance provided in the North Carolina Administrative Code
February 2, 2023Page 2 of 2
NCDEQ; 6361_Bass Country Store CATLIN Engineers and Scientists
CATLIN Project No. 221267 February 2023
(NCAC) Title 15A 02C .0113 (Abandonment of Wells). The outer metal well shield was removed and the annular space was filled with bentonite chips while simultaneously pouring water to
facilitate hydration to within 0.5 feet of the surface. The remaining space was filled with topsoil to the existing grade.
The well location is shown on Figure 1 (Attachment A). The well abandonment record was submitted to the NCDEQ Division of Water Resources on January 27, 2023, and a copy is provided in Attachment B. Photographs of the abandoned well are included in Attachment C.
CATLIN Engineers and Scientists appreciates this opportunity to be of service. Should you have any questions or require additional information, please contact us at [phone].
Sincerely,
Benjamin J. Ashba, PG
Project Manager
Attachments: A: Figure
B: Well Abandonment Record C: Site Photographs
FA-202_6361_CA_LTRRPT_20220202_Well_Abandonment

NCDEQ; 6361_Bass Country Store CATLIN Engineers and Scientists
CATLIN Project No. 221267 February 2023

ATTACHMENT A FIGURE

FIGUREPROJECTTITLE
1SITE MAP
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RED HILL CHURCH RDNC H
W
Y

2
7

E
A
S
T
RW-1MW-1MW-9MW-2
MW-8
MW-4
MW-5
MW-7
MW-6
MW-3
WSW-1
MW-01
WSW-B
WSW-A
Source: Esri, Maxar, Earthstar Geographics, and the GIS User Community
³
NOTE: Well and tank locations were obtained from previousreports preapred by other consultants and are approximate.
BASS COUNTRY STORE8440 NC 27 EASTCOATS, NC
INCIDENT NO.JOB NO.DATE SCALE DRAWN BY/CHECKED BY6361221267FEB 2023 AS SHOWN KMC/BJA
50 0 50 10025
Feet
LEGEND
Approximate Location
of Former UST System
Parcel Boundary
(Incident #6361)
Monitoring Well
(Type II)!>
Parcel Boundary
(Incident #3357)
Recovery Well#*
Abandoned Potable Water Supply Well!(PD
Inactive Potable Water Supply Well!(P
Electric Lines
Communication Lines
Abandoned MonitoringWell (Type II)!>

NCDEQ; 6361_Bass Country Store CATLIN Engineers and Scientists
CATLIN Project No. 221267 February 2023

ATTACHMENT B WELL ABANDONMENT RECORD

WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
Agricultural Municipal/Public
Geothermal (Heating/Cooling Supply)Residential Water Supply (single)
Industrial/Commercial Residential Water Supply (shared)
Irrigation
Non-Water Supply Well:
Monitoring Recovery
Injection Well:
Aquifer Recharge Groundwater Remediation
Aquifer Storage and Recovery Salinity Barrier
Aquifer Test Stormwater Drainage
Experimental Technology Subsidence Control
Geothermal (Closed Loop)Tracer
Geothermal (Heating/Cooling Return) Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
Neat Cement Grout Bentonite Chips or Pellets
Sand Cement Grout Dry Clay
Concrete Grout Drill Cuttings
Specialty Grout Gravel
Bentonite Slurry Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
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.
9. Site diagram or additional well details:
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.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
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
abandoned.
For Internal Use ONLY:
ATTACHMENT C SITE PHOTOGRAPHS – JANUARY 23, 2023
NCDEQ; 6361_Bass Country Store CATLIN Engineers and Scientists CATLIN Project No. 221267 February 2023

Bass Country Store
MW-01
Prior to Abandonment
Bass Country Store MW-01
After Abandonment

NCDEQ; 6361_Bass Country Store CATLIN Engineers and Scientists
CATLIN Project No. 221267 February 2023

ATTACHMENT C SITE PHOTOGRAPHS

ATTACHMENT C SITE PHOTOGRAPHS – JANUARY 23, 2023
NCDEQ; 6361_Bass Country Store CATLIN Engineers and Scientists CATLIN Project No. 221267 February 2023

Bass Country Store
MW-01
Prior to Abandonment
Bass Country Store MW-01
After Abandonment