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Home My WebLink AboutWake_Well Abandonment_20230109 (8) WELL ABANDONMENT RECORD For Internal Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILS! Corey D. Futral 7a.For Geoprobe/DPT or Closed-LIo Ip 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 4300-B �J wells abandoned: E °. : ' "°, NC Well Contractor Certification Number 7W'Approximate volume of waterremaining in well(s): (gal.) CATON Engineers and Scientists JAN 0 2023 FOR WATER SUPPLY WELLS ONLY: Company Name ,.. {rii:t•:::::"? �;`_; '1�7S;Type of disinfectant used: 2.Well Construction Permit#: NA 1 ' 'DG_ List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)l#'known 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 ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay ❑Industrial/Commercial. ❑Residential Water Supply(shared) 0 Concrete Grout ❑Drill Cuttings ❑Irri ation ❑ Specialty Grout ❑Gravel Non-Water Supply Well: . ❑ Bentonite Slurry a Other(explain under 7g) RMonitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Pellets 60 Ibs ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑StormwaterDrainage Topsoil 5lbs ❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer —8 inches of well removed, remaining well abandoned in place ❑Geothermal(Heating/Cooling Return) .❑Other(explain under 7g) with hydrated bentonite;pellets to top of well and a.Date well(s)abandoned: 12/6/22 topped with topsool to existing grade. 5a.Well location: NCDEQ-Former Star Flite 52 Property NA L Facility/Owner Name Facility ID#(ifapplicable) 8.Certification: h `� 1904 St. Albans Dr., Raleigh, 27609 12/29/2022 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Wake NA By signing this form, 1 hereby certify that the ivell(s) was (were) abandoned in County Parcel Identification 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 ivell 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: 35.834 N -78.606 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 WELLN BEING ABANDONED SUBMITTAL INSTRUCTIONS Attach well construction record(s)ifavailable. For multiple irjectionornon-water supply wells ONLY with the same construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID9: AS=1 abandonment to the following: Division of Water Resources,Information Processing Uniti 30 1617 Mail Service Center,Raleigh,NC 27699-1617 6b.Total well depth: (ft.) 10b.For Infection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: 8.25 (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: 19.26 Division of Water Resources,Underground Injection Control Program, (ft.) 1636 Mail Service.Ce+ter,Raleigh,NC 27699-1636 6e.Outer casing length(if known): NA (ft.) 10c.For Water Supply&Injection (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 611 Inner casing/tubing length(if known): 25 (ft.) abandoned. 6g.Screen length(if known): 5 (ft.) I ' Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-1 i 1 i WELL ABANDONMENT RECORD For Internal Use ONLY: . 1.Well Contractor Information: WELL ABANDONMENT DETAILS Core/ D. Futral 7a.For Geoprobe/DPT or Closed-Li op Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-3'0 is needed. Indicate TOTAL NUMBER of r"5 wells abandoned: 4300-B . NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.) CATLIN Engineers and Scientists JAN 0 9 2023 f g� FOR WATER SUPPLY WELLS ONLY: Company Name t-F"NA '7c.Type of disinfectant used: �Tl's:.iii +:;it.-"2':� ��•. :.] 2.Well Construction Permit#: ass : List all applicable well construction permits(i.e.UIC,County,State,Variance,etc)ifknown 7d.Amount of disinfectant used: 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check ali'that apply): ❑Agricultural ❑Municipal/Public ❑Neat Cement Grout S Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout I ❑Drill Cuttings ❑Iiri ation ❑ Specialty Grout ❑Gravel Non-Water Supply Well: ❑Bentonite Slurry e Other(explain under 7g) RMonitoring ❑Recovery Injection Well: 7E For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Rem ediation Bentonite Pellets 75 Ibs ❑Aquifer Storage and Recovery ❑Salinity Barrier []Aquifer Test ❑StormwaterDrainage. Topsoil 5lbS ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer I ❑Geothermal(Heating/Cooling Return) OOther(explain under lg) Well abandoned in place with hydrated bentonite pellets to top of well and within 6 inches of surface. a.Date well(s)abandoned: 12/20/22 Topped with topsoil to existing grade. 5a.Well location: i NCDEQ-Former Star Flite 52 Property NA Facility/Owner Name Facility ID#(if applicable) 8:Certification: 1904 St. Albans Dr., Raleigh,.27609 12/29/2022 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Wake NA By signing this form, I hereby-certif5l that the ivell(s) teas(were)abandoned in County Parcel Identification 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 ivell owner. 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: j (if well field,one lat/long is sufficient) 9.Site diagram or additional well details: 35.834 N -78.606 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. I CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED. SUBMITTAL INSTRUCTIONS Attach well construction record(s)ifavailable.For multiple injection or non-water supply wells ONLY with the same co nsiruction/abandonnient,you can.submit one form. 10a. For All Wells: Submit"this form within 30 days of completion of well 6a.Well ID#: AS=2 abandonment to the following: i Division of Water Resources,Information Processing Unit, 6b.Total well depth: 45 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Infection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: 8.25 (in.) above,also submit one copy of this form within 30 days of completion of well abandonment fo the following: 6d.Water level below ground surface: NM Division of Water Resources,Underground Injection.Control Program, (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636" I NA 10c.For Water Supply&Injection Wells: In addition to sending the form to the 6e.Outer casing length(if known): (ft.) 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): 40 (ft) abandoned. 6g.Screen length(if known): 5 II Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources f Revised 2-22-2016 t I f I WELL ABANDONMENT RECORD For Internal Use ONLY: I 1.Well Contractor Information: WELL ABANDONMENT DETAILSS Corey D. FUtral 7a.For Geoprobe/DPT or Closed-LO,op Geothermal Wells having the same Well Contractor Name(or well owner.personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of 4300-B r_ wells abandoned: i NC Well Contractor Certification Number Y"'ti�" y ,y ^�� yb:Approximate volume of water r 4m fining in well(s): (gal.) CATLIN Engineers and Scientists. I A �, „��,t FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: I 2.Well Construction Permit#: .j , List all applicable well construction permits(i.e.VIC,County,Slate,VaAdii'ce; JL)'ifkhoun 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 ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay ❑Industrial/Commercial: ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings ❑Irri ation ❑Specialty Grout ❑ Gravel Non-Water Supply Well: ❑Bentonite Slurry e Other(explain under 7g) CMonitoring IjRecovery Injection Well: 7E For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Pellets — 50 Ibs ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑Stormwater Drainage" Topsoil — 5 Ibs ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) []Tracer Well abandoned in place with hydrated bentonite ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g). .. pellets to within 6 inches of surface and topped 4.Date well(s)abandoned: _12/20/22 with topsoil to existing grade. 5a.Well location: NCDEQ-Former Star Flite 52 Property NA Facility/Owner Name Facility ID#(ifapplicable) 8.Certification: 1904 St. Albans Dr., Raleigh, 27609 12/29/2022 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Wake NA By signing this form, I hereby certify that the ivell(s) was (were) abandoned in County Parcel Identification No.(PIN) accordance with I SA NCAC 02C.0100 or 2C.0200 Well Construction Standards 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 lattlong is sufficient) 9.Site diagram or additional well details: 35.834 N -78.606 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 Attach well construction record(s)ifavailable.For multiple injection or non-waler supply wells ONLY with the same construction/abandonnieni,you can submit one forms. 10a.,For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#• MW-2 abandonment to the following: Division of Water Resources,Information Processing Uniti 6b.Total well depth: 25 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 101b:For Iniection Wells: In addition to sending the form to the address in 10a above, also sum one copy of 6c.Borehole diameter: 8•25 (in.) b l bit f this �form within 30 days of completion of well abandonment to the following: j • 6d.Water level below ground-surface: 20.11 (ft) Division of Water Resources,Undergrou I nd Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 I 6e.Outer casing length(if known): NA (ft.) 10c.For Water Suooly&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 6f.Inner casing/tubing length(if known): 10 (ft) abandoned. 6g.Screen length(if known): 15 (ft.) Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 • I