Catawba_Well Abandonment_20230127 (2)

rY L'LL'HDL L\LOl\1rJL1\1-RECORD..CORD"" For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAII S
Justin.Marlowe. _ .: . d- op 7a.For Geopiobe/DPT or Close . Geotliermal'Weils having the same
W611 Contractor Name(or well owner personally abandoning well on his/her property)" n/deA only 1 G - ER .well constructio W 3�0 is needed. Indicate'TOTAL NUMB of
wells abandoned:
4452-A
7b. roximate volume of water r`e I inin in well s. 1'� al.
NC Well Contractoi'Certification Number' . . APP , ;g ()' (g ,)
S&ME,."I nC. FOR WATER"SUPPLY WELLS ONLY:
Company-Name
7c.Type'of disinfectant used:
. Not
2:Well Construction Permit#: Applicable
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):
i
'Water Supply Well:. 7e.•Sealing.materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑NeatCeinent Grout - ❑Bentonite Chips or Pellets
El Geothermal Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay.
❑Inddstrial/Commercial ❑Residential Water Supply(shared), El-Concrete Grout ❑Drill Cuttings
01rii ation ❑ Specialty,Grout ❑Gravel
Non-Water Supply Well: a Bentonite Slurry O Other(explain under 7g)
I•Monitoring ORecovery
Injection Well: 7L For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediatiori `. Approx.,2 gal..'Quik=Gfout"used
❑Aquifer Storage and Recovery ❑Salinity Baniei (7%O
❑Aquifer Test ❑StonuwaterDiainage f 1.50 1b.,bag of.Quik-Grout)
OExperimental Technology 'OSubsidence Control
7g.Provide a brief description of the abandonment procedure:
DGeothemral(Closed Loop)• ❑Tracer . . 1: j . -
l7Geotliemrai.(Iieating/coolingRettim) oother(explainunder7g) 1" batch grout mix makes:approximately 30 gal.:grout�
per'Quik-Grout specs. (1 50 lb.bag'and.25 gal. watei)
a.Dateweu(s)abandoned:" 1/6/2023 Grout pumped from.bottom of well"using_1" tremie
5a.Weil'location:. led to ou S. pipe until:well is filled gr nci urface or above.
Duke Energy Garolrias Not Applicable
Facility/Owfier Name" Facility IDLE(if applicable) 8.Certltleatlon: E
8320 NC=150; Terrell, NC'28673 JAN. 2 ,'t" P023 4/16/2023
Physical Address,City,and Zip - 'Signature'ofCenified Well'Contracturor Well Owner Date -
Catawba' . 46180342635.0 Inns-Fr�:i. 1.ref, ",��uP✓:'�• �f;;
'By signing this form, 7.er T cep l at,(he wel s-whs•(were)"abandoned in '
County Paicel Identificatio):No.(PIN) accordance with 15ANCAC 02C.aM orti( 200 Well Construction Standprds "
t th
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:.
'and hat a copy of this record has been provided to' a well owner.
9.Site diagram or additional well'
(ifwell field,one lattlong is sufficient) ". details:
35.6102013 .. . N -080.97'15728 �, You may use the back of this page to ipiovide additional well site details or well
abandonment details. You'niV alsoiattach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED .
SUBMITTAL INSTRUCTIONS
Attach well construction records)ifavailable.For multiple injection or non-water supply wells
ONLY with the same coiutructionlabandonment,you can submit one form. -
�+ 10a, for All Wells:. Submit this form within 30 days,of coinpletibn of well
6a.Well ID# AB-8�7 abandonmentto'the following:
Division of Water Resources,Information Processing Unit;'
"6b.Totalweil depth:
13. 1617 Mail Service Center,"Raleigh;NC 27699-1617
' (ft.) _ .
lOb.For Iniection Wells::.ln'addition to sending the'form"to.the address in 10a
6c:Borehole diameter' 8 y.0 (in) above;:also submit one'cop of this form Within 30 days of completion of well
abandonment to the following: j
I. I
6d.Wate 4. erground.Injection Control Program,
r level below g round s urfac e: (ft.)19 Division of Water Resources,Und
1636 Mail Service Center,Raleigh;NC27699-1636
):6e.Outer casing length(if lmownN/A' loc.For Water.Suunly&Inlection'Wells:.16 addition fo sending the form to the
(ft)
known): N/A
above,.also submit one copy of this form within 30 days of completion
of well.abandmmerit to the county'.health department of the.county where
6f.Inner casing/tubing length(i known): 3'0 (ft.) abandoned.
6g:Screen length(if known): 10'0 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016