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Home My WebLink AboutWake_Well Abandonment_20220725 RECEIVE( W� �T7� 7�T j� j'� �y� i 5 2022 EU�1T•L\LOj��•'-�'1`T jWMM, ForlrnetnalUseONLY: HECEIVEDtsn P untr 1.We11Coatractorinformation: _ e t ,� WELL ABANDONMENT DETAILS Thomas Will JUL 19 2022 79.For Ceoprobe/DPT or Closed-Loop Geothermal Wells having the same Well Contractor Name(or well owner person Ily abandon iA fvell df�i` y) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of 2700b N( wells abandoned:_v ` NC Well Contractor Certification Number Central Office 7b.Approximate volume of water retraining in well(sr_(gal.) East Coast Environmental PA FOR WATER SUPPLY WELLS ONLY: Company Name None Well Dry 7c.Type of disinfectant used: �7 2.Well Construction Permit 11: na --7 Liss all applicable well construction perm Its 6.e.UIC,County,State.Variance,etc.)ifknoKn 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 ❑Bentonite Chips or Pellets ❑Geothermal(Keating/Cooling Supply) BResidential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay ❑kndustrial/Commercial ❑Residential Water Supply(shared) 18 Concrete Grout ❑Drib Cuttings ❑irrigation ❑Specialty Grout ❑Gravel Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g) ❑Monitoring ❑Recovery Injection Well: 7L For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation clay from 28' to 2' bis Poured in top of well ❑Aquifer Storage and Recovery ❑Salinity Battier ❑Aquifer Test ❑StonnwaterDrdinage Concrete 2' to 1' Poured in top of well ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer Filled well with clay to 2' BLS ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) y 1' concrete plug followed by covering 4.Datewe0cs)abandoned: 7-14-22 with soil to land surface Sa.Well location: April Minh na Facility/Owner Name Facility ID#(ifapplkable) 8.Certifieati 4301 Graham Newton Road //�,/ 7-14-22 _(" r Physical Address,City,and Zip Ftpa-r ae cfCecdf[ed Well Contractor or Well Owner Date Wake 0770769354 By signing this orn 1 hereby cent' that the wells aus S+t S f Y rIY () (were)abandoned in County Parccl Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards gib.Latitude and longitude in degreeslminutes/seconds or decimal degrees: and that a copy of this record has been provided to the well arvner. 017welt field,one 13VIDng is Sufficient) 9.Site diagram or additional well details: 35 41' 23,17" N -78 44' 14.36" 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 .4ttach%rJlconsimctronrecord(s)yfamiWIe.Farmuttipleinjecdonornon-xntersupplyurlls ONLY wuh the same corutrucoon/abandonmenk you can submit one form. 10a. For All Welts: Submit this form within 30 days of completion of well 6a.Well im-W-1 abandonment to the following. Division of Water Resources,Information Processing Unit, 6b.Total well depth:28 (ft) 1617 Mall Service Center,Raleigh,NC 27699-1617 r� lob.For Injection Wells: in addition to sending the form to the address in 10a 6m Borehole diameter:24 (in.) above,also submit one copy of this form within 30 days of completion of well abandonment to the following. 6d.Water level below ground surface:28 + (it) Division of Water Resources,Underground injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): 28 + (k,) 10c.For Water Supply&Iniection 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 Cif known): NIA (ft.) abandoned. 6g.Screen length(If known): NIA (ft) Form GW-30 North Carolina Department ofEnviromnental Quality-Division of Water Resources Revised 2-22-20116 RECEIVED JUL 2 5; 2022 WELL ABANDONMENT RECORD . For Internal Use ONLY. lf,�,,,ll„ 1�roe...:q no RECENO 1.Well Contractor Information: WELL ABANDONMENT DETAILS Thomas Will 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same Well ComractorName(or well owner personally abs= A on saRrcr property) well construction/depth,only 1 GW-30 is ncedc& Indicate TOTAL NUMBER of 2700b wells abandoned: e�yt11 i NC Well Contractor Certification Number INC~ O � �� 7b.Approximate volume of water remaining in weil(s): (ga►,) East Coast Environmental Vttwv FOR WATER SUPPLY WELLS ONLY: Company Name Chlorox pnool shock 7c.Type of disinfectant used: M 2.Well Construction Permit#: na Ust all applicable waft construction permits(i.e.UIC.Coamy.State,Yariar=etc.)ifknown 7d.Amount of disinfectant used: 6 OZ 3.Well use(check well use): Water Supply Well: 7e-Sealing materials used(check all that apply): OAgricultural OMunicipal/Publie ❑Neat Cement Grout O Bentomte Chips or Pellets ❑Geothermal(Heating/Cooling Supply) f9Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay Olndustrial/Commercial ❑Residential Water Supply(shared) H Concrete Grout O Drill Cuttings Olrri^ation O Specialty Grout O Gravel Non-Water Supply Well: Q Bentonite Slurry O Other(explain under 7g) ❑Monitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: QAqui&rRecharge OGroundwaterRemediation clay from 38' to 2' bls Poured in top of well OAquifer Storage and Recovery ❑Salinity Barrier I❑Aquifer Test OStormwater Drainage Concrete 2'to 1' Poured in top of well OExperimental Technology OSubsidence Control 7g.Provide a brief description of the abandonment procedure: QGeothermal(Closed Loop) ❑Traecr 6 oz of pool shock poured in well followed by filling OGeotherma)(Heating/Cooling Return) ❑Other(explain under 7g) with clay to 2' bls. 2'to I"concrete plug 4.Date mvell(s)abaodoned: 7-14-22 followed by covering with soil to land surface Sa.Well location: City of Raleigh na Facility/OwaerName Facility IDk(fapplicable) 2616 Holloway Road r=-� ---`'� 7-14-22 Pbysical Address,City,and Zip i;�r ture of Certified Well Contractor or Well Owner Date Wake 1722476075 .8v signing this form,I hereby certify that the tv¢ll(s)was(were)abandoned in County Parcel Identification No.(PIN) accoi:f2Ze with ISA NCAC 02C.0100[or 2C.0200 Well Construction Standards Sb.Latitude and longitude in degrees/tainutes/seconds or declmaldegrees: and that a copy of this record has been provided to the well owner. (ifwell field,one latllong is sufficient) 9.Site diagram or additional well details: 35 44' 49.35" N -78 34'46.93" 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. CONSTRUCTIONDETAiLS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS Attach nwicoastructioarword(.$)ifavoilable.For mrdtiple injection ornon-water supply xwlls ONLY with the sane comtructiordabandorimern,you=submit oneform. 10a. For All Wells: Submit this form within 30 days of completion of well 69.Well ID#:W-2 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 38 (N 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Infection Wells: In addition to sending the form to the address in 10a 6m Borehole diameter: 24 (ln) above,also submit one copy of this form within 30 days of completion of well abandonment to the following: 6d.Water level below ground surface•38 (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if(mown): 38 feet (ft.) 1 Oc.For Water Sno tplly&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 jhealth department of the county where 6L Inner easing/tubing length(if known): N/A 00 abandoned. 6g.Screen length(if known): N/A Form GW-30 North Carolina Departarcat ofEavironmemol Quality-Division of Water Resources Revised 2-22-2016 RECEMD RECEIVED WELL ABANDONMENT RECORD For Internal Use ONLY: ME 2 5 1,22 JUL 19 1.Well Contractor Information: WELL ABANDONMENT DETAIIS Ur* Thomas Wili NC oEa/owa Dtg04M ,� { -Q 79.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoniJng we0 on hislher property) well construction/depth.only 1 GW-30 is needed. Indicate TOTAL NUMBER of 2700 b wells abandoned: NC Well ContmetorCertificatioa Numbcr 7b.Approximate volume of water remaining in well(s): (gal,) East Coast Environmental PA FOR WATER SUPPLY WELLS ONLY: Company Name Chlorox pool shock 7c.Type of disinfectant used: p 2.Well Construction Permit#. na List all applicable well comtruction permiu(<.a.UIC,Counn,,State.Variance,¢tc.)ifkrmwn 7d.Amount of disinfectant used: 6 oz 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Munieipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets ❑Geothermat(Heating(Cooling Supply) BResidential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay 131ndusttial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings ❑Irri pation ❑Specialty Grout ❑Gravel Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g) ❑Monitoring ❑Recovery Injection Well: If,For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation Gravel from 165'to 100'bls Poured in top of well ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑StormwatrrDrainage Bentonite Chips 100'to land surface Poured in top of well ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure; ❑Geothemtal(Closed Loop) ❑Tracer 6 oz of pool shock poured in well followed by filling ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) with gravel to 100' bis. Final 100'of well �.Datewell(s)abanaoned: 7-14-22 was filled with bentonite clay to land surface 53.Well location: City of Raleigh na Facility/Ownerblamc tacilityID#(ifapplicable) 8.Certification- /'�� 2616 Holloway Road J 7-14-22 _ 'Physical Address,City,and Zip Signature of- cd Wake 1722476075 1v ell Contractor or Wcll Owner Date By signing this form,I hereby cent that the well(s)was(were)abmrdoned in County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0I00 or 2C.0200 Well Construction Standards Sb.Latitude and longitude indegrees/tninuteslseconds or decimal degrees: and that a copy of this record has been provided to the well owner. (Sf wc0 field,one lat/long is suf6ciart) 9.Site diagram or additional well details: 35 44' 49.59't N -78 34`47.96" 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 Aaach well co7tructianiccord(s)ifavaitable.Formu*le injection oram-watersupplyweils ONLYwith the same comtructimdabandooment,you can submit oneform. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#:W-1 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 165 (fL) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Injection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter- 8 (ill,) above,also submit one copy of this foie,within 30 days of completion of well abandonment to the following: 6d.Water level below ground surface: 40 (ft) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 276994636 6e.Outer rasing length(if knowa): 90 feet A) 10c.For Water Suanly&tniection 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 6£Inner casing/tubing length(if known): N/A (ft-) abandoned. 6g.Screen length(if known): N/A (ft.) Farm GW-30 Worth Carolina Department of Environmcotal Quality-Division of Water Resources Revised 2-22-2016