Craven_Well Abandonment_20221222

WELL ABANDONMENT RECORD For imemal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7s.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owns personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned
NC Well Contracra Certification Number 7b.Approximate volume of water remaining in well(s): (gaL)
CATLIN Engineers and Scientists j ,E WATER SUPPLY WELLS ONLY:
Company Name
J 7a Type of disinfectant used:
n�C
2.Well Construction Permit 0: NA _ 2 ZOZZ
tut all applicahle well U1C,Count',Slam,Yanamr'am.J iflamwn
111(0flilfiasIOH Prr="014 UWknuount of disinfectant used:
3.Well use(check well use): DW01$0131
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout N Bentonite Chips"Pellets
OGeochennal(Heating/Cooling Supply) OResidential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
Olndustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
Diminution ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bemmnite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7L For each material selected above,provide amount of materials used:
OAquifer Recharge OGmundwater Remediation Bentonite Pellets 25 Ibs
OAquifer Storage and Recovery OSallnity Banner
OAquifer Test OStormwater Drainage
OExperimental Technology OSubsidence Control 7g,Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loup) OTracer All well material pulled and backfilled with
OGeothermal(Heating/Cooling Return) OOther(explain under 7g)
hydrated bentonite pellets to existing grade.
4.Date well(s)abandoned: 12/15/2022
5a.Well location:
MCAS-Cherry Point NA
Facility/Owner Name Facility IDa(if applicable) S.Certification:
MCAS Cherry Point, Cherry Point, 28532 12/15/2022
Physical Address,City,and Zip Signature of Candied Well Contractor or Well(Avuer Dare
Craven NA
By signing this form. I hereby center that the well(s) was (were)abandoned in
County Parcelldevdfication No.(PIN) accordance with I5A NCAC 02C.0/00 or 2C.0100 Well Construction Smrulards
and that a copy of this record has been provided to the well owner.
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:
34.92954211 N -76.89756546 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 WELLISI BEING ABANDONED SUBMITTAL INSTRUCTIONS
Armchuellc tmctionrecordpJ fmwlablr. Formulliplelnjemi�ornon-watersupplyuells
ONLY wah the same romoucnon abandonment you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
(a.Well Ing: B4213-SB04/B4213-TW-01 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 20.0 (D-) 1617 Mail Service Center,Raleigh,NC 27699-1617
106.For Iniection Wells: In addition to sending the form to the address in l0a
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•. --11.0 (�) Division of Water Resources,I'nderground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (R) 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
6E Inner casing/tubing length(if known): 10 (R) abandoned.
6g.Screen length(if known): 10 (ft.)
Form OW-30 Nonh Carolina Depamnent of Emmonmental Quality-Division of water Resources Revised 2.22-2016

- N
r
{
m
ti
� 4213
O
O
� B43 0- BO4 21 4
B4219- 6 'rr
313 BO] B43}- BOB
21 B1
4219 SB 9
B42tJ- B10
B42 T1 B11
5
y LEGEND
B42-1SBh, ` Rendering
Looaeor
1pproa matjjF ,
Forme
ExavNon
WARNING'
_ M
•iuT�n i su�rswirm�r NOTES See Boring local suyW to Men,Npe4 on field conedowns CATLIN rxell-An,E.,,E=.1111 $iTEN�P,nENECO-WM IW.,tl,uBxE cow ua siamx SOIL BORNG LOCATION
Engineers and Scientists,w