NCD980602163_20011004_Warren County PCB Landfill_SERB C_No 55 - Well Abandonment Record-OCR

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TRANSMITTAL COVER PAGE
WARREN COUNTY PCB LANDFILL DETOXIFICATION PROJECT
IT Corp. Project #827062
Submitted By: IT Corporation -200 Horizon Center Boulevard, Trenton, New Jersey 08691
Transmittal Number (chronological sequence): 036
Transmittal Date: 1014101
Submittal Register Item Number: _12
Resubmittal: No_x_ Yes __ _
Specification Section: 02221 3 .01 F
Description: Well Abandonment Record
Drawing/Detail Number: NI A
Subcontractor/Supplier: S. S. T. Inc.
Comments: NI A
Number of Copies Submitted: _4_
Number of Copies to be Returned to Contractor_Q__
Earth Tech Engineer's Receipt Signature: ___________________ _
Comments:
Receipt Date:
Engineer's Approval
Comments:
Reviewer's Signature
Project Manager's Signature
D A. "Reviewed and approved, no exceptions taken"
D B. "Reviewed and approved with comments
□ C. "Revise and Resubmit"
Date -------------------------
Date ------------------------
•
Well Abandonment Report
Warren County PCB Landfill
Warren County, NC
Submitted by: IT Corporation
Box 426, Route 4
Warrenton, NC
October 4, 2001
Table of Contents
Well Abandonment Report
Abandonment Checklist
Well Construction Record
Well Abandonment Record
Map To Site
Well Location Map
Photographs
Well Abandonment Report
Well Well
Construction Abondonment
Well
Number
Record
Attached
MW3A (Dee-p) X
MW5-S X
MW5-D X
MW-7A X
MW-7 X
MW-11 X
MW-12 X
MW-1A X
~~
MW3
Record
Attached
X
X
X
X
X
X
X
X
06.26 .2001 p. 2
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J,/C-C::.:r::-1: ------__ __. __
. 1 : . CHLO~IN •
' 12. C.:..!ING:
'
t'PT>i
FIMI Tct
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SCH {
l,.f ,:,,?,,:
S·C
___ .-;.,.__,,_........, _____ ._......,. .... i
· L·:C 4iT;p!-: SK£1C-t.
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., .... ,,. -· ... ,.,., ~11• ~ •• ,., ......... :., ••
• .•·• -♦ '."ti, 11 •• • I ·• 'W r• "°" I
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13: G~OUT:
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Fr:r:-, T:-Ft.-Ir.. _Ir., ___ _
. F,cm 'Tt _ rt....,___ Ir.. _ Ir.. ___ _
id. SJ..NO,OP.A. :l r ;.~K; ' . .
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i F~:m Q.l.(.O i; li.:Q_ fl:t. il= 2-: ! Ftom __ .., T~ -Ft. ___ _
i
~.!. F\c:~IArii<S: ..... _______________ _ ·-----.....:•-
I 00 l-l!!~Ea ;~ii:s:'(, Tl-iAiTM
0
IS WELi.. WAS CONS':'PtUCT'e~ IN .t.CCCAOANCl Wt,~ 1£-\ NCAC 2C. 't'l!\.L i
CCNSii:iUCT, ~ !T,&,NO.A.i\06, ,.,NO Tb:.,~ c:o.=y OF rrilS R~cer..o H-'5 S!i J:101/' c, 10 Tti! Wl'.1,.\. C\'IN~~-I
s:0,\11\T~,:;~ e~ ~,:;iMe.:-ol\ 0~ ACl!:r.
S..:\mlt ■ris'r. 11 1, ~1~tsi1111 el l -~~,_.11tal MC
_,.•/h :..~}
Ol:"i \
, ,. i ., I I 6 -'' ., 1' '
S.S.T., Inc.
33 Brickyard Run
Warrenton, NC 27589
April 25, 2001
To Whom It May Concern:
Well Construction reports were supplied by the NC DEHNR for eight of the well sites.
One report for the ninth site could not be found. Without this report, a Well
Abandonment report could not be provided.
We were instructed by NC DEHNR to proceed with the reports that we could do and
write this letter noting that the remaining report could not be completed. This letter
serves that purpose.
Sincerely,
J~$.~ Y facqueline M. Teeters
Vice President
Jun-27-01 Oli41P GMA G . -~••nv111e
L0 39tld
2 62-768-8835
North Carcliu • ~nt of fnvircnm.-iit and NlmZ'll llellOurc:1• • Divi•ion oC Wttc Quali:y -~~er S«i:tior.. 1636 Mail
Service: Center-R.&ltigl\, NC 27199-16?9 • Pbcaa No. (919) 73J-32ll .
WELL ABANDONMENT RECORD
<12-'1,,-,. 7 2 •
Wll..L CONTRACT0Jl 11 '-"' 4 A 7
WELL CONTRACTOR. CIR.TIFICA noN •
l. WEU USE (Cbeci Applicable B01): Ruidnrial □ Mu.aicip.10 In.duatral u A.JriC\lltun.l :J Monjtoting ~
:Recovery □ Heat Pump Water lnjcciion □ Other O l! Otlm, List Un: _____________ _
P~oz
•
2. WELL LOCATION: (Show, 1k411Cb cf the loc&tion 011 bad: o!tonn.) ·::t·
Nearc~ Town: .ilJt.1 rce !:~? n j rvc_ . County _..;UAr.=.,..;..;~:,..;.r;...:.r.._.;e;;..tt;...:.1 _____ _ A,mbee:~~ .&cl_. :
{RDad Name an:1 Number, Community, Subdivision, Lot No.) Q~gle No.
3. OWNER: Wc{.cren {l O , /Jct.3 bruui/J/·• -=-==::ac:.a:::aa:a111a==--=:iac:zs
4. ADDRESS: A,'m b-ec "1·-eu..NI K:.d-
5. TOPOGRAPHY: draw~Utop, valley, :flat
~lt one) ., 11 6. TOTALDEPTH: "i-' ·DIAMETER.. __ ""\ __
7. CASING REMOVED:
fw
'.2
diameter 2... ,,
8. DlSlNFBcrtON:. j r ~ 4. '-& z: 2 ·
(Amount of 700/4 hypoc:hlorite used.:) .
9. SE.ALINO MA 'I'ERIAI.:
Nast Cement
br.gs of cement -1..i..:bS
gtllons of wa.t:r~
·. Sand Cement · bais of cement. __ _
gallons cf water_
Olhct
Type matcrial. _ ___,,11-:§:L.:;.ii:IC...~,..ilJ:,,,..ci'...:::7r=-..li....ce...::1r .... r ... t.r;:.-.-
Amount, ___ J~,C-.;lS:...1.&:;1o~a.c;.;1z..--, -· -.-. ~---
10. EXPLAIN METI!OD EMPLACEMENT OF MATER.lAL
[ A @ -,' i ,.,,, «' ,, ~ ·
WBU DIA~: Dtaw a. detailed sketch of 1!3c
well lbowi:l.g total depth. dcpCb and dia.tuetec of
sereeu, rcm,inin& in the well. p'lcl uitatv1l,
imernJs o( ca.sq pedon..t:ions, md. dq,!ha &nd
type, of fill mamrill, Ulcd.
~· •.: :
.. -:·.--
·.:,.:", -: ... ,
:...•• .. ':tf: ·•.·: , .. , ;,...i.. 4_ •.
·t,1 ..
,:~\; ..
t;ffe.t~_, ··,; ·'·Ji.
'.•t' ... -.".· . ::.:·}
·-(~~ .... _:
11 . DATE WELL ABANDONED 't)rrjo I ; ;6.:-;f:-j
I do hereby certify that tlu, well wa.s abandoned in accordance with l SA NCAC 2C, well eonstruction
sundud.s, and that a c:opy of the. ~eord has been provided io the well owner. , . '.· :;.:.: · \:-::!fr_.
Signabc<c of penon ab,mdoaing the ..,.11 ~J!z;;;;;, ~,_ Datcf )~'6.,
'WELL LOCATION: Daw a lOQtion sketch on the revcne of this sr.eet, 1h.owing the direction and c.istance
of the well to at least t<,t,c (2) nearby reference points sucb as row, intc:sectiow and
streUM. Identify ro.1.d.1 with Stlte Highway road i;kntificauon r:1.1tnben.
_ .. . :· .:IJ .. •~•J"'lf,.
Submit original to the Division cf Water Quality, Groundwat:r Section, one copy to the c~cc~/lfys
from completion of abandorunent. .. Y\ ::\~'
GW•30 Rmsed.:12/9~-,, ,,,)i\~~l ·~ ':
' ' .. '.~~· . ~: :~•~i' ~i(r.~ : 19S-S3~
Jun-27-0l Ol·4lP c~A · ,__.. -G~oonv111e
10 391;;/d
262-758-8835
North C..,-olw -Dc-pan:-:ient o! Enviroc.m..-nt m:S Natunl Reiiourc:es • Oividon or Wu~ Quality -GroUlldwul!t' Secrior. • 1636 Mail P.02
StfVit:.e Ceutc-t -Raleigh, NC 2?599-16H. Phone No. [phone] .
WELL ABANDONMENT RECORD WELL CONTRACTOR S::: 1: · t.-".'l A I li ~ '-Y' ~ L...
:iC1<+(14: WELL CONTRACTOJl CtRT1J'lCA TION fl .l... J L 3
I fl
1. WEU USE (Chct:k Applica.bic Bax}: Rclideutial D Mwu,ipll Cl IruiuslriaJ O Agricultural :J Monitotiugca--
Recovcry O Heat Pump Water lnj~tian t:l Orbu O I! Other, List Use: ______________ _
(Road Name md Number, Community, Subdivision, Loe No.)
3. O\\'NER: {u4cren (!_()' Pc 8 64 ndf,'U
4. ADDR.Ess: A,'mbe.c fawn t2c/·
5. TOPOGRAPHY: draw. slope, hilltop, valley@
(circle one)
6. TOfALDEPTH: '1:..l.. · DIAMETER ~ 11
7. CASING REMOVED:
fw
3
diameter 4, rt
8. DISINFECTION: ( ~ l-:, t t. < r{
(Amount of70¾ hypochloritc uied;)
9. SEALING MATERIAL:
Hgt Cc;m=xit
bigs of cement-~~--
g&llons of water ~ 4::>
Qthtt
Sand Cement bags of cement __ _
gallons cf water_
Type material_........;/J.::::...~B_.rs--~...;."-t:?:::--:'1:tc-J.'-' ..;..7'.Ai.-----
Arnount ___ ...:3:a.-..=a4---=-k"-S-.., ______ _
10. EXPLAIN MEIBO".) EMPLACEMENT OP MATERIAL
LA 6::"' i S f2,'lf-<,
11. DATE WELL ABANDONED _...-;~,-,J;-~..__..oi __ _
Quadrangle No.
VJ'Ell DIA ORAM: Dra.Y.. a detailed sketch of~
well abowbs 10cal depth, dc;pth and diameter of
sc:eez:us :remaining in the ...,ell. gravel int:tV1l,
mtDrVtls o! c:uing per.futatiom, 11114 depths Uld
typN of fiD maCeriab used.
•· .. ·.i-
J.:;.;·
. •/' . . ·,.· ~<
I do hereby certify that thb well wu abandoned in tcco1da.nce with 1 SA NCAC 2C, well construction
standuds, and that a copy of the record bas bem provided fo the we 11 owner. . .:
SignaMe of pmon aba:.do:,Ulg the w,,U ~ ~ Date '1 j, fr-/ c,''j
WELL LOCAT10N: D.aw a location skr:tch on the reverse cf this ~heet, $howing the direction and distance
of the well to at least twc (2) !\carby reference points such as roads, in~tioru r.d
streams-Identify ro1ds with State Highway road i:ientifica~on r.umbers
Submi: o~gma.l to the Division of Wz.tcr Quaiity, Groundwater Seetlon, one copy to the cwncr withb 30 da~
from c:,mp\er,on of abandonment.
OW-30 Reviscd'12i9~
'•.
I9S-S3cJ
90
Jun-27-01 01•4IP G .... -G · ,..,... -~00nv111u
39tld
252-75B-BB35
Narth Caroluia • Dcpan:-:,er,1 oC Env!roiun:nt and Nltllnl Resources • Oivi1ion or W&tC' Qyah:y • Orot.m.dww:r Secti01: • 163<1 Mail
Service Center• R.a.leiah. NC 27~99-16~!1 • Phone No. (919) 733·32.Zl
WELL ABANDONMENT RECORD WELL CONTRACTOR ~v c;,,,,, "' ,
WELL COl'\'TRACTOR CUTIFJCATION •
P.oz
L:Zt,t,,lf: I • C
I. WELL USE (Chee'.< Applicable Box): Rcsidc1ni&l.Ci Municipal □ Industrial D A~ltun.1 :J Mc,njtoring ~.
R.ec.ov~ □ Heat Pump Wam Iojccticc □ Otbct □ l!' Othsr, List Use:. ______________ _
2. WELL LOCATION: (Show, *""' ot,._ ?!on 00 bocl: ofform.) ~e,::!O~Afz2;:e»!Jc1 ~ ~ C_o_un_ty==f&t:.-~ ...... C ...... C.._t~n'-'-----
(Road Name and Number, Community, Subdivision • Lot No.) Quadrangle No.
3. owmR:@tcrn (!o, /JC f6 hc"--ndP~ I I
4. ADDREss: A ,• m be c iP W/l Roi·
S. TOPOGRAPHY: dra·N, slope. h:J1ltop, valley, tlat
(c~le one) 2 // 6. TO f AL DEPTH: ? 5" · DIAMETE.R. ___ _
7. CASING REMOVED:
w:i
~
diametcr l.:. II
8. DISINFECTION: 1£Z1 lt _La $
(Amount of70o/o hypoc:hlorite u,ed;)
9. SEALING MATERIAL:
Nc:;atCemcnt
begs of ccrnent _! __ Sand Cement bagsofcement. __ _
:illons of wa.ter S: gallons 0!water_
OlhcI
Type material. ____ ,:..l1,t..,:..[_1::.i:;...:..l..;;o;....;.:-~>....;,-._,..t;. ____ _
Amount. ____ ~,-~L.:::.....b ________ _
10. EXPLAIN METHO::> EMPL.t\,CEMENr OF MATERIAL.
[ &.... i' 4 e2. < tflr!
11 . DATE WELL ABANDONED __ ~~~½~/ J>.c.---
WEll DIAORAM: Draw a dcw.1.ed sketch ofcie
well mo'lll-'l!'lg tor al depth, dc:plb ud dia.tiieter of
,~c.s n:m■i:ning in the w11SU. grav&l mt:rval,
mmrvala of caaing perlontiollt, and. depth.a wi
typu of fill ~nab used.
I do hcteby certify th.at this well was abandoned in accordar.c:e with 15A NCAC 2C, well coonruction
swiduds, and th~t a copy of tha record bu been provided to the wcl1 owner. . . , . . .·,;
. '· .. --~--
Sign.atcrc of person abzmdo:-iing the wcn. __ _;g~.,&.~--==-.,_,, .. ~c....c,,-=c.:;;;:=-~--. .;...-_Date 3//18" ~>'~-:-
WELL LOCATION: Daw a location ~tch on the reverse cf this sbcc~ showing the direction and distance
of the well ~ &t least ~o (2) ~earby reference points such as roads, intc:settiecs a..~d
streuns. Identify ro1.ds with Sb.te Highway road identification :-.um-oen.
I9S-S3cl EL9t,-f;AA-7C7
S0
Jun-27-01 Ol ·41P . · GMA -G~eenv;11e 252-758-8836
Nortb C&:olina -Dcpan:-:ieat of E.nvironm::nt and Natunl R.e,ourcc1 • Piviaion of Watr. Qu.liry -<miundww!t Sattior. • 1636 Mail
SCNicc Ceimr. Iul,igtt, NC 17H9·161~ • Pll!Xle Ho. [phone] _
WELL ABANDONMENT RECORD
4Z ff,, -;[ /;
Wi.LLCONTRACTOR. J[v .... A 7 5,IZ~ c,-1' c.. L-
WII.LCONTRACTOR CERTIFICATION• :2,. / t-'
1. WELL USE (Checi Applicable Box); lluidc1ltial □ M~ipu □ IAduslrial O A(licul~ :; Moc.itoriog B!r-
.R.ecovc:ty O mat ~p Wati:r Injection □ Otber □ I!' Other, List Use: _____________ _
(Road Name an:i Number. Community, Subdivision, Lot No.} Quadrangle No.
P.02
3. O\\'NER: Y./C{ rr-en Co . fJC-8 64.nefBIIF=--==-===-===-====-==--===
4. ADoR.Ess:A ,' m h e c -tow /l E.ci
5. TOPOGR.A.PHY: draw~billtop, valley. fiat
-~ir:;1-one)
6. TOfALDF.PTH: (&, 2.. · DIAMETER. .l. 1
'
7. CASING REMOVED :
.fw
/2,,
diameter 2--,,
8. DISINFECflON: f ~ t:,-, cS L ~ "f->
(Amount of70¾ hypochlorite wed:)
9. SEALINGMATERIAL:
NwCcment
bi.gs of cement ~
ia.l!ons e)f w~t-:r I t::>
Qlhf:I
S&nd Ctrncm bags of cement __ _
gallons of water_
Type :na.terial._....:a:..L...c;f..;"1--.;:;...J..t._o;..-;=..C ... "s;:..,-: ..... ____ _
Amount_-___ ?,_.;;:~::..:6 ....... 4z._ ________ ,
1 0. EXPLAIN METIIO:) EMPLACEMENT OF MATWAL. r Ar-ta 10 / 1.2.e
l :. DATE WELL AB.ANDONED ___ '-/__,.¼~l-.~,_/o_i _
WELL DIAGRAM: Draw a det&iled lketeh of tic
well saowi::lg total dq,th, depth and di.at:1.etcr of
screeall remaining in the wlill, ar-vel il:lt:rv1l..
inmcv&la of cuing picrfontio~, and. dtpthl md
typei or fill ma~riab used.
.. .-1
. ~~,.:~~-
; .,., ·:.· 4
.•· .. :::-
-;. .. :·
l do hereby certify tilatthis well was abandoned in accordance with l5A NCAC 2C, we:11 construction
sbnduds, and that a ::opy of the record has be:n pro"lrided to the well owner. : _ ·
S1gna~e of person abando:1ing the well ~~ ~-: Pl.~• _'IJ! f-}d~/
'WP.....L LOCAT?ON: Daw a location sketch on the reverse of this sheet, showing the di."'Cction and distance
of the well to at least ~c (2) nearby refcrimce points silCh as roads, inte:'scctions and
streams. Identify roids with Stlte Highway Nad idetitificauon :-.u.-n'bc-:-s.
Submit o:iginal to :he Division of Water Quaiity, Groundwa.ter Section, one copy to the cwncr withi.~ 30.d.J.ys
~om comple~1on o: abandonment. ·
GW-30 Revised ·1219 ~
.\ji]~
j.' :.~·;':~;·
I9S-S3cJ ·,:·.~ ... :;. _,: . Jq'?,·.
Jun·· 2 7 -0 l O l · 4 l p Gtu.. G · •·~ -rgenville 252-758-8835
North CacciiA.a • D~■r.t o( Environrn:nt and N&Nr'll R.e,ourc~, • Diviaion of Waw. Qu.Ji.-y • Gro'-'lldwucr s~ctior. • : 636 Mail
Service Cenrcr • R.llcigt:, NC :Z7599-l6J9 • Phooe No, [phone]
P.oz
WELL ABANDONMENT RECORD WELLCONTRACTOI( i t leA 6 T V /l t,,.j c '--
WELLCONTRACTOR Ci:.R.TIFICA110N,, _.2-~l~-'2c:--~L----,;7 ve,, 3 -::e-•
I. WELL USE (Chee'-Applicable Box}: lwidentia..l D MIUUcipa.l D Industrial o A~cultural :J Mowtoriog [!----
Aetovery Ci Hut Pump Wa-i:r Injection O Other □ I! Other, List lis:: _____________ _
2. WELL LOCATION: .(Show a akau:h of~ kxation on back of fonn.)
!-fcarestTown: uJacreafo a, A-(!. . County @c_ce h b,m becCOuJn (2 d,
(Road Name an;i Number. Comm\Dlity, Subdivision. Lot No.) Quadrangle No.
3. ov.'NER: We-< ct:--e n <:.o . fr B h-Q.1yvj-t,· I I 111=-===a:s=s=:::====-=====:s:i==sm:::=
4. ADDRESS:_ h~".J'. b:t r ±cw~:) pJ,
5. TOPOGRAPHY; drawfsi~lltop, valley, !lat
~it:lt OM) / /
6. TOT AL DEPm: ' ~ · DIAMETER 2 ·-----
7. CASING REMOVED:
fw
2.,
8. DISINFECTlON: I .'l. T:! J L,£ .,. 5
(Amount of70¾ hypoc:hlorite used:)
9. SEALINOMATERIAL:
licit Cement
btgs of cement .:2..
g&llo.~ of wz.t~ l t!>
O.tb.ct
SUld Cement
bags of cement __ _
gallons of water_
Type material._~(l:.L.-..1;;£_,;..;--~,-....;..• -~~;~r.1;.,___ ___ _
Amount ____ -:i.;;;;_£:;;.-~-""''--------
10. EXPLAlN METIIO:> EMPLACEMENT OF MATERIAL.
f"A~-•'~ J'Jl/2.l;
l L DATE WELL ABANDONED ~--L-;_1/_1..,....fr_)_D_i_
WELL DIAO!tAM: Draw a deuiled shtch of oe
1Vell ahowi:lg total deptb, dc:ptb and diametoc of
s~em RnU1.inmg in the well, eravcl inte:v■l.
intervals of c:uuig perf0ntiom, md depths a.ad
type, of fill materials used.
1 do hereby certify that this well -was abandoned in ,accotdance with 15A NCAC 2C, well caastrUction
standards, and that a ;opy of the record has been provided to the we!J owner. . _. _
Sign.atu-1:ofpersor,abando::iingthcwcll .~~1u~ Da~e Lf/fo/oj>
V/ELL LOCATION: O.aw a location sketch on the reverse cf this sheet, s.howing the direction and distance
of the well to at least :we (2} !:l.earby rcCerencc points such as roads, intc:-settioos BLd
streuns. ldcn:ify roads with Snte Highway road identmcaoon r.u.."Ubcrs
·-i>
Submit o:igrm.al to the Division of Witer Quaiity, G:oundwa.ter Section, one copy to the cwner wnhfa 30',days
from c:i.nple~1on of abandonment. :-
OW· 30 .Reviscc.'\ 2/9 ~
·. >-:, ...... ~~·:~
> : :«\ ii~,• .!':}! I9S-S3~
.Jvn•-27-01 01 ·4IP GMA · -Greenville ~52-758-8835
North u.:olw • Depa~er.c of E.nvircnm:ot and NaNnl .Ruouree, • DiviJion of '\Vue:-Quali:y • Growidwusr Sect1or.. l 636 M•il
Service Ctllter-RJ.leigh, NC 27H9-l619 • Phortc No, (Sll9) '733-32~1 _
P.oz
WELL ABANDONMENT RECORD MU, CONTRACTOR. $ t: k:& ,1 l _f,,t t'. 4 , ', L
WELL CONTRACTOR. CER.l'D'lCA TION • i,_ , 2:: '\
1. WELL USE {Chee:< Applicable Bax}: RuideJnw o Mwii.:ipa.l CJ Industrial O Agricu).OJnl :J Moaitoring c.-
Recovery Q Heat Pwop W&:u Injeaion □ Otbex O I: Other, Li3t tls:: _____________ _
2. WELL LOCATION: (Show a akmh of the location or. back offonn.)
Nearyst Town: uJacc e nioo N c.. . County Warren 6~mbec :iow.,n (k.-J,7 -------'-·-----
(Road Name sn::l. Nutt.her, Community, Subdivision. Lot No.) Quadrangle No.
3. OWNER: Ui« C ('en Cva. Pc 13 /....c<,)"(lt: / ,tw=======-==-=-=====-==1:a:::==
A. ADDRESS:_. A ,' (11 b.~ r J-o...v n rcoJ.
5. TOPOGRAPHY: draw~lltop. valley, flat
~=le one)
6. TO r AL DEPTH: '-,.. 0 · DIAM:ETE.R ;l 11
7 . CASING REMOVED:
.fw
b
diaroctcr
2., II
8. DISINFECTION: I 4' T 4; ~ '"-• .,. S
(Amount of70¾ hypochlorite u.sed:)
9. SEA.LINO MATERIAL:
NcatCc:mc:nt
bags of cement '• ....._
gil!om of wit!:r: : $
SandCLJDent
bags of cement. __ _
gallons of water_
iliw
Type materia1. _____ ,J~f ... :2:::-=--.... l..,...:..0 ---s...-=--t ...... t .. a._ __ _
Amount ___ ~tr....:..r~2~£ __ L_-~_)..._ ___ _
10. EXPLA.lN MErno::, EMPLACEMENT OF MATElUAL.
C!lB-...tr£ ,t(Jipe
l l. DATE WELL ABANDONED __ t/.,_.1/1_,· y;,__/_o_l_~ , J
WELL DlAGRAM: Dra"" a detailed sketch oft!:ic
well aho"l\oi.:Jg total depth, dep1b and diameter of
,creens remaining in tbe wcU, &ravel int:rval,
intervals of cuing pcdontious, and ckpths 111d
typea of ftll materials used.
-'::··
.• l~_.:•
-~ .:'~°{·.
I do hereby certify that thfa well was abandoned in accordance with 15A NCAC 2C, well c0t1stn1ction
sundards, and tha.t a copy of the record has been pr0\'ided to the well owner. _
Sig:,an:rc of pman abandooir.g the well ~ u /2,C Date <(jt fr'·• .
VvE:.L LOCA T!ON : Daw a location sketch on the reverse cf this sheet. showing the direction and c!.i!tancc
of the well to at least rwc (2) :1earby reference pomts such as roads, intc:-scctions u.d
strcuns. Identify roads with State Highway r.iad ide-r.tifica!lon r.umbcrs
Submi-; o~~•l to the Div:sion ofWr:ter Quaiity, Groundwater Section, one copy to the cwner withi!l 30 d&ys
from c::imple:-,on of abandonr.,.en-:. . •
GW•30 Revised 12/9~
,~:~
•• .. ,:_,,,:,~':l
Jun-27-01 01 ·41P G~A G • .,,.., -reenv111e
252-758-883~
Norda Ca.-olw -~111 of E11vironm:nt aid Nanni !le1K1uru1 • Diviaion oC W&1r. Quali!:y -Grouu.dwuff Se«ior. • l 636 Mill1
Service Cnru-R&lei&h, NC n599-l~9. J'hoclt No. (919) '73l-lU1 .
P.02
WELL ABANDONMENT RECORD WllLCONTRACTOJl 5:t: ·'--? 6 J U-' ._,,•~ L...
/JJ.u.J I) .. Wl:LL CONTRACTOR. ctRTirlCA nor; • .l.. 1 ? 3
10 391;;/d
I. WELL USE (Check Applic&ble Box): R:side1ltil.l O Mwii;ipal CJ Wun:i.&1 i:J Arncull:W'al :: MowtotiDJ't:r'
R«ovcry C Heat Pump Watet" lnj~ticn D Other □ I! Other, Liat Use: --------------
2. V.'Ell LOCATION: (Sho-w a 1btdi9!c. location on oaclt otfo:nn.)
Ncan:rt To~u,Jtu' .v e Y\ 1"-o n A) C-. Co~cy Wa I' re n A ,'m~i-i ,£d, 1 = _ _.....__,, .................. --'-·------
(Ro';dNa.mc an:i ~un:ber, Col'Olinmity, Subdlvision, Lot No.)
3. O\\'N.ER: ub.cren ~o. (Jc.13 l... ll.nd~, \ I
4. ADDRESS:~\ m b-e,i-0-UJh -re_J •
5. TOPOGRAPHY: d.'1lw, slope, hilltop, valley@
(ciri:lt OM) . ,., .
6. 7or AL DEPTH: 3 vi, 0 · DIAMETE.R.__._C_-_-__
7. CASING REMOVED: r diameter ~ II .·
8. DISINFECTION: ~ Q l _,, ,f t. < f"<
(Amount of70% hypoc orite wed:)
9. SEALINGMATERlAL:
:&at CeroClt
be.gs of cement i, S'
gallons of water_:if -
QIW
Sand Cemcm baisofcemeut. __ _
ptlons cf water_
Type material /J £ ,..,__ 7 ~ "'%-/ 'l'A
AmO\;llt I I ;), s L h s
10. EXPLAIN METIIO:> EMPLA.CF.MENT OF MA TF.RlAL. r ..... -tz.' -e: ..... ,s. ·•{
l ! . DATE WELL ABA..~NED __ J-J_)_, Pl_i_o_l __
Quadrangle No.
\\/'EU. DIAGRAM: Dn" a detailed wtcb of t!2c
we.ll abowi:111Dutl depth. dcp1b and diameter of
s~em remaining in the well. araval iJlt:rval,
i:Dmvlls of c:uq perl-citttious. 1a4 depth$ &Dd
typea of fill materi&h used.
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I do her6y certify that this well was abandoned in accordar.cc with l SA NCAC 2C, well eonstructioo
standuds, and tho.ta copy of the record bu bcmprovided to the well owner. ..
Sign.roe of P"'"" abandooing the w.U ~ ~ Date ·t;!YVo l'-
WELL LOCA T! ON : D.aw a location sb:tch on the reverse cf this sheet, $bowing the direction and distance
of the well to at least rwc (2} :iearby reference pomt5 s-.i.cb as roads, inte":l;ettioru r.d
streams. Identify ro1ds with Stite Highway road i:ier.tifica~on r.umi>ers
Sul)lni: o:-:~a.l to the Division of Wi:.ter Queiity, Groundw1t~r Section, one copy to the cwner withi.'1 30 da~
fro:r. c:imple~1on o: abaodonr.ient.
GW-30 Revised 12/9~
I9S-S3d
Jun--27-01 01 '41P GMA G · -~eenv;11e
E0 39\i'd
2:t>:z -70t,-ac::,::,
NQrth C&rolill.a • Dr:patt':lent of f.11viroo.mcnt m, Naninl Ruourn:1 • DiviJion of Wttl:' Qu.&li~ • Growiciwu.r S<:ctior. • 1636 Ma.ii
Service Cectcr • R...ltig~ •. NC 2?S99· l 619 • Ph.octe No. [phone]
P' • Or:
WELL ABANDONMENT RECORD WELL CONTRACTOk 5, T v ,f ti T ·1/ ~ v,' '-'-
WELLCONTRAcroa. C'i:RTIFlCATION • 2.., 1 9 ,l CZ ~11 F
1. WELL USE(~ Applicable Bax): Real~□ Mwucip&l □ Industrial D Agncultuta.1 ::i Monitoring e--
11.eeovcry □ Heat Pump Water Injection O Otbet O I.: Other, List Uae: --------------
2. WELL LOCATION: (Show a stctcll of the loca.tion 0J1 back o!fonn.)
Nearest Town: & /Ctrre nto n IVG County _UA_· _t:l._l' __ r_e__,_IQ-4_... _____ ~_
, b·10Jb:erft:),-<Jv1 Rd -'
(Road Name an:i Nwr.bcr. Community, Subdivision, Loe No.) Quadrangle No.
3. O\\'NER: u/.a Cl t' n eo . /{;/3 io. rd._f, /I
4. ADDRESS: At' mh e c ~ -<~ CJ f?.d ..
S. TOPOGRAPHY: draw~hilltop, valley, flat
(eir:le one) ,
6. TOTALDEP!H: 4 ;l_ OIAMETER._2_1 __
7. CASING REMOVED:
fw
1.
diameter 2-,,
8. DISINFECI10N: f T:4 I i-. 1, Z 5
(Amount of70¾ hypocb3orite uaed:)
9. SEALING MATERW.,:
Heat.Cement
bigs of cement L, £:
g'-1lon! of water_-fi>-.._
Qthc
$and Cemc:nt bags of cement __ _
gallons of water_
Type matctial. ____ 4""'""f"-""a,, ___ ,.. .... p--""--___,,,_' _r_.a_._ __
Amount ____ ~/"'"' ..:l-::...._f""'___,L__.'2 __ ..._5 _____ _
10. EXPLAIN METIIo:, EMPLACEM'.ENT OF MATERIAL.
r12i'~e ,
11. DATE WELL ABANDONm __ 1~/ ...... 1__,t/ ..... ·o_/ __
WELL DlAGRAM: Draw a detailed sketch ofbe
well a,owbg tow depth, depth II.Gd diameti,c of
scrceus rcmainmg in the well, pvol mtcrva1.
interval& o! c&siDg pcr!omio11s, Nld depthc and
typcl af fill macerials us.eel.
I do hereby certify that this well waa abandoned in &ceordance with 15A NCAC 2C, well construction
standards, and that 11 copy of the record has been provided to the well owner. .-,:
Signa".:r• of person abandoaing !he wdl Jk. J~ Date_ "-1 jt s-;)_~:/
WELL LOCAT10N: D:-aw a location sketch on the reverse of this sh.est, ,hewing the dire~tion 11.:1d distance
of the well to at lea~ twc (2) ~earby reference poi.n~ s;.icb as :-oads, m~ctioos 11r.d
streuns. Identify roads with State Highway rvad i~er.tificauon ::umbers.
Suornit o:iginal to the Division cf Wzter Quality. Groundwa.ter Section, one: copy to the cwner within 30 diys
from co:npler1on of abandonr.icnt. ·· · _,. ·
I9S-S3cl CJ O+.._rnn. -.,..._
GW-30 Reviicd· 12/9~
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[NVIROMENTAL. INC .
N0RIH CAROLINA D(PARIU[Nl QI lN"1RONu
ANO NATURAL F>lSOURC(S
DIVISION Of,, .. ·""Sl[ WAN,..
WARREN COUNTY -PCB' LANDflll DETOXIF"ICA TIC
[ N T
Oj[CT
DEMOLITION PLAN
DttAMNO fNfO•WAT~N
"'Oo.(Cl NO..: CIC.9CNrD ft 1111 tJ111AIIH .,, • Ir• I 1,1',
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Patricia M. Backus, PE
Division of Waste Management
401 Oberlin Road, Suite 150
Raleigh, NC 27605
Phone: [phone] ext. 308
Fax: [phone]
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NCDENR
fax
\
To: Jackie Teeters, SST From: Pat Backus
Fax: [phone] Pages: 9
Phone: [phone] Date: June 26, 2001
Re: PCB Landfill Monitoring Well CC:
Construction Record
□ Urgent @For Review □ Please Comment □ Please Reply □ Please Recycle
• Comments:
Jackie,
The well records for MW-1A, MW3-A, MWS-5, MW-5, MW-7A, MW-7, MW-11, and MW-12 are
attached. The folks I deal with usually refer to them as "S" for shallow and "D" for deep. I have made
those notations next the official designation. The record for the number 3 shallow well was not with the
others but I am sure it is in a file somewhere. I will send it later.
If there are any questions, please give me a call.