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Home My WebLink AboutCatawba_Well Abandonment_20221028 WELL ABANDONMENT RECORD 1.Well Contractor Information: ELL ABANDONMENT DETAILS Alfred Kiesling Jr. -a.For Geoprobe-II)PTor Closed-Loop Geothermal NN ells WWII Contractor Name wr ,:!!o%kner personally abindonina n only I GW-30 is needed. hidica-..e TOT.-',L NUMBER :f 3266-A NC'Well Contractor Certification Number 7b.Approximate volume of eater remaining in A ell(s): D. a-212-11(PO� B & K Well Drilling Inc FOR WATER SUPPLY WELLS ONLY: Company Name -c.T,.pe of disinfectant used. Chlorine 2.Well Construction Permit 9: to a4z I to sr/ Livr till applicable u-cli coam-liction permits I.I.e.UIC.Corry:. -d.Amount of disinfectant used: 0 3), 3.Well use(check well use): Water Stipply'A'ell: I -e..Seafing materials used(check all that apply): CAgticultural 13Nlul1i-z:,_-i Pubhc Cement Grout :3 l3critunite Chips or Pelfcts *Geothermal(HeatinggJCooling Supply) 211kre�iticntial Wwcr Sur r 1 Sand Ccrnen:Grout D Dry Clay [:Industrial/Conimercial EIRc4identiLl Wait:r Suvpk ;.hard: Grout :3 Drill Cuttings Olrri.-atiun Sne,::altv GrouL :1 Gravel Non-Water Supply Well: l3cnionite Shan D Other(explain under7i, F.Monitoring DIRccovrry Injection Well: i 7f.For each material selected above,provide amount of materials used: *Aquifer Recharge F36roundwatcr RL=;xi;afi,?r- *Aqui fer Storage and Recovery 715alinivv 0AqUifcrTcst O.Storrnv titer :ale CLxperirnental Technology L:-Su'11.,:dcnce Control 7o..Provide a brief d ription of the abandonment procedure: *Geothermal(Closed Loop) ElTracer "7 L Geothermal(Heating/Cooling Return) 00ther(explain Linder'gj �Z UZ 4.Date well(s)abandoned: -7 7 /.z Z OCT 2 8 2022 5a.Well location: Un4 FicilitN/0%-ner Name Facility Mte(il'applicable) 8.C rufi atio 7, pi i I �k' —7— r Physical Address.City.and Zip Sian., e of eriticd Well Co ...Clor or H:,Ijl nl-r" ate C _,rchl.cel-Ii" that IF,e ivell(s) ivas fivere) abandoned in County Par-Li Identification Nc,.:?!Nl accordunc,?-ori'lh .;_5.4 NL'.`C 02C.0100or 2C.0200 Mell Construction Slandllrdr n d rho:r,'coon of-i I.S YCL'Ordhas been provided to me ivell owner. 5b.Latitude and longitude in clegrees/ruinu tes,seconds or decimal degrees: I irweli field.one laViong is sufficient) 9.Site diagram or additional well details: You may use the back of this page to provide additional wc1l site detail.,or well N N abandonment bandoniumit ciccails. You max-also attach additional pages if necessary. CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUB'MITTAL INSTRUCTIONS ONLY pith the same con Ftructiottlabandonnurnt.You ran submit one fbnn. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#: abandonment to the following. Division of Water Resources,Information Processing Unit, 6b.Total well depth. —(ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Iniection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: -(in.) above, also submit one copy of this forni within 30 days of completion of well abandonment to thc.following: 6d.Water level below ground surface; 3C) -(ft.) Division of Water Resources,Underground Injection Control Program, 16361lail Service Center,Raleigh,NC 27699-1636 be.Outer casing length(if known): 10c.For Water Supplv&Iniection Wells: In addition to sending the fomi to the addresses)above.also subn-dt one copy of forni within 30 days of completion of well abandonment to the county health department of the county where 6f.Inner casing/tubing length(if known): abandoned. 6g.Screen length(if known): (ft.) Form GW-30 North Carolina DcoarLment L'I'Environnicnral Q11a1i[V-DtViSion 0MULui Resource, Revised 2-222016 1 WELL ABANDONMENT RECORD I F,:I--mat Usc ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILS Alfred Kiesling Jr. 7a.For Geoprohe/DPT or Closed-Loop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on hi:.hr fir. %%ell construction/depth,only 1 GW-30 is needed. Indicate TOT.0 NUMBER as wells abandoned: + 3266-A NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): B & K Well Drilling Inc iFOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type Chlorine of disinfectant used: 2.Well Construction Permit#: O f—.202,2- 1740//4 List all applicable well construction permits(i.e.UIC""',Cormn-Srare. 1ariar-.r-cr ! itiz9 nn 'd.Amount of disinfectant used: l�•'L� 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all that apply): ❑A,,ricultural ❑Iluuicipal Public -Neat Cement Grout eutonite Chips or Pellets ❑Geothermal(Heating-JCoolin Supply) E]Residential.Water Supply(sit:l-41 a Sand Cement Grout ❑ Dry Clay ❑Ind ustriaUConimercial ❑Residential Water Suppy isharedl lI._ ;Ite Grout ❑ Drill Cuttings ❑Irrigation - Specialn'Grout - ❑ Gravel Non-Water Supply Well: - Bentonite Sliury ❑ Otter(explain under 7g) ❑Monitoring ❑Recover- " injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation ❑Aquifer Storage and Recovery r ❑Salinity Barrier ❑Aquifer Test ❑StonnwaterDrainage ( '� ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: [-,Geothermal(Closets Loop) ❑Tracer ❑Geothermal(Heating/Coolinn Return) ❑Other(explain under 7g) �� ' ��1 V ' A.Date well(s)abandoned: S Well location: C y , Facility/Ow rName " FacililyID�(ifappl.cable) 8.Certification: - -- — - - -- — - I ate Physical AJddress,City.and Zip ,7 Signatur 1'Cenined ell Contra c ell Owne ✓GLY'Q GI s (6 y 4SM'16 7 BY si;•ning,his 1br•ni, I hereby ceriy/-rh( the uell(s) Wets (here) abandoned in County Parcel ldentitication No.iPiN) accordance with i5.4 rC.4C 03C.0100 r 2C.0200 Well Construction Standards and that a color of ibis record has been provided to the well on•ner. 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field.one lat/long is sufficient) 9.Site diagram or additional well details: You inav use the back of this page to provide additional well site detail;or well N NN abandonment details. You may also attach additional pages if necessary. CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBNIITT:\L INSTRUCTIONS .4rtacTnnllconsnnrtionree•art/.e)ijwai/able. Frn•uaritipleirUcctionornou-•,vateraupplrurl/c 01vLY rid?the same r"onstraction%abandoruneni,roa ran subnrif one for . ' m 10a. For All Wells: Submit this Form within 30 days of completion of well 6a.Well iD#: abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: T (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Iniection Wells: In addition to sending the form to the address in I Oa 6c.Borehole diameter: (in.) above. also submit one copy of this forni within 30 days of completion of well abandonment to the.following: 6d.Water level below ground surface: �® (ft.) Division of Water Resources,Underground injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6c.Outer casing length(if known): (ft.) loc.For Water Suonh•&Iniection Wells: In addition to sending the form to tine address(es)above.also submit one copy of this forni within 30 days of completion of well abandonment to the county health department of the county where; 6f.inner casing/tubing length(if known): (ft.) abandoned. 6g.Screen length(if known): (ft.) Form GW-3 0 North Carolina Deparonent ol'Fnvirunn+ental Quality-Division of Water Resources Revised 2-22 2016