Harnett_Well Abandonment_20220805 (2)

WELL ABANDONMENT RECORD For Internal Use ONLY
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.111C,('ounN,State, Variance,etc.)tjknown
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 S Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑lrri ation ❑ Specialty Grout ❑Grave(
Non-Water Supply Well: ❑ Bentonite Slum X Other(explain under 7g)
aMonitoring ❑Recovery
Injection Well: 7f,For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Pellets —24 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Concrete —5 Ibs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Removed concrete pad and cut well — 6 inches
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7
below grade. Abandoned remaining well in place
4.Date well(s)abandoned: 8/2/2022 with hydrated bentonite pellets to within 6 inches
5a.Well location: of surface and topped with concrete to existing grade.
NCDEQ-Roadmaster Driver's School NA
Facility/Owner Name Facility IDM(if applicable) S.Certification:� L��
1100 South Clinton Ave., Dunn, 28334 \J 8/3/2022
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Harnett Na By signing this form, 1 hereby certify that the well(s) tm� GW �S� V n
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 It'eFl&E
and that a copy of this record has been provided to the well owner. nnq
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: a,I��- Q v 21,L2
(if well field,one[at/long is sufficient) 9.Site diagram or additional well details:
35.298784 N -78.615672 W You may use the back of this page to provide additio a w Ie bs amliv
tltn�
abandonment details You may also attach additional
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)tfavadable.For multiple injection or non-water supply wells
ONLY with the same construction abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-2 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 (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: 7.93 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 10c.For Water Suouly&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): 5 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

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`. �. ® Monitoring Well
�� (Type II)
e ,
Abandoned Monitoring
Well (Type II)
Soil Boring
SB-MW-2 Water Lines
MW-2
Q Telephone Lines
Approximate Location
+. of USTs
Parcel Boundary
Pfa (Incident No. 6499)
f Parcel Boundary
` !' (Incident No. 15454)
V" Parcel Boundary
CO
o
(Incident No. 47681)
I Sourf . Esri,Maxar. EarthstafG� .Trap M,MRd the.GlS UserCommunity''
NOTES:
1.Well,tank,and utility locations were obtained from previous reports
prepared by other consultants and are approximate. 60 30 0 60 120
2.Wells installed per Smith No.2(Incident No. 15454)and Feet
Leland Lee Site Incident No.6499 assessments included.
PROJECT TITLE
ROADMASTER FIGURE
ATLINDRIVERS SCHOOL SITE MAP
1100 S CLINTON AVE w
Engineers and Scientists DUNN, NC B{+
INCIDENT N0. JOB N0. DATE SCALE DRAWN BY/CHECKED BY
47681 221222 AUG 2022 AS SHOWN KMC/SJO