New Hanover_Well Abandonment_20230213

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 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
4330-B 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: { .? r y E (�;;r -
Company Name )-—r
7c.Type of disinfectant used: I r
2.Well Construction Permit#: NA D ZOl,,
List all applicable well construction permits(i.e.(/1C,County,State,Variance,etc.)if known IfiiCi rz:;y+� .; . _
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) 0 Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry 0 Other(explain under 7g)
UMonitoring ❑Recovery
Injection Well: If.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Pellets —5 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer All well material removed and backfilled with
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
hydrated bentonite pellets to existing grade.
4.Date well(s)abandoned: 2/10/2023
5a.Well location:
Geosyntec NA
Facility/Owner Name Facility[IN(if applicable) 8.Certification:
L>.
2830 US Hwy 421, Wilmington, 28401 2/10/2023
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
New Hanover NA By signing this form, I hereby certify that the well(s) was(were)abandoned in
County Parcel Identification No.(PIN) accordance with ISA 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 lat/long is sufficient) 9.Site diagram or additional well details:
34.277795 . -77.958630 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)if available.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 form within 30 days of completion of well
6a.Well lD#: TMW-20230117 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 25 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6e.Borehole diameter: 4.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Vi ater lea el below ground surface: 22.71 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft) 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
6f.Inner casing/tubing length(if known): 15 (ft) abandoned.
6g.Screen length(if known n): 1 0 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

.\..'- ' .r i i Cialkier!" ' t �' RR` , '`
W.
•
•
AV tt
Ai
,. �w .'t. r.
Three Existing
Production Wells ` lik-p.• 41`
\ t,..
~� 1 . e Wt_Raw Water
Water Treatment %le , ,.<
P1-,,1 i i Facility f - -
Former Direect .kr
JApplication Storage Area..
is Proposed Building I.
S Auto Repair h>> - - r —..r....:...� t-
•`,
y TMW-202 --• ,
1 j a�� « »Il
I Former Ammonium N
i _ ._�^~ t� �` r1. Nitrate ASTs .? 1- ,
1 IV ti
o, Maintenance.Building .rDukeEnergy,r/ 11-1� .' .. 01..,'- aDelomza• titonP J Mt=Pond
*�, -,_ M'SubStation- r `� e
A, .. �r may. ,-T -• M. ` .o i- el r_ .1 f i•L .. r
rj- Y[' a .
.. ,.
i... . 77----
G Retail Warehouse � il�j*
• i f \=, .
•
�' n - Former Ammonia"
1 �, Z. - - _ IA ht•• Storage Area
streeta� t, _ :parr r .AJtl.i. Imo.. ..,.. -
, II ioplitlk. ..,.........
, ,.. „. . .
t� - a J
,„,. 11:-:
..
.. ,...
• ,
,a„
r. ,. 7 -.------.....„ _. 11/, . • ,
�, �!"' """t"— I r.1' ram' r , r j .
I• , , S1 — • �_- I _ I
iii14:75.1,. .
; ..
_ __
_: I I/1 ' - ,. ,
j µi a r j
•
�
•
O � t let 4 OFi
Legend o 400
IIIIMI Feet
O Site Boundary • Historical On-Site Wells Site Layout
l i-t Proposed Building a August 2021 Monitoring Wells
2830 US Highway 421
- - Proposed Utility Corridor • August 2021 Soil Boring Locations Wilmington,North Carolina
t Railroad n Site Feature N
c Approximate Concrete Slab =Existing Building/Structure Geo syntec° Geosyntec Consultants of NC,P,C. Figure
O Existing and Occupied Building/Structure NC license No.:C-ssoo and c-295
Notes consultants
1 Service Layer Credits Source.Esn DigitalGlobe,GeoEye,Earthstar Geographies,CNES/Airbus DS,USDA,USGS, A
AeroGRID,IGN,and the GIS User Community 1
2 Site boundary estimated using the New Hanover County GIS GN9094 February 2023
3 See features obtained from Phase I and II ESA horn April 2022 and August 2021,respectively
\\Raleigh-01\PRJ\T\Treeline\2830 US HWY 421 LLC GN9094\7 0 GIS\7.1 MXD\Figure 2 Site Layout mxd 10/21/2022 10:13:00 AM EHoward