Onslow_Well Abandonment_20220822 (2)

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor information: WELL ABANDONMENT DETAILS
Lewis LeFever 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 1 GW 30 is needed. Indicate TOTAL NUMBER of
2480 wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 7'18 (gal.)
Parratt-Wolff, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.11W,County,Stale,Variance,etc.)iij'known
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 a Neat Cemen;Grout-." f Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout _15'Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout AUG -2 21 2.022 ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentoniteletitj��' "D ri`` ='`� '� I-b'btlier(explain under 7g)
RMonitoring ❑Recovery ti.tt.��DV.1 `r'
J.. 1.:i
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 9.6
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 7-1 1-22
5a.Well location:
United States Military
Facility/Owner Name Facility ID#(ifapplicable) 8.Ce 'fieation:
Camp Lejuene, Jacksonville
Physical Address,City,and Zip Sign,lt re of Certified Well Con actor o well Owner Date
Onslow
By signing this fo•nn, (hereby certlf},that the ire/!(s) was (irere) abandoned in
County Parcel Identification No.(PIN) accordance ivith 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one hit/long is sufficient) 9.Site diagram or additional well details:
3838510.929 N 285729.382 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
Aiiaclnrellcoiistructionrecord(r)iJ'nrailable. (briniiltipleiijectionoi•non-iratersapplyu,ells
ONLY u,iih the saute con.rti•uctioii'ahaudomneiit,you can stibniii one Jorni.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: GW-122 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 60 (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: 2 (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: 15.15 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) loc.For Water Supply&Infection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this tbrm within 30 days of completion
of well abandonment to the county health department of the county where
6E Inner casing/tubing length(if known): 50 (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

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS''
Lewis LeFever 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 1 GW-30 is needed. Indicate TOTAL NUMBER of
2480 wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 7.35 (gal.)
Parratt-Wolff, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permas(i.e.U1C,CountV,Stale, INarianc•e,etc.)irf'known
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 a Neat Cement tR- -_� ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement, rotjt—t—P L_'t.k`` ;(L) iSry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout n) ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout 2022 ❑ Gravel
Non-Water Supply Well: ❑ Bentonite ❑ Other(explain under 7g)
❑Monitoring El Recovery ,�yyi� u�)t
injection Well: 7E For each material selected Ab e,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 14.56 Gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 7-1 1-22
5a.Well location:
United States Military
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
Camp Lejuene, Jacksonville
Physical Address,City,and Zip Si 4 ature of Certified Well Cont• for or Well Owner Date
Onslow
By signing this farm, I hereby cerri,that the well(s) was (m'ere) abandoned ill
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field,one ladlong is sufficient) 9.Site diagram or additional well details:
3838508.952 N 285736.103 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
Attaclnrell c•ousiruciion rec•orcl(y)i/arailable. 1•itr unulliple ityection orvtou-walersatpply welly
ONLY with the Sarre conylructiott,abanclonnteni,you can submil one farm.
10a. For All Wells: Submit this tbnn within 30 days of completion of well
6a.Well ID#: GW-123 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 61 (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: 2 (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: 15.05 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (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
6E Inner casing/tubing length(if known): 50 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Font GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Lewis LeFever 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
2480 wells abandoned:t 1
NC Well Contractor Certification Number 7b.Approximate volume of water!remaining in well(s): 7.34 (gal.)
Parratt-Wolff, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.1/1C,County,State,Variance,etc.)/f'knou•n
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used.(c�beck all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout` '� (` - r'' Y1�Bcgtcryite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout A ❑•-Dry-Clay
❑ ❑ El Industrial/Commercial Residential Water Concrete Grout QIr !' 2[�W213rillCuttings
❑Irri ation ❑ SpecialtyGrou` ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurryf�-(D ex lain under 7
DVI;. • J 1 t�,( P g)
❑Monitoring ❑Recovery "�t'S6�;
injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge []Groundwater Remediation 14.56 Gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
d.Date well(s)abandoned: 7-1 1-22
5a.Well location:
United States Military
Facility/Owner Name Facility IDN(ifapplicable) 8. rtification:
Camp Lejuene, Jacksonville
Physical Address,City,and Zip i nature orCertified Well rotctor or Well Owner Date
Onslow
By signing this form, l hereby certij�that the well(s) was (mere) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C•.0200 Well Construction Standards
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field,one ha/long is sufficient) 9.Site diagram or additional well details:
3838510.023 N 285739.738 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 hell ennxtructimr record(.)if'm•ailahle. l•ihr nnultiple ih#ec lion or non-(rater snppl}'Ire/ls
ONLY with the sanre conea•trc•lioti ahaulonnhent,you can subunit one fornn.
10a. For All Wells: Submit this tbrm within 30 days of completion of well
6a.Well ID#• GW-124 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well.depth: 61 (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: 2 (in.) above, also submit one copy of this torm within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 15.12 (ft) Division of Water Resources,Underground Injection Control.Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 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(if known): 50 (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