Watauga_Well Abandonment_20220603

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WELL ABANDONMENT RECORD For Internal Use ONLY
I.Well Contractor Information: WELL ABANDONMENT DETAILS
KEITH PRESNELL
7a.For Geoprobe/DPT or ClosedLoop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well Construction/depth,only 1 GWIi 30 is needed. Indicate TOTAL NUMBER of
2780 wells abandoned:
7b.Approximate volume of water remaining in wells 172.5 al
NC Well Contractor Certification Number pp g O' (gal.)
DEWEY WRIGHT WELL & PUMP CO., INC FOR WATER SUPPLY WELLS ONLY:
Company Name
2.Well Construction Permit#:
184350 7c.Type of disinfectant used: HTH
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc)ifknonm 3.5 OZ
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 a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) RResidential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation - _ q Specialty Grout-., _ 9 Gravel,_ _
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
❑Monitoring El Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 20 BAGS BENTON ITE
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage 1 TON GRAVEL
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer GRAVEL WAS POURED INTO THE WELL FOLLOWED BY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
BENTONITE CIPS BEING POURED INTO THE WELL
4.Date well(s)abandoned: 5/25/2022
5a.Well location:
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
LOT 8 OFF CRAB ORCHARD696 < 7,0�,
Physical Address,City,and Zip Sign Lure of Certi ed Well tractor or Well Owner Date
WATAUGA 1879-29-1051 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 i0100 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:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.189611 N -81.704577 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 records)ifavailable. For multiple injection or non-water supply wells
ONLY with the same consiructiomlabandomnent,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: 210199-1 E'v �,, i " 'abandonment to the following:
[� Division of Water Resources,Information Processing Unit,
6b.Total well depth: 145 —(ft.) `�u►,`� 03 7D27 1617 Mail Service Center,Raleigh,NC 27699-1617
t I I 10b. For Infection Wells: In addition to sending the form to the address in 10a
((?' xv' ,,, above also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) tttrlrua¢•I(y;j monment to the following:
6d.Water level below ground surface: 30 (ft.) Division of Water Resources;Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
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6e.Outer casing length(if known):
22 (ft.) 10c.For Water Supply&Infection 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
6f.Inner casing/tubing length(if known): (ft.) abandoned.
6g.Screen length(if known):
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

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