Onslow_Well Abandonment_20221021

WELL ABANDONMENT RECORD For late.]Use ONLY
1.Well Contractor Information: WELL ABANDONMENT DETAILS
D.T. Chalmers 72.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 l GW-30 is needed. Indicate TOTAL NUMBER of
4146-A 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 N: NA
List all applicable well wratrumiou permlrx(i.e.(17C,Counp.State.f'ariance,elo.)ifknown
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
OGeothermal(Heating/Cooling Supply) OResidential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial OResidential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
Olnigation ❑Specialty Grout ❑Gravel
Non-Water Supply Nell: ❑ Bentonite Slurry ❑Other(explain under 7g)
IffMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
OAquifer Recharge OGroundwater Remediation Bentonite Pellets —10 Ibs
OAquifer Storage and Recovery ❑Salinity Barrier
OAquifer Test ❑Stormwater Drainage
OExperimental Technology OSubsidence Control
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed loop) OTracer All well material pulled abandoned with hydrated
OGeothermal(Heating/Cooling Return) OOther(explain under 7g)
bentonite pellets to existing grade.
4.Date well(s)abandoned: 9/29/2022 RECEIVED
Sa.Well location: NF T ,So.a�
MCB-Camp Lejeune AST-1657C-01 G L E E
Facility/Owner Name Facility lDk(if applicable) 8.Certification: Df OPrniB�Unk
Marine Corps Base, Camp Lejeune, 28547AtiqT /17/2022
Physical Address,City,and Zip Signature of Certified Well Contractor in Well Owner Date
Onslow NA By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Idemification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
Six.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/leng is sufficient) 9.Site diagram or additional well details:
34.617787 N -77.330796 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
AltachweilconstrucaonrecardO)Ifuwilable. Formuloink injection ornan-walersuppiv wells
ONLY wah the same connrucoon abandonment,you can subma one form.
10m. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#- 1657-01 G-TWO2 abandonment to the following.
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 13.5 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For luieetion Wells: In addition to sending the form to the address in IOa
6c.Borehole diameter: 2.25 (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: NM (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
be.Outer casing length(if known): NA (R,) loc.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
6L Inner casing/tubing length(if known): 3.5 (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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Data Sources.GIS data layers provided by the 1,500 750 0 1,500 Feet
MCB Camp Leleune GIS Department and ESRI
'ROJEBT AST 1657C-01G _r`E FIGURE
DIESEL RELEASE
• DAVENPORT INITIAL ASSESSMENT REPORT SITE VICINIITY MAP
MARINE CORPS BASE
CAMP LEJEUNE,NORTH CAROLINA
CATLIN
En9lnoen mU Suenpss r.-. oniE s[PLE --. .. ,.
1580391E JUL 2019 AS SHOWN MJM KLP