HomeMy WebLinkAboutOnslow_Well Abandonment_20220907 --own—
WELL
NTRECORD llacmil i, (-M Ir
I-Nell C-ittructor Infortfultion:
"4 qO'N-,I rx r 0 FT I I-S
William Ewing 7a.For GeoproheAWr or Ctosed-lAntill Centhrrmt Weik h;Wrg the NI.Mr.
W01 conimcn" MIX MrsO.Ully AtMmllnnm writ oft halter roPcn,? well "ly I(;W 3( ,hee
ded Indic c T(YrAl-
NI MER of
3110 well,abandoned
gaj.I
XC Well Contract 7h.ApprWorrite volur",(it writer rernetining In Ivelliq
or CullficuunnNUITAIT
Y.
Crawford Environmental Services FOR%V•\TER StIPPIA Ivul-S ONIN:
7.,Type of disinfectant used:
"r�pe of
di, ......
2.Well Construction Pet-ruit#: Unknown
rdl disinfectant
7d.Amount ardjsjnfeetnrvt used:
3.VVell use(check.cell use):
Water Supply\Veil: 7e.Scaling Inalerials used I check fill 11la1 APPlY):
OAerlculurral K I%Icat Cctn,-nt Grout 0(knic-Ille Chlrti or Relief,
0C,eothcrvnil Mcats"Z/Couhng Supply) 011"identull Water Supply IlIngICI 0 Sand Ccinent Grant 0 Dry Cl.,v
01ndustrial/Conn-nercial 011cniential\Vrq%%upflv2,, Cl Concrete Grout 0 Dnll Cuttings
,
1— ❑0 Spettally Glow( 0 Gm,cl
01rTiLation
Non-water Supply VVeil- t 0 Rcillonlic slurry 0 other texplain under 7g)
MMuncuring 0 Rc=!6 used:
Injection I X For each alaterild selected above,provide aniount of rnat0ri0b
Or 4.
V., 01�
O-quirc,Rcchrj7c oGroundwater Reniqdgwo_r-�M
I Hh-$
ge and Recovery Q - -1�464iq CYC-
��AIJI-
O'lIci-fie,Snt'a Isiamwa'14 Ora- ate
0,u.,-re.
OlExperuirrent-M Technology OSubsidence Control 7g.Provide a brief description or the abandonment procedure:
013cculvernIzi 1(71occd Loop) 0Tnocr Cv-o..r q
013cothermal(11callnWoolfinE,11clurn) iEl
.Sk Tit i*rv- ke`-c
4.Date well(s)ahandoned:
;a.VVeB Intention.
GPM 3066(ScotChman#3066) UST 0-020149
H. 3
C.1ily IDN(If OPPIK-3MC)
rd,Jacksonville, NC 28546
267 Western Boulevard, Nall 0-,—
Pbv,tc;ll Addtec.CaY-'nL'ZIP 023114 cignnrC -aN(1417 1 we
lj� 11,14.bl.retufl� that dir wellf%l it e aba I&
Onslow Parcel Idera,fil,110--N"I I"N'v a -dt 15A YCIC 02C 2C 0200 Well Conctna'11110 Sltladarilc
cottra) -idthura-v,of dot rr urd hen he",
'
5b.Latitude and longitude in degrees/Mintitc-Jseconds or decimal degrves* 11).Site diagram or additional well details:
o f till, I,)provide addillnual well Nile ciclall%or\veil
I,r vcll field.One 13111�g suffilicnll` You my tlw the KIA. I,�nach addifit)1131 Pjgc�'"'ecs"ry
34.749181 77.382395 You nlayuk(a
L
Col C-Tloj4 DF!r,,�tiis . ........ ....I 11TRUMON�F dn,46nn wulun 30 lby, 11
of corapfellon of c
n Veils: SnInnil
1,f"I"t loa, For All Wrils
ONLY'o?h fit Alandonlocro I"the lollowlrlr
71 j)i%i,jaIl nr Waicr Resourvvc,Information processing Unit.
6a,%Veil If)#:J!�
1617 Mail Ser%ice(.'ruler.11rdeigh.NC 27699-1617 A.) f to the a0drc-In 10,1
6h-TOW ill). I-lion In addilion III'endint!the to"In
I well depth: ( 30 Jays n(collipletion of well
jl,u s�jl)niu fine copy Ill (an"
wnhmI"the folimk Ing.
list.) pbandontneut
fic.1�(.rehole diameter.-------
If Water Rvsourires�tindemround Injiclinn
Division. 16216,Moil Service ljjjciLlj.,\C 27699-106
(.Al,Woter le,el helo-ground ailing t1tv "I tile
I Wrll%- In jIldn"'ll u, e I
I fit,.F.'r,\%ahl!L.Su If)(hy,of ovinpl�llon
\, A- ok oip�o(dn,lon""llun "hoc
tR,.()offer jen,_-th tit kno-All-, a. to the be.1111I &Non,cru of the
cr+mac�cl-een luaqh ill -------
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WELL AI3ANDONNiFNT RECORD lee Ieternsl U't,(IUI,Y
1.Well Contractor Infnnnallow WELL ABANDONME.NT DE"fAll-S
William Ewing 1
Af,For Gcoprobe/DP•f or Cloccd-Lunp("cothcr aml%Yells havmV fix anttc
Welt Cnmracnn\ame:ne edl uorcrt>;•raonolly ahamL,mtr�will on havlxf pmgenrl m:li Conslmctennl(lepth only I(ZV 10 ri needed Indreule TOTAL Nlil•1B1'R of
3110 wells Amuck lcd
R'C N`oll Canerntos('cnrfnatavl vnmfxY 71).Approiimale volume or w-rlcr remaining in itr Mist:—L.ti_-____(gal.)
Crawford Environmental Services FOR n•A'rF.R SUPPLY%YELLS ONLY
C,ret,na \amc
7c.T)pe of disinl'eclalu u.ed:
2.well Construction Perini(k Unknown
I'll a/I apr7n"N'tl,-wnrrarfl.•n prnunr(r r 17(_.Creaaro.Aare.Var,i n,r,ens)If kirrmn
7d.Anmunl of Jish)fcct:mt used:
3.Well use(check well usel:
Water Suppiy wY ll: 7e.Sealing umlerials used icheck all that npph`):
ClArricullunl OM1lunuipalfl'ohlic (Neat Cemcnt Grout O Itentunite Chrp>or f'cttefs
(3Geotherrnal iHcaunJCarthn&Supply) QRcsidemial Water Supply(tingle r Cand Cc neniGrout O r1r,Clay
Olnduslital/Comnlercial ORc edcnual 1 tcTSu"5 g
F .onactc Cimw ❑D ill CuttinES
❑Imeau°O { `3 ,p .••9 O Spectrdty(iroul O Gravel
Nan-Wuler Sol) 1v Well: n
ek1otonnp 2l'� O Bentoniie Slurry Other(explain under Tel
QRecol•cry
Injectimon Naell:
�1_VfoN&cacb material Selected above,pcoOde a rnount of materials used:
OA wfer Recharge ❑ c
QAquierSurgc and Recnecry Osalinitytodnr Re�m'c,rli ':aj.`+.C)C.%f•'^'I J
IS 1 1(} DF A) 44-16^i e
OAquifer Test ❑Stormwalcr Drainage
0EXperimemnl Technology OSubsidencc Control
7g.%'invite a brief description of the aban(1mnnenl prrlcevlurc:
OGerxhermallClosalLoop) OTnccr `-
OCxothennal(Ileaun oolin Return)__ Q()jher WxpiSiti:untier 7 ) /"I.��t� NO4 6axU -
r-
4.Date we.Bis)abandoned: / —2;-'27'
Sa.Well location:
GPM 3066(Scotchman#3066) UST 0-020149
F,xilm-/1),a•r,cr ar Faciliry IUi tf appti:a6le) S.Cerlilicnibur J�f
267 Western Boulevard,Jacksonville, NC 28546
p6ysiral Cm zed Zip S,gn:lturr of Ccnified%%jell"•lcnlof itr well 0"*' Uare
Onslow 023114 '
13v s,gntnq this form, l hen-In-renq', that the ❑r//f,1 i,ac ll,em) &wndo»ed in
Groaly Parcel Icknuficmran Ku.a 111Ni arrordam-r a tilt 1 A A•(-M 02C O/(!l:)'r,r'( ()$X)Bell Crweni Y n.Slnl),lnnl4
inert duo r,rope of dris re•r ran!hen hero prvt nlref to err 1.�•1/honer.
b.latitude and lungitale in deprees/mioules/seconds or decimal degrees:
of»ell reeid.rangy IaT,•kng a,,aflirrcm l 9.Site diagnun ur additional(hell details:
34.749181 N 77.382395 1Y Yet]may use the back,)I fill,pa,*c I.pruvwie ad'hoonal well the demi or well
abandnnmcnl dcNik. You nlay also auaeh addinonul(,ages of ocee"I",
CON:STRU(--TION Dt rAl1.S 01 WrLIJS)BEING ARANDONED SURN111-I'Al.INti rRt'C`ljONS
:tinK4 a ell nnra+:.a to-!:rn rnrJt.l davnilunlr PLn rnvinplr in/n-lien nr nun m»err mpply nrR.
p.Yl-re*eels else+n,cr,-.v:,na,rncrahmr!crrnrrnr rein,ran erhrmr.,nr fr,mi 10a. For All Wells: suhmil (lux feral wnhill 3f)days of Completion of w0l
qq to ahendonmcnt the fullowln_,
6a.Weil I1N1: �✓ " L.�
Ditision of Watr Reseource�.Inforutation Processing Unit,
6ir,"total well depth: � 7— Z, (et.)
1611 I\'Iaib Scr ice Center,Raleigh•NC 27699.1617
101).For Injection%Yells: Ina lditluolfo,cudmr toe form 10 the addles in IOa
above i,l, .0 w(Incnnc")fly of lhls bir wo" uhen 11)d.r„of comp w icliun ui well
(x.Borehole diameter: et
nb,mdunmenl u)file loflow'Inc.
6d,Haler lovel behm ground surface: �' y Ifl.) Division of Water Rv,uurees,Underground Igleclino Coulrul Prugmin,
1616 Mail Serciev Center,Raleigh-NC 27699-1636
^� 10C.For Water Sunup\Inieclinn 11 ell': In addumn to,cudtlle lac 101'tll In(Ili
6c.Ihocrc:ninglvm_thlifkrn„tnl: fl'L) addrv„ty<I.ibe„c ;d.n. hn one<o)r�,p`Ihnlornl �q.omplCuno
of 'tell al6.nufunmm1l ihC ",tent, �hr,dlh dop;utulcm nl II1C .aunt, where
61'.Inuer ra.ing/lubing length lit knouu): r+ Ift.i dsmdrmcJ
S,rreu leneili art klm.rn): �f ifl.l
I.a�n t iR U7 4.cant �r.�6,n I\p.�uave .��1 n•.rr".un,uw i�I)y.ihr. Il, n.,t w m:Il ...n.r, I
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WELL A RA k1)OiJINtlFVT 1U.CORD h:r:rn:rlt
L\Veil Contractor loro,nuuian• 1%ELL AIt.\.NDt)\\Ih,NI DP.'I:\II_til
William Ewing
_ 7n,For(ropruhr/1)VI or Cloyed-Lot if Genlliermal%%ON lid,ow.the•elnr.
Fall c,om'.1,m,Nam, vn"ot well consink Ctn r/tic th only I GW 11)its nr^.tl:t1 hrrltrate f(�)T At,\(,i1•I Ill R of
c.�;,r.a,nath ,r::e:,lnntn!•„rll on hrzficr pmlrngt t P
3110 ,Isle abandoned
e-_.. .-_loll...__._-•--
Nf,Verb C',nurt-,c.C cnn,cnrn z lb.,l pprosimnle anhf are Of u[uer remlrinin;:iu,+elllsk
Crawford Environmental Services FOR WATER SUPI l Y WEII t C O:NII Y:
7c.Type of disbtlect-o l used:
2.Weil Cmrstructinn Perntit n: Unknown
Iry nil n�cA.rfNr r.rr.'r,nr,nr,;x.m+„-r,mr..r ['f[r'nrm, Grsrr trt.ronrr crl,fArmm
7d.Anoouut of disinfectant aced:
a•\Yell tole(check.:ell u,e):
-Water Supple\Veil: 7c.Scaling materials tiled Icheck all that tq)pI,r
OAgncultulal ONIumcrp;lil'nhhc V Neal Cement Groul (7}Renn,nue Our, ,I POIC1,
OGeothMmal(Hcaung`C Ane Suppi�1 0Re,ldenttill Water Supply(slnnie) O Snnd Cement Glow O Dn CI..c
OlndurtnoNGommerclal Ol:esldelmnl Waatgi.Su; s vc 1 O ConcreteGroul U DIM Cwunq_s
Olrtreatron i<^,'
f 4: � - ❑SpeelahyGrout O Cir,,crl
Non•Waler Gtppl.Well. .r"`_.•,_�.4 B �
O Bcnlonue Slurry O Other Ic,pkun muler 7g)
Mon unnnp. Okci•bi crV
Injection Well: �� p � 71'.For each material selected above,itrovide amount of materials used:
OAquifer Rerharge OGrneN�Iuer Remcdtangg:
�F OtF l�^rI •✓ �w..�t 4
OAqutfer Ctorage and Rm,-cty OSahnity 13:". ir:�n'CYG ,
OAquifer Test Cl\t�rgnriVtt'ticr�eli�{i i
OI>xpattnental l'cchnofu y OSubsidcncc Control 7g.Provide a brief description of the abandonment procedure:
Ofxothermal(Ctn---d Lonp) OTraeer 1
OGeothcru al(ficaon^JCoohn^_Return) 00diff(explain under 7 ) l`'l•s[ /yO4�'(soav> %✓� { ...— a»J P�
i =0h
Z T�17u•J�. TMr�Mi• P•p. `�'--r /.So>ri•- 1'L>
4-Date wells)abandoned: ! -2;''2
5a_Well location:
GPM 3066(Scotchman#3066) UST 0-020149
j FociliwO.-net Narrw Fociliq tl)R(ifappficohlc) R.Cerlilication:
267 Western Boulevard, Jacksonville, NC 28546
a-
1 Prq-real Arkhr:s.fa:.—J 71p Sign lure of CcnilStvl—Wrll�$.nu�i.ol nr Wctl U,rocr pale
Onslow 023114
R.I..signing this front„ 1 hemb, (snip that I),,, nelir,l-nas(ogre)abandoned or
gourivy P.urel Idenortesur,n No(PIN) accarrinuce n till 15A NCAC 02C 0100 m 2C 0200(aril<•nrl,nTUYrorl Standards
and rhea o tarp,oJlhis rr•vnd hat the u-rtJ o,.urr
5b.latitude and longitude in degrers/minules/seconds or decimal degrees:
(it,rrll t rkl..o m htam s" rrrtm) 9.Site dingrant or additional well detaih:
j34.749181 N 77.382395 W You may use the back at laic pure Iniptovlde additional well vile de.,i le or well
i
abandonnxrn dtaails 1'nu may area uu:tch ad(tu,nnal page,of nccc,<al y
CONSTRUCrION DF`1.VIS OF WF',LIAS)IIFING ABANDONEr) SURIVII`ITAL INSTRUCTIONS
GAnrtrAe•rN rvm•rrnr n•n rn�.'rrfr!t+/n,'nilrNdr Fcrmnhiplr ur�rcrnm nnrnrr-wnvr nrq,plt•'n•1!r
ONl1'tnrh rhr m,ar rr.nam.n.m/nhorrinnmrm .'rro.nn arbwit tart Anna r IOa. For All Well : Subuol If,,,, lixnl wuhul 10 Joy, of compleaon Of until
6a.Well 11W rvn t-/- 3 abandonment to tire foiluivom
Division nr Water 16-our•ri•s.hilorntatiou Vroct•.siuL Unit,
rib."I'ntal aril depth:
_f--1S (fill 1617 N'Inil Service Center,Raleigh.NC 27699-1617
IOb.Fur..Inieclion Wells: In addition u,•eudine the lone to the arltfles,in IN
V n 6c.ISrehnle diamvler: (in.)
ubovc,also,uholil oar copy of du,form wuhm 10 day,ul cuoyhnton tit ell
rx ab:mdauncm to the 1011nu•mg
t
3 r t-- ULI WaterDivision nl Water Wsuureec,Ihtilergronml Injecliou Canu'nl Program,
6dWaterIt-,cl helu,.Au w rond rfaf 1636 Nlail Servicr Center,Raleigh.N(.'27699.I616
IOc.For Willer Suppl, \luipclion\1'clFs: In mLlotmn In.rud'm^the loan to the
(w.Ilutcr ca,ur2 lcnAlh Iif knoo n(: lfl.l adtlrc,.lc,t,dn,cc al,o.uhnu one.o,l td dl,•Lau,..ulna t(1 da„of cornplcm
If well nh;nulonnrrnt to h,r (,not heohh Jc(?,nlmim nl +Ite mnl) ,chin•
lil.Inner rt,inA/)uhurA IrnAth(if kno„ftr. I flu all.u:dun,:d
far rtor It•uclh nl knn.,ni..
,; =r ., .i, .. r .•.•.t,11-,,nr;k r. (.-,,.,^.nl,O nl rr(?;,,Ir., It- r -n,n ten (<..r
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V'ti'I-A L 1 RI-XORD�
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1."e"I—Ilractur Information; 11'FI_1.,.Alt,\\DI)\\ll_\'f DI--r•\II S Y
William Ewing
7a.For Groprol OD11I or('Ine•d.I oupY •nl hernral N'elkiu,rnr ilia,:nnc
v.,-!ft«....:,-r,�. .+.n 'mlruelnutf,:ash onh. I l.,R'-Efllr•t _<!cd Itnl�i:nr rol Al,"'L A1fi1...R n(
- nryy 4r,ahan•3 ^moll m,h�*ttlel r+r^.pma.l ,hell.0 !.I
?: 3110
F.
W IN rn r„n...-...,rrmn 7h.Approtimale toh n e or wan•r remaining in wFlhsl: ,tgal•I
Crawford Environmental Services FOR W\TF.RSI1'PI,1 WI,1,1-1;ON1.):
7c.T%I,e of disinreel:ml used.
2,Nell Cnnstruclion 1'erntil 9: Unknown
U1(- Cn :?c Sant.!`7et nrrcv,rr<
7d,Amman of ditinfex-mnt n,cd:
3.Well trse reheck'Veil use):
\\mcr Suppl+ 1\•ell: 7e.Senlinc material-used Iclicck all thatapplpl:
•7AcrecuRtrrl 0munict(:nllpuhlie 4kr\ca1 Cemcni Gioui '_i Ilanu,r,ne Chips or Pelfcl,
0Gen4h,•rma4 qrl an«^,fCoselinr,.Supply 1 ❑Residential\Pater Supply(y p Sand Cenwin Grout r)D:,-CIa
Cfn lit tr+»51( ern crct:ll ��
pRcylrJcgllak'ti`ciSNifAI�1 la Q Concrete Grout fI Drill('atones
Chrrrzin'n ,•• "4.9 -�5"� p Spcctally Crtanl G Gravel
N'omt\'ater Supple Well: •.a..
r1 p Benloul!c Slurry 0 Oilier levplain under 7g)
�;'.•IM;r-<yrr ORecov
Injection\\'eft: .Foreach material wIeLcted ahove,'provide nutonnt of ntalerials used:
Gr
t1.Aga4ter R«h^rm ODundwater Rfn ib fit�i+��
pAgo4fcr Sma+a and Rrovcn c3siws'rttay Q 4,q,.,;3i;
1' CAGuifer Test
p510Tt7twalCr Dra1n:1."
EFcr-ramcma?iccflnolevgp pSubnllcneeControl
7g.Provide a brief description of i lie iabandunntenl pr6ecdure:
.t (3(..tother;t 1(Closod Long) OTrater 1
i riGrniMsmw(flieznrr Cootin�Return) OOthcr(ci lain under 7 ) /'^•st�✓ NOai-Gav+r� i r /�y,�� a«J Po.;.,p'.
!; G.Date wit.tits)afxrridoned` 7-2f'ZZ
Sr.tireo••►
E
Sa Well bcation:
GPM 3066(Scotchman 93066) UST 0-020149
i. Fscdr+•>L'Is^n-r h-arr Fxilily ID►h(applicable) R.Certification: �3/f o
i
# 267 Western Boulevard,Jacksonville, NC 28546
Ptr.±w!AF,,tr•�zz,Cr =1 yip Spmrs,ofccndied We :nlru rr m N'Il Ehancr Date
onslow 023114
'( Hi-tignurn dus firs+n. I lrrrrlr <•rnJi'+htr+rfu•ire/!(,!ivns(Derr)nhrrnrloned in
Gtctrg Parcel Ideruificmion No(PIN) orrei tlnnre-tit ISA k(„A(.-02C 0101)ur 2C 0?00 wat Cn ITIllaYrpn Srondor-da
nrid shut r+rapt r+f+Itit rerurrl l,rn hreu'�prn r+dr-e/it,+h(•,sell ins-trer
4 Sb.Iatitrlide and knrg)lude in de rees/minules/seconds or decimal degrees:
fit.rd fettl,Ox bUt•ng is:a(rna nl 9.Site dingnim dr additional w'elf dciails:
t 34.749181 77.382395 \\, You may use the,back.uI Ihis pate lo'provide additional well site details or well
z ohnndonlncm delnils 1'„u rosy also,Ii:u•h.rddmnnal p:IgCs i(ncccl-<nly
! CONSTRUCTION'DFI'A11.S OF WELDS)BEING AIIANOONI;D St?imn-rAL INS TRUC"PIONS
f Ao,,I rJFrv,r,^+^na,•n err�t(fcJ ifrrnrhblo r mnhfpf ogrtrrnn nr,lnrniMir,rrgrph nrlt,
().1'11 soli r%]r r.n>,.,seriTlrnr rinlim+drm,rrrnr tYw,rmS:nhtnll rwN fiYnn. 103. for All \Yefts Subutll Ihl, loins w%oflin 10 J;iy�of Cmnpleurilt of well
6 Ga."'ell I6t1:.. nhandvnnlem us du Inl....in,:
k'
Division of\\',der Resnurci•s.Information Processing Unit,
6h,l'rnnl well rkrpth: CT. 7 ffl,l
1617-\tail Ser+'it•c Crnler.Raleigh.NC 27699.1617
IOb. In addition ua.cudulo die rnnn to the address in 10a
6c.Cnrclrrde tliamt ter. tin.)
atxwe, Aro+lifuun one Ut1y, I III,,Is-), wino, 11)al:lys of Completion of well
c
,hnndanntcm nalhc rnllnwm,!
ML.\tarts level(trlot+yrnnnd surface:��_Ift') Division of\\'ides Resources.1 htih•r�rrauld Injecliun Cunlrol Progrant,
1636-Mail S,•r,ive('cuter;R;deigh.NCI 27699.1636
I
Ilk.For%Vt II-r tiugpl+•R_htiri�tiul,_1\'rdh; bl add,uvo to Bench n,•life loim ro ihC
rr lhHcr rl,inr h n_Ih lit kn(o'nJ: Ifl.j ,+:Idic"Ic,I eh,.,c.ako—hulo nuc.,qi,01 Ilu,fill it,,vihln 10 da„of ci•mplcnou
If well nhdndnrint-lof n, Iltr i,iiililti IiCdllf dep,ululCnl of die couolY when,
"hand.n ii rl
M,Inu,rraon^lrulon;:Irn�lh ii(knurl): ffl.i
6-.ticnro l'tr't(r sit knm+n): —� 1I71,1
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t f.- r_I..i`: :i' \. .n(..-.I,n:•11,:eN„ton .1In .,.nna r.r:l ll„1i1- Ile nq ,.i,\.i. N_„y , �
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WELL A HAN"QN)'"rNT RECOIZO �
1.Well Cnrrtru`lur Infornmtinli: \\'hLI.Alt,\VNl V\ IIf 1 I E\1'DI-1:A l lts
William Ewing
7a.I'or Gcopruhe/OPT or Oosr•d-l.ilup Gfvclhrrm•d Wells ft,,,ng the-In!:Well C-1—lnr\;nnr,ol null Dauer iZ.e,mgll�uh;erA—"Ty cell uu WOW,Jury'"', ,cell construeortmldepth only I GW.tp n ire<Y&d Indic.tl--TOTAI,,NUMBER of
3110
welk ahaudrx,cd
NC Well 6nfntar,or('eni6sattam�umtrcr 71).Apprustmalc volunM of tt'afcr rcmainin.in wi•11lS.n 40.6 (gal.)
Crawford Environmental Services FOR,\'ATE.I(SIJI'I'1.1'„'I::I,t COVI•Y:
Cmuryny'\�nra•
7c.Type of di.infeclaul used:
2.well Consiruciion Permit p: Unknown
I'll nil nMtGnih/r oy/t rfnurnmirvr pernnn 6 r UtC.Cnronr $tp:r-Vuirnn�•,rtr))din:>ar,
7d.Amount of dicinfeciam used:
3.%fell use(check will use);
Water Supply H'cllc 7e.Sealing materials used(check ull,thal apple!:
OAancnbural ONluu ; tXNeut Cea:n�i Gmuf O Rcrnonue Chlps or Pellcls
OGernhennalHemmJ + � l C py Lii 0 Sand Cemm +Gmul
0 Dry Clay
OindustnalifCoin+oerc+al k�74 sf Pnli ,\ncr Supply(sharod) 0 Concrete C+rotu O Dnll Cumm�
Oh,i ationP-ir 0 Specialty Grout O Gravel
Non-Water Supply
Well-0 Bauonlie Slurp, O Other(explain under 7F)
❑Rccotut Urlk
Injtttinu 11'ell. p _
to{via 7f.For each material selected above.provide amount of malcrials used:
OA uirer Rechar e rat\ + �'" 1
q € OGrmrndatlhF�ime(hamn f S�If" �F Pb
OAquifer Storage and Recovery OSahniry Harrier d
�
❑A uifer Tess' q OStonnw•afcr Drainage
(' OExperimental Technolo-,y OSuhsidencc Control
OGecmhermal(Closed Loop) Ol'racer
lg.Provide a brier description of;ilwalmndonnient procedure:
l
013cothermal(Hell inAlCooling Return) Miller(explain under 7g) /VO4I'lsxt,,trr ih (Ql,,r�
S .
s�+�u-J� ?M•ryMj• P'/�- F.�r.� /3o>Pi— 11>
4.Date wells)abandoned• 7-2S'Z'L
Sa,%Veil location:
GPM 3066(Scotchman H3066) UST 0-020149
l=aci6tt'/Owrtet Name Facility InY(if apnhcahk) S.certification:
267 Western Boulevard,Jacksonville, NC 28546
Physical Addrecss,City.and 7iP SiEnaturo of Cenifter!N'eli m+raciur a\vNl Owrrr hate
Onstow 023114 k slgtling"Ill for'", f lierrb% cerrifvMill dlr-elffvy um blere)vItnndoned in
1 Courtly Pared tdcari6calien No.(PIN) nrconlance%ith IJA.NCAC 0217,0100 or 2C.0200 Welf Crrisnrtcnun Stnrulairfs
and that n coin of this nrord hat berm pon,'tdrtf to the,.-ill nurrrr. -
5h.latitude and longitude in degrees/niinmes/seconds or decimal degrees:
fif.ell hell•mr lattl—V is stlfficxrn) 9.Site diagram or addilinutil well details:
34.749181 77.382395 W You may use the back of this pace to provide additional well site derails or dvell
abandonment details. You may also ait:Mh additional pages If ncmv.,iry.
covFiroN rliU4'rluiv D�rans of wf t.(.S)al IN(::AHANnON1-1)
,ttt•icri l,.,DFrdlr)rfrorbV Fur M)VII'Itrl/Y"t ABAJODOiNl-- "I rtc.,rlh SUHM11TAL INtiTRl)CTI0NC
O,YhI'x•;rhdirdrrrurr•neytnnri.n✓nAanrbmirnit.nnfrnnurtttnaof:rl•+f'rtr IRa. Fur All wells: Submit this form within 10 day,of completion of well
6a.well Ink:_ C-, abandonment in fire(oil...vinL,
Division of„'tiler RPS01lrel`5.hdortualion ProriNshw tlnil.
6h.Total well depth: �.//O nh)
1617 Mail Service Ccnti:r,Rlilcigh,NC 27699-1.617
•�
IRh.Fnr Inieelion%Veils: In additinti it).ending the form to the:ddrecs m l();t
fie Borehole dianrctcr. (in.) alcove,also siibiuit one copy of lhrs limn tyithm 3f)toys ill corripleitort of trcll
[� abandonment nndre following ,
6d.%%':tier lrycl belt-_vnund surfare: `/ 7 (A.l Division or, .",Rtc ources.Underground Injecliou Control Pro_,rnm.
1636 i\goil Scrcire Ccnll•r,lltulcigh,NC 27699.1636
I
IIIc.For Maier Sunph fi Inieelion 114c11c to:uldnurt u,�cmhro�fie it,ft nouIt"fie.(hdcr cn.in,le"'Ill lit'lout,ni; ill.% addw-lc,)al—c alto mhnm r nc cold fr(fhi�(dwoi tyuhin i0 d,y ui p.ntplcttnn
of well ahan,lunincnt to +he a,,.ni, rah11 dep:olntnml of the uauuv whcrc
hl'.hio-rcasiu;:/iuhin-,Irugihlirknoonl: tlt.t hn,�nntd
bg Yfer�len-thtifkmmnl:
\•e'1-l.'n'<•h^e ITg fngxi fn e•(hue.mmonGrt el tJnshn Ileu.vm.•1 tt no>.R.�,-u t,. 4 �., i,
`mr
I i
"l�f(.•"•�_• ���1 E-1tYaJ\JIV.LY`1,�!\�� �In�h\��\l� la�hn..ni:tt t,.�l, {€ •.
4
nutnrtor Inlo+nratinn;. 1YF;1.1_.1tS�NO(I,tiIIF:\"I h_(`7�)Itif
William Ewing
7;t 1%r,r 1 Inp nhrsll)I'1 nr l ttr�ed-Lu ip I c tilt rrtr.'rl well ii t4 the-im
Vann cu Cell nai*Wrl,rrc.t•dlT;+h^r:d xnne well ou lwza r1+,-^na, „•'OIco,at I(,tl 10 fnd+catr. TOT AI. NL0,01'R of
3110
vC\Ir11 t oanao,n t Br'ufir:m;m`romtwrr 71).ApproNu,uoe voloine of+uurr rcmaininy in oclllsl: f�al.l
Crawford Environmental Services 41Pp1\ WF.1"`(ll Y.
Cgmp:,nc�:tn,c
7c.1'ypo of(1kinfectaul nced�
2.Weil Construction rcrmil N: Unknown I�
l.icrrF er.;,lr;^r+(.fr c.•rl:,nnurrurren+,rvnrtirc W, (!IC Crmrrn Strrt�.Inr;p n:g.rn ri(`l'r.,•+xr
7d.Amount of dixiofcraant uvcd;_ _
3.(Yell use(check+,ell use):
tYater Sul>f1A•\fell: 7c..Sealiw;:inateri;tis used(i•Iit•ck all"he1 appivl:
OA-�ncohtual 011lunicip,11(!?tthlic &&'cal Ceut+=gr Groul - rl 13cmonife Chips M pellets
OGcothermal(llry,rinr/Coolimt Supply) ORc:idenhnl\Pater Supply ism+.lcl ❑Sand C'ea+,ur Gtout 0 D,\CL.
Ckli,duttnollC'on,+acre+ai OReedenrial\Laler Supply Concrete(rrc:r+t 11 Drift Curlint
Oln+•anon
r-�'•�' �, '1 Spcy;rllvtisr+cl O Grtac'cl
Nnn lYatrr`irpillj R'cll; - t'=-+� �
�•4t�+ -- O Ilemonoe\luny 0 Other ieN&iin ender In-)
r!n•Ir�rumm�% ORoiovery ro ,�nrt ..
Injccticn Nelt: -- i{ 7f•For rich umleival selected allove.provide amount of materials used:
i
CI:Agtafer Recharge OCraund�tccr Remedintion . 1
OAgtrdcr Storage and Recovery OSalinity Bamcr-.;l :''+~' -
OAqurfcr'rest OSt1111d rice Deiyl'ott�:'
OF_spennienml Tex^hnology OSobsidence Control
7g•Provide it hrierdcscriprion of the abandonment procedure:
OCieothermal(Clo ed Loop) 1Trraccr ``
06eaicirnal(Heating/Coolin Rctum) OOlher(explain under?_-) Nht� /t7CgI"6wav, ;0% L'Al *-d
_:r4170•5/1
4.Dale cccll(s)abandoned: 7—2
�sr.rt
Sa.Well Itrcaficin:
GPM 3066(Scotchman#3066) UST 0-020149
Facililyto.,vr Njme Facility IDt!(it appl',cabM) 8.Certification: 3ft O
267 Western Boulevard,Jacksonville, NC 28546
Pisysn-a1 Add:rSs..Co, aml Zip &nnafore o(Ccndtcd 14e11 mnsr+r r N ,COwnc+ Date
Onslow 023114
!3y TfRII g tbry form I hereh, rr,Yt Iitur IN'oell(O oac(o•rre)abaoilnued tit
Catmy Parcel Idcmilicaiinn No IPIN) ocrordncre n'ab 13A MA( OR 0100 rr,-_h 0100 Well Cn,rrtrrrrliwr StOod(lydS
and flan o cep,of thta rev�n'rl hn,been pl»,irlril ro file t,ell oo'nrr
ab.L�tihtde and longitude in degrc'eslminutesfseconds Or deeintal degrees: .
Fit«VI1 fend,one 1.14 g is mmciem) %Site diagram or addiliorul+cell details:
34.749181 77.382395 \V You may u4•the hack of this Pace to pio,-ide additional well site derails Or well
abandonment details. You may,also aoa+.'h addoional pages if necessiny,
CONFI f1UCY103N DFTAII S OF WELMS)MANG AIIANDONRD S(Atr111'l-I'Al,INSTRUCTIONS
AtuerA tT „n,rr,a r' .rernrr/i c)fn,Krdab4 Fnrmnh1p1-`sye,1iennr,inn.otaerrrgph rwlh
ONLY-M the kr,ar+r,rtururtibn/altanrl.Hrrarnt,sou crrrr v+lturit ewer/lien. Itla. For All \Yells: Std)nut till,font, ,ohin 30 daps of conipletlon of well
ba.Well IDR: f^�� �/ � � abm,donnlem to fill,lolla,cme
Di,ision or 1Catcr Resources:Infornsuliou Isrocessing tlnil,
Gil.'r—mi+cell depth: f.�. 5�1 011.) 11117\tail Sereice Cents.Raleigh•N('27699-1617
I(Ib.I:i.i Injeclinn\Yells: In adiliuon io scodme the Ierht to the address in IOC
be P,orchr,le tlihmcicr (in.) obOvc. .da, oboul one,.oll of do,hero tvi+htn i0 rlaya of complttam of well
abaridunmem to the follow.q,
6d.IFatrr It"el hilt,ground surrace: � ' � � _ _Ill.) Division of Mufti.Itt•.aurces,Underground Injecliun Control Program,
1636\"oil Service Ceoler.R:dcigh,NC 27699.1636
11h•.Vol\Paler till h \lu crliou t\'rills! In addition n,:ending file for I('(Ile,Itc 6e,Ootrr+astug Irnelh(if known); (ff.) ---11-P
a±Idrr,:6-ti):d.„c •dco.uleu,u rm,•cup, .,I(hn Win,„thin VI day,of Completion
of ,Of .+b,urdon+nenl u, the. scant,- Hraith dep,anoant or the ceunn :owre
r+ ,,hanilnu•d
td Im6�r cv,nr�h td,in;;leu•,;Ih lif knn,rn)c ill.) '
6.•.1,11-vn klhlh of kilo„fit:
4vig t;?• 'd `spr(v,um. U„vn„m n,1 n,a nin.nr al r):r dn• I+r..n n.a l,. k.- .+.
li—:,1 i51 f•
I
R
YVI LL A11ANDONN1ENT KEC;ORI)
1. hncn,IG �(Iu1_Y
1.\ticll Comructor lufunn;uion: \1'f_I_I.,\IS,tNUO/\"A14\T Dh'I'.t11.S
William Ewing
to a 7n.For I;citprolnlPF''r ur Closed-I ro'lr Geothermal Wells h;t m eh_s<rezc
e Conna.aot N,ma ern well v,art lxrb,x:Irll+.thanAmm��well xe Itrrnr_y pin7r,�m., well sunstrucuonldCplh nnly I GW 10 ib Ihvded. Inlic3re. PJAt NIJ\`If)1`R(d
3110 ,ecli.a6endratrd __ __ __
NC W'utl Cmm,cror t'crnuvann„Numb I 7h.Approximate volume of walcr reniaining in wcll(s): 1. 3 twit.)
Crawford Environmental Services
FOR\\'ATIsR SUPPLY
COmrany Mans. -
2.Well Construction 1'cnnit
Unknown A.'I cpe of disinfectant used:
Unknown
Len a!/ ,,a muse.."•.,•,l.enurn t,r U/C.'rear.• Srnr.�^nr.m•r air.d 4r:.• �
7d,Manual of di ioreciaal used-
Witter
Well use(check well use):
water Supply Well: le.Scaling materials used(check all Ilial mpplvl:
OAgrt ermit pd.9umt p•tl/ Is''v. 9 1] 7\cat Cement Grout C]Ncntoniic Clupp or fillets
OGeotherrnai(Neann:K anion Supply} l sld iatteL S p�'icmgle) 0 Sand Cement Grout O Dry Clay
Olndustnal)Cotmnercial tl COjt tarsal ttst'aler,S �jjl!�1 hared) ❑Concrete Grout ❑Drill Ct:nin s
Obrieauon rt p Specialty Grout ❑Gravel
Non-\Niter Supply We1L- .- IR p Rcntonne Slurry
;•,-.,p y O Other(explain trader 7e)
G'Hloirtonng ORcmvcry -
Injection R'ell; r Jr - 7f.For each material selecled alrove, tovi(le nntounl of ntalerials used:
OAquifer Recharge tb`Grdwndw tilt Remedialinn _1
OA uifer StorarBarrierI S �6i 42F A)^V 1-� i.a✓rf
q }rye and Recovery OSahnity
OAquifcr Tcst OSttmnwater Damage _
OExperimemal Technology 0SUMidence Control
7g.Provide a brief description or the abandonment procedure:
OGeothermal(Closed Loop) OTncer
OGeothermal(I leaung/C(whng Return) ❑Other(cxplatn under 7e) }2-4 :air .._
-`f 2z ���-:s� 'ln.'.t..n•.;. P•_�• Fes--- /So>r�— >7j
4.Date well(s)abandoned:
5a.Well location:
GPM 3066(Scotchman#3066) UST 0-020149
FacilitylOwncr Naror f-acllity IDN lu.ppl—lik) R.Certirica(ion: J/1 0
267 Western Boulevard, Jacksonville, NC 28546 _
=—
Physical Atldres.Cnx,anti Zip Sirnaurre of @enrlird\yell _nnactnr.rn\Ycll'Uwyrr �patc
OnSIOW 023114 Bc signing this/ornt. 1 hrmbt rroif+ that the rvelHv mac lucre)nlxutd(nte(I at
County Rueel Identif.calain No.(11IN) arenrdanre nnit/SA NGIC 02C.0100 u,1C 0100"'ell Crnrsrrurrton Stmeta',15
5b.Latitude and-longilude in degrees/minutes/seconds or decimal degrees: and that n cop%pjt/ris o-eror(l has brut pvor uktl m rile tell or,ner - --
(if..ell i cW,one bdl.mg is su/turcn) 9.Site diagram or additional well details:
34.749181 N 7T382395 W You may use the back nl lhis Page to pr I ovide additional well site details or well
abandonment details. You may also almeh a(Witinnal pages it necessary,
CONSTRUC-PION QUAILS OF W►iI.LfS)MANG AIIANDONF.0 SUIS\gll-I'AI,INSTRUCTIONS
Anrrrb n�!l rurronw nrrc�rrcordfcJ+/nrrri/nhle for rnufnp(e m)r.ru.ur..... ur nggrfi•,•el(r
ONIIY u nh rlr, ate „rnrnn•pon/nhmubronrvn.r nr rem qr(n,lr,mr/arse,
l0a. For All l\re11S: Subnw thie roan w•nhm 10 days of completion of well
�s abandonmem it)the follouvut?:
Ell-Well I D#* wfi�•-�- -1
Division of\\'aler Rcsource�.Inl'mrnation prncr,tSiup,Unit.
61).Tutai well depth: 1fL) 1617 P4ail Scn ice Cculer,Raleigh.NC 27699-1617
lilt).Fo_r ern clioll Wells: In dddinon II).cndmp the limn In dte address-in 10.t
6c.Borehole diameter: �r tin.) above,alit wheat nnc Lamy of this Itu'n withal 20(I:n•s ul completion of aril
abandonment to the Rillowm•_
6d,Water level bvhm grousul surface: 3�• 7 l rri.) Divisiou of Maier Rewurces.Under;round litjectinn Cimral 111-oeralu.
I636 Mail Service Ccnlcr Rhlcigh.NC 27609•I636
Sir>pl+ R Iniedun 11 ells In eddmnn m.enahng the frnhe
be.Outer auiul;leniah!if knm•n): _(fL) I.,to t
ad(lre"tc,l eho,e 'Iso nthnul one cum.nil Ihr,loan wnhnt it)(ray,nl-complel it
of well to the arum, hE,d(h depanrtlent JI the c(xi ma .char
61.Inuercaiinijiubmgleogiltlirkutmnn: �+ fit.) .l.andoncd
n IYI�I'I,t�l hrirkttnw It l: _�� III-i �
.�'; ...It.(. •..;. rt„.e. .,a.e I,rn.I li. r .n ,I t1.r :i...In+,. F.:: _�. .,•t, _
i
{P
WE1,L A I t,%N,nir)NliIEN"I It17CORD i
I.11'ell ContraCtirr hdonnaun+t: 10EL1_AB.�NI\D�\11t;\"f 1)I:h,\11��--
William Ewing
-- --- 7u.For(:evrprobCA)PT nr Clr st•d-I a oil( eoillormail k%vlls ba mr dte t,mx
\\'cu(:Wilms r,rr ti .., .�,t ,r, -Cllin„�I nrC tinn/dr t A„,,(a:r, dh.<hai:uonoag,aq•i!m,hrslhcr pnrenyi p h.tMty I Ci\1' )(1 r<n,�.^rt InJicatr TO"fAt-e1'(111if.R of
3110 wells abandoned
NC\;`ell Q,m aa.n+_nnrsaia,n vronix, - 71).Approvinate volume of.,afer reittanun:,in
Crawford Environmental Services FOR 1vA"n:R sl)rrL1 1v+a lsO.M:Y:
Cnnirynrc;`lance• :
7c.Type u(disinleclaut used:
2.Well Construction pernol k: Unknown
I,c1 Fll oppf,nw,h c:, ,,,,,, r,iK,-rr•,r A,�r WC G,n,rn,Shtre.Vv,,(,cs.et,)+fknu+an
r.., 7d.Amount ofdisinfettnnt uscJ:
3.Weil use ichrcl,,yell use):
1Nalcr Supple 1\1•II: 7e.Sealing materials u.ed(check all Itlal appiv):
C3Anncuhural OBh,mci alfthhc
p VNcal Ccmem Groin i"l I;enamue Clops or PCllrts
,rrn
❑Inau.n,alJaClo0nlnc'an"al xru,1dv) ORede;aal,Ka Stp^f ppQGrntln
�s Q Sand Ccmen,Glow - 7 Drs Clay
Ql zj ii ppl (sae ) Cel rout
O Drdl Coronet
❑hrieauoee1107O Sptoeiahy Grout Q Gravel
h U'
Non-Waled SuppcJI: q,I;cntonue Slurry Q(jihrr texpin,n under 7 )
P N1onilnn ne ❑Recovery u
Injection 11'cll: 7L For each material selected allots.provide anxaun ofmalerials used;
OA uifer Recharge
q OCutnerrJA'afer Rri4tledr'AFib� ' S a t'�S /��1�"i/���(r.w.�rt
OAquifer Storagc,end Recovery Q$alinil)•Barrier
OAgmfer Test OSltxmwater Dminoge
OFxperrmclu il'r,,hnology OSuhsidence Control '-
7g.Provide a bri}f description Of the ubmtdnnmrnf procedure:
❑Geothetmal(Clu:rd Lv)p} QTracer
OGenthermal Ole run,JCootine Return) DOthcr(explain under 7 ) / )•tt NO4r Cnenr� !.� �.�� ab-6) P..,,,_p.J
1-4-10 5 Tit,*rrM�•
4.Date well(s)abandoned:
_a.Weil location:
GPM 3066(Scotchman 43066) UST 0-020149 n
F�citiu"/0-mr Nanx Facility 104(if npphcabte) 8.Cerliricalion: J�f
267 Western Boulevard,Jacksonville, NC 28546
. t.F.LL
Physrnl Address.Cih,amt Zip Signamrc of Catifred tVdl -,mracwr m\velf O,••i,er Pate
Onslow 023114 Br signing thrt form. I hereh, (rill(Yhrit the welly„<rt ft,ere)aboadoned io
Coumy Parcel Identification No.(PIN) acconlonce oath I JA NC-AC 02C.0100 or 2C 0200 tl'r11(onetrytctlmr Slaudards
and that a cop%of this rrrord has hrmt�rrorrdcd a,-the,rr11 ON,tier
Sb.Latitude and longitude in drgrrtx/minutcslscconds or decimal degrees:
of-elf field.arts "rfi K'nt) 9.Site diagram or additional n'ell details:
34.749181 IN77.382395 11, You may use file back of this page IN)provide additional-ell silt details or well
abandonment details. You may alsv aniKh;idditinnal pa,r.tf nccessary
COVsi,yuurION DI•-1'AIIS OF.WFLIAS)BEING ABANDONED SUBD117`IAL INSTRUCTIONS
Aaa,1n•r/l rrxr:rrtn•tn,n.rrurdld/mrodnhFr f-mithiple ur je,iirnt demon•,+4aer ngrpfr•nrllt -- -
p:vu,ml,the xn+,r,•.n,+rnnv
10a. for All Wells: Suborn fh,. Iniin taifhm 30 J;tys of cnn)ple)ton of well
63.Well It)#:`+r'j fr-16 abandoomeni in it,,followioc
Division of Water Resource.%.Information Processing Unit.
fft.l 1617 Mail Service Cenler-Raleigh,NC 27699•1617
66.'I'oml,tell depth: ..
IOb.For Injection Wells: In addom,i or.cndin+:file lone to the address in IN
6c.Borehole Jimov(er: (in.) .dove,also submil one Lnpy of the;limn•.villno 3Q(L,v;Ali ctonpleuon of well
abandonment In file,following
6d,Water li•crl l,rhot):round surface: 3• Z (fl.l Division of Waler Resources.Undergronud Illyclion Cunlrol pro};r:un,
1636 Mail Seniee Ctuu er.Ralvi h,e\(_27699.1636
6e.Outei't7 tog leo--lb fit kimviol: -' Ifl.l Illc.For\1'inrrSupnh \Inirclinn 11'rlhs: lu aM"I'm I",Cnilutc the Iona to lIc
add (r + d ,ac ;dvr+ohnr,l One:op,,'.I Ill"fora,tt thin ti)d , of rrnuplcunn
of .ellih n Jrin n,e in ill the ouma he`Jth Jvllm l ant of tale Cnuntc w1wir.
lr �� JI IIdiLl:cl
r U1iin�Ln_Ih fil'knnaut:
k
l
u.
.,gr1 �• tiail .,fTh.;1'k.r . err Ixl i,...teat f ....,• .aW _ "i` � i ._ ,ni{.
14
i
F113F�\1)U\'�fil>"' RECOR ) fn,hnrna,t. r<)Fl, �
1.N'cll Cnntnuanr Inlnnnsdion: \YF t N) N -�LL.\L.L I lL .Ih.\'I'I)Lr:\IIS
William Ewing I
7,t Pnr GrnprolxJl)1p'r or ClnSrd•LftA!p t:MthernMl ti`rals')tuvcnc the a,nre
xx'\d f urn-M:erq\inn:,nr na91 f-:nrr rxv umslle afar fonm1 u01 on hiom,properryl P f
teU a?n5fnr.urxnAh !h nntx I GA to r.new fed. ladicatc rOT.\l.N(,1dfi[R Of
3110 wens t,hndvn d._. ---
V(:Wt1l!`nmmctur Cer ifitemon Nvrmhcr 7h.Approxintate vohunte ur-tiler rertiamin2 in o'ell(sl:
Crawford Environmental Services ,.OR\Y,\rfR el.rrl.v w1.1 LsrTVl.1
7c.1'p{reof(Ikinfec-tnfil used:
2.Well Construction I'ernirt 4: Unknown
laa rdl,rpin"I't,„r?/rnnartrcfnur rennu,r,r I:fe.Cm,rc-Store vitrinnfi etr
7(l.Amount of disinfeciant used•.
3.\1`cll use Ichcck well user
!\';tier Supply Weil: 7e.Sealing matcHnls n r(I(check kill that apple):
CAgrrculunal O\lmticipallPublic KNeat Ceincnr Grout Ci Remorule Ciurp of Pellet,
OC,tothernml Oieaun.elConling Supply) ORciidenual Water Supply(sincic) (J Sand Centenr(trout O Dry Clat
Cl Indust rtol Coromercrai OReadential Water Stt)Tlyt e I O Crgicmte Grout O Drill Cuuings
❑Irrigation r""�'�
" a O S(h'Cnllly Grow O Gravel
\tin•\Pater Supply\Yell: .,'• _ O Rcnwrttre Slum- O Other(explain under 7g)
�lonitonng ORecovery
injection Nell: F t 7f.For each material selected above•provide amount of materials used:
OAquiferRecharge OGroundwaterRemediatim -
zoU t 1
❑Aquifer Storage and-Recovery GSLaI'niSX,1t S? �
OAquifer Tes+ 03�orm1A•ater I mnae
OF_xperintemal Technolony OSuhsidence Control 7g Provide a brier 11escriplmn of the abandonment procedure:
OGeothermal(Closed Loop) OTtacer ) t
OGecu ma herl(Iieatin`/Coolin Return) 00iher(explain under 7 !ti 1 t vt�✓ /voa/' le✓- i:n' Qbe- a—s! Po!2.22 v j
4.Date well(s)abandoned:
z ���u•:s� Tn,',t.n••;. P'=n- Fes--- /3o>r��• h�
:a.Well location:
GPM 3066(Scotchman 113066) UST 0-020149
Facility/Owne,Name Facilir,•IDN(ifapplicahk) S.Certification:
267 Western Boulevard,Jacksonville, NC 28546
Ph},iGd Address-City.and Zip Signiturc of Cm ificd W•tr ,mrac for of Well(xvner Wre
Qngipyv 023114 ft, sig,rm rhrx roms, /hrrrbr re)iif% iheo the-ell(O ona(here)abandoned i,,
6\ntmy Paf 1 Icle'nt licbtion No,(PINT nccor lance„irh l.SA MAC 02C 0/00,01-2C 0200 Well Con.clntr-tion Standards -
aud Thar a vain of tius rrrorrt bar hero pro,klrrl to III('trell nu tier.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrm-
(il well field,om tadlb ?6 su11"fctcrtp 9.Site Airientru or nrldilional well details:
34.749181 N 77.382395 W Yoo may Ilse the back of this page w IStm4de:additional well site details or well
abandonmenl details Yau stay akin kit uich additional pate;if it r5cary.
COtNISTRUCTION DITAILS OFAVI LL(S)llrING.ARANDONIA SUItD91'1`I'AL.h�STRUC PIONS
Atrahnr!)rrm.an,c rr:o,ar.,rd(r)i(mvilnh/e Fnr,nfih pG nJi•c7innnrrMn•ovurr wpph•ae!6
On 1,)',.irh rhr wren,-.mnru.-ennr/nlxfrxhnrarnl.fva,vie,m,brnir,tile f fnn '.
W.I. For All Wells: Suhmlt this form within 30 div)N of completion of well
//6.9.Well 11)ff: � abandonment to the fUllnwrne
1
Division of\1 tier Resriurce>;Iuforntafinn Processing Unit,
61e'rotal well(Ie(rtlt:
, ' Y (ft) 1617\boil Scm ice Colter.Raleigh.INC 27699-1 6 17
IOh.For Infection\Yells: in ad(linon to.ending the form to the-,Adress in IOa
above also. m uLu ate cnpv of Ihf.from rn wuh 30 days Of com n pletio of well
fie.Borehole dinrmter: �r (in.) abandonment u>the folloxing
•2 7 Ill.) Division of N'aler Resources.Iludi•rhrnwrd lu m
jeclion Control Program,
(oil.tCatrr level befog ground surface: 1636 Mail Service Center,Raleigh.NC 27699-16,16
I
Itic.Fnr 11r;fler tir11lrh\Inieclinn N�i_:11 : fit add u-on(,I cnd�mz III..,farm to the
6e Ouh r(lsinn Iro_Ih fir knn-n); Ill.) ddrlresctr.l abme .,f.n.nhnm,tie rnpJ uGlhi.loml-ohm 10 dnv.tit eomplem.nr
rot Of ah.mdnnment its the it+uoa hetibh deramnem of the count\ .\hc+e•
I it *1Iting tent th lif kuocutI, 11"h1
w
e ,( �•ah( , .lrl Dena,• i, •t•At it 1 itt•tn-a c+r 1 -.. �, ! ftr•,�.d '
f
1-1,—NIND 0 N N I E M r RI C 0-1111. )
%%'ell Contractor Information: NM! jNll-Vr I)l
William Ewing
7a for Geoprobc/11111'or Ul,.sed.l.loop(';colhernilif U ON ha,mf!the ante
Hwh—ri-—11 A"o"11K.PTj—I ketl -11v I(.W Ili i� Trst-d lo&u jlc I'O'I'Al NII:Nilll"R of
3110 sells ah:mdmicd
1K.W01anti
Cnmmrw,Cennn 71). 1
Crawford Environmental Services FOR WATER S1111111.111 IVIIJAti ON'.Vy:
2.Well Consorineflon Permit#: Unknown 7c.Tylte of disinrictilol used:
Oil Ml nmlficabl,—if.1-1-M.",P-11-1,e 17(7 eu 1,1`0
3.Well use(check viell jisel: 741.Amount of(lisinfeclarn oc&
Water ShIpplY%veil: 7e.Scaling materials wed(check all that appivi:
E]Apnculiural ON-lunic,pall!"u6in: VNleat Cement Gout 0 nerov"lle Chips or Pellel,
0Gcothermini Oiratmo( ooloje!Slirrilv) OResidentiril Water Supply(sm-le) 0 Sand Ceirmni Grout C3 Dry Cl:,%
01"dustrilaItC.01"Incrc
'al 011csidcrofal r 0 Concrete Grout 0 Drill Cwtmt!,
0 Irrigai ton
'IV RD
0 Specialty Clout 0 Grawl
Non-Waler Supply Well:
0 fleolonitc Slurry q 0 Other(explam klndCf 7P1
La.lalantMinI-i1c.i.will,
X For each mawrial selected above-provide antount of materials used:
0Aquifer Recharge CIGroundwaterReTedig"
- . ,�7, -,04-1
0Aquifer Storage and Recovery 0salift* 145 ofEb
Uf
0Aquifer Test 0-isirl]Z(c"\e,*t;na.-c
ClExperimernal Technology Mulisrdence Control
ClGeothermal(Closed Lnopl 01'racer 7g.Provide a brief description or the ahodoonren,procedure:
LOGcothermal(licatingifCoulitig Return) 001hci(explain under 7,0) /cam .—d
o7o
4.Date well(s)abandoned: 7—2.i;e,2 IL,
6 lit Alp-
52.Well location:
GPM 3066(Scotchman#3066) UST 0-020149
F*ciIi;j40.w,Ntor,i, raciii.y ION(ir,ipplicA1,10 8.Certification: Off 0
267 Western Boulevard,Jacksonville, NC 28546
Physical Address,Coy,and Zip
Onslow 023114
81 Signing this forni. I herebi ceitifii that rite aveffl%)mac ftiere)abandoned in
C—nly R-mri ldcalificm.on No.IPINI acco"IVire 11 ill,15A M011C 02C.0100 ill 2C 0200 Well Crottwurnati Standards
and roar a rap,afthis wrord has been pmvided tf�rite is t,11 saner
5b.Lalitude and hingitude,in degreWminule-s/seconds or decimal degrees:
fit ell field,tine latth-nit rs suffiKiml, 9.Site dingnam or additional well details:
34.749181 77.382395 You may lose the back of this page to provide addiiional well site details or well
N %V abandonmem details. You may also attach additional pa----cs it necessary
coNsTRuc-rlON DrTAII-S Or WE.1j,fS1 BEING ABANDONED Suimu'rr.At-lN,.1rrRucn0NS
Allrrrh cell rnnunu ii—--dripfmvdable F.r.ardrlple rt jade..........m-ivaie, —11,
ON1.V.*h the I~—.........Mbht fi-n-?.rnu ran i'd........../ran. 10a. For All Wells: Submit this form within 30 da%� of completion of well
6a.Well 10#: P�*V G-f t abandonment to the following
Division of Water Resonrecs.inflarliniti(in Processing thiii,
6h."rural veii aeloh: fl'0 1617 Mail Service Centerj ftfileigh,NC 27699-1617
101).For Injection Wells: In addition to sending the form to the kd,jrec in Ilia
b also
ao surito one copy of illo,
(w,Borehole diameler: (in.) shove, . juli'll 10 Joy,of cmnpleotnl of ell
abandonment to rite follo,ving
(A.Witter level)lei... --round sni-Face: (I.I.) Division of Water Resources,Under"roond Injection Control Vrogl-.Ilo.
1636 Mail Scr,ice Cenlcr Raleigh,NI:27699.1636
1
fie.Outer casoo_, (if kn....vj: Mc.for Waier Sinnik & Injection Wul'!S: In 1,10flion io cndni:,Ill,-lom,-the
M",'WhPill 011c c0l" it Ili!,lam"ohn,'41 d^,t,l coollAct"In
,)f ,well ah—doomei'l 'Ict'.ulownt of On: cn ily "two,
61'. l,n...•nj:
fit tanmfw
............ ........... ............
WELL r1I Aid JNt
1.Well Contr'acloa I"Involation:
William Ewing
7a.ror Croprobe/D P-] or 1.lowd-I illop(.cidherotal WON Ili,ow hl.ieinc
tt'"o J"Aw, well conso-U,I 1110kpill ,oIV I(AV 145 Inti,rite rOT ki..Nlj;\Il)fR ol
3110 IIAR abaininned 1
,'a('(cell C onfla, m Nnmtx, 71).Approximate rolujoe of I,aler r(,njainilp.it,
Crawford Environmental Services FOR WA H-AZ SUPPI-l'NVI,I.LS o)1\11
2.%Veil Construction Permit N: Unknown 7e.Type ni'disinfectairt ir�rd:
bo all ..............
1,111401111 V(C C.,rmx Swl"Vaiwnr, ef,,rJ Snoun
3.Well useIrlivelk well rise): 7d.Anotoot of di,inlectaof nw&
Water sopill, Well..
7e.Scnilint,,rooterinf,;n,,ed Iowa all b.11 appl%I:
OAeticuliura
KNezo Cement GWAll Bm000e Clops of llmlcl,
017reciiherinal(licalolf!/C t�fingSuppjy) o
Vwr',Su�ply(single) 0 S.Ind Cement Groot I- Dn CL.,
olodil'Ifial/CornlocrClal SU ared) 0 Concrete Grout 1" 0,111 Culooz,
ObTilation %140 Spmiahy Groot
I N'o i 1 0 6-ra"!I
-Water Supply%Veit:
0 ne"loone SlarrN
Injection
7 V,It:
OA4uifcr Rectirope
"', 7r.for each material selected ribove;'provi(b.oloollol lit materials used:
OAqutfer Storage and Recovery
OSahnny Barrier
OJXquifer Ten OStorrowater Drainage
OExperitneroal'rechnoll-rgy Mubsidence Control
OGenthernial(Closed Looff) OTracer 7g.Provide a brief description of the ahandonjocol procedure,
OGcothcrrnal(Heating/Cotyling Return) 00ther(explain under 7&)
4.Date well(s)abandoned: 7-2 sir Z 53.Well kwalion:
GPM 3066(Scotchman#3066) UST 0-020149
F-acdoy/0Name Facility IDN 01'applicible) 8.certification:
267 Western Boulevard, Jacksonville, NC 28546
Physical Aklrec,5,Cu..and Zip silmooe of C,:roti C it 0,M,
Onslow 023114 Rr SiRnoliz this fora?, I hr,clo verfifl !rhos dw me! q
cmitly Pan Id el railkiroon No(PIN) flf (o."") &,00r med fit
acroidonctroah 15A NCAC 02C 0/00o, 2(. 02(j0 11,rit(,,,moocom Standards
5b.Latitude and longitude in degreestairinules/seclands or decinnal degrees: ood that a ropy ho,b"",i),nh-d f,,djr,,Of m,orr
1.1 well I-0d.one 9.Site diagram or additional well delgils,:
34.749181 N 77.382395 %V You may use the back 01 Chi%paLe 10 firovicte Adilional well 11,details or weil
abandonment details.:
COINSTRU(:7110N DETAILS OF WrLUS)RE'INC ARANDONE MIMITI'AL INSTRWI'lONS
Amah-11 f hople oy,cli........
ONLY.oh fire vm,r r mtrnrritri,lydumdnnnrrnr afar r nn orb."if titreft-i
100. For All Wells: Submit lhi" loon 10'lays Of completion 01 well
6a.Well ID#: abandoloniall to tht foilm vme
Division of 1%aler Resources.lororloalion I'mceNsiot,Unit.
61).Total v,-ell depth: 33. f I r..1 1617 Nlail S,-r,i,c Ceoter.Raleigh. 27699.16 g 17
l0b.For Injection%%,I!L: in a(kinioni 10'Codore the lorin to the ajomgs to Ina
6c.Borehole diatrocler: - (in.) above,;ilqo.trbjoll one clilly cv, IIo, 4o,w11111o`10 J.,yN A completion it weil
abandonment to(lie f,)Iliwi,,L
01.) Division of ltvioorcp�.Und
(oil,Wawr le%cf beh-ground surface: C11*91-flood InJI'dioo Control Vro2rroo.
1636 kjail S(,j-j ire llalvi-ji,NC 27699-16,16
Ae.0al,:r va�ioL fit know a!: tile.For \V I ells: 1-�J111111101)III IIIC 1111111 o.II)C-
A(Ife"'C'I ,I \C at") !,I lom,
Of well Alamlomoent I,. ill, e.r,oI\'I b"'0111 depmowvol ,I 111c tmoll\ Itew
61.Initer lungth fil'kii....rW ahandone.1 I.
-it