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Home My WebLink AboutAS-305_5314_CA_LTRRPT_20230718_MW Abandon WithersRavenel Our People. Your Success. 115 MacKenan Drive | Cary, NC 27511 t: 919.469.3340 | f: 919.467.6008 | www.withersravenel.com | License No. F-1479 ASHEVILLE | CARY | CHARLOTTE | GREENSBORO | LUMBERTON | PITTSBORO | RALEIGH | SOUTHERN PINES | WILMINGTON July 18, 2023 State of North Carolina Department of Environmental Quality Division of Waste Management Underground Storage Tank Section Federal & State Lead Program 1646 Mail Service Center Raleigh, North Carolina 27699-1646 Attn: Ms. Sharon Ghiold Reference: Letter Report – Monitoring Well Abandonment Hill’s Grocery 5024 US Highway 64 West Hayesville, Clay County, North Carolina UST # AS-305 Groundwater Incident Number: 5314 WR Project Number: 23-0307-CN Dear Ms. Ghiold: WithersRavenel, Inc. (WR) has completed this Letter Report to document the abandonment of site monitoring wells MW-1 and MW-2. This event was described in our proposal numbered Task Authorization (TA)-02, approved by the Federal & State Lead Program on June 7, 2023. The enclosed report summarizes recently completed activities. A site location map is included as Figure 1 and a site map is included as Figure 2. Monitoring Well Abandonment WR mobilized to the site on June 22, 2023, for the purpose of abandoning the referenced monitoring wells. Monitoring wells MW-1 and MW-2 were abandoned by placing bentonite in one-foot lifts until one foot from the top of casing. A concrete cap was placed from the top of bentonite to the surface, completely filling the casing and manway. The manway lids were not replaced on the abandoned well. The well abandonment record and photographic documentation of the abandoned wells are included in the appendix. WithersRavenel Our People. Your Success. Hill’s Grocery – NCDEQ Incident # 5314 Monitoring Well Abandonment July 2023 Page 2 of 2 WR appreciates the opportunity to be of service to the Federal & State Lead Program. Should you have any questions regarding the attached, please do not hesitate to contact us at (919) 469-3340. Cordially, WithersRavenel Flora D’Souza, CHMM Elizabeth A. Allyn, P.G. Environmental Project Scientist II Environmental Project Geologist II Attachments: Figures Well Abandonment Records (GW-30) Photographic Record FIGURES 500' 1,000' DCV FD DRAWN BY: 05/11/2023 23-0307-CN 1 SUBJECT SITE ±1.63 ACRES SCALE:FIGURE NO.: PROJECT NO.:DATE:APPROVED BY: GENERAL LOCATION MAP 1"=500 ' GRAPHIC SCALE 1 inch = 500 ft. 0 500250 1000 WithersRavenel Engineers | Planners | Surveyors 115 MacKenan Drive | Cary, NC 27511 | t: 919.469.3340 | license #: F-1479 www.withersravenel.com HILL'S GROCERY TF # 5314 / UST # AS-305 5024 US HIGHWAY 64 WEST HAYESVILLE, CLAY COUNTY, NC MW-1 (Abandoned) MW-2 (Abandoned) 2 US HIGHWAY 6 4 REPORTED FORMER UST AREAS EXISTING AST CREEK SWEET W A T E RFIRE 'S CREEK ROAD UN-N A M E D T RI B U T A R Y DCVFDDRAWN BY:05/11/202323-0307-CN2SCALE:FIGURE NO.:PROJECT NO.:DATE:APPROVED BY:SITE MAPWithersRavenelEngineers | Planners | Surveyors115 MacKenan Drive | Cary, NC 27511 | t: 919.469.3340License #: F-1479 | www.withersravenel.com1"=20 'LEGEND MONITORING WELL LOCATION WATER SUPPLY WELL LOCATION SURFACE WATER / WETLAND FEATURE NOTES: 1.) AERIAL OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT. GRAPHIC SCALE 1 inch = 20 ft. 0 2010 40 HILL'S GROCERYTF # 5314 / UST # AS-3055024 US HIGHWAY 64 WESTHAYESVILLE, CLAY COUNTY, NC# WELL ABANDONMENT RECORDS (GW-30) 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: George M. James 4164-C Withers Ravenel, Inc. N/A ~30lbs Bentonite ~5 lbs grout 6/22/23 Bentonite was placed in one ft lifts and hydrated until one ft from top of casing. Remaing space was capped with grout to surface grade.Hill's Grocery 00-0-0000012436 5024 US Highway 64 West, Hayesville, NC 28904 Clay 1722-97-9965 35.45555 -81.051267 MW-1 & MW-2 29 2 ~8 10 7-17-2023 PHOTOGRAPHIC RECORD Photo 1: View of site. Photo 2: View of MW-1 following the abandonment. Photo 3: View of MW-2 following the abandonment.