New Hanover_Well Abandonment_20221118

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
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George Bridger 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
2393A wells abandoned NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): N/A (gel)
Bridger Drilling Enterprises, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Wen Constriction Permit#: U I C#W 10800528
List all applicabk Hell consoue ion permits(La UIC,Carmy,StatA Variance,etc.)ifbwwn
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply WeII 7e.Sealing materials used(check all that aPP1Y)
❑Agricultural OMunicipal(Public ❑Neat Cement Grout ( ❑Bentonite Chips or Pellets
❑Geodtrnnal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout I ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) O Concrete Grout ❑Drill Cuttings
0irrization ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
❑Monitoring ORecovery
Injection Well: 7L For each material selected above,provide amount of materials used:
[]Aquifer Recharge eGroundwater Remediation 7
❑Aquifer Storage and Recovery ❑Salinity Barrier
OAquifer Test ❑Stormwater Drainage
❑Experimen al T-1mology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(closed Loop) ❑Traccr Filled geoprobe hole with bentonite chips,compacted
❑Geothermal(HeatingtCooling Return) ❑Other lain under 7g)
and then sealed with asphalt patch
4.Date well 10/4/22s)abandoned: a ,-,a F-7
5a Weft location: ib_m;nth r__.,,11.,
rb—wewM Clay arox—WeimmmsonuWW PMPNOW DSCA ID#65-0001 NOV 1 8 ZUZZ
Facility/Owner Name Facility ID#(if applicable) S.Certification:
3750 Oleander Drive, Wilmington, NC 28403 g
Physical Address,City,and Tap Signa6&ofCcrtffied Well ContractclVorWeR Owner Date
New Hanover
By signing this form,1 hereby certufy that the well(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the weft owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
171013.833 N 2331802.6AR �, 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 WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifamlable.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 jorm within 30 days of completion of well
6a.Well ID#• 1-17 borings abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 30 (tr) 1617 Mail Service Center,Raleigh,NC 276994617
10b.For Injection 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: 6 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
N/A 10c.For Water Suooly&Injection Wells: In addition to sending the form to the
6e Outer casing length(if known): ( ) 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): N/A ( ) abandoned
6g.Screen length(d known): N/A (fL)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
i.