Catawba_Well Abandonment_20230127 (3)

WELL ABANDONMENT RECORD For internal:Use ONLY: j.
1.Well Contractor Information: WELL ABANDONMENT-DETAILS'
Justin.Marlowe
7a.For Geoprobe/DPT or Closed Lbop.Geothermal Wells having the same .
Wbll Contractor Name(or well owner personally.abandoning well on his/her property)' well construction/deptli only 1 GW- is needed. Indicate TOTAL'NUMBER of
4452=A wells"abandoned: l
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): - - " (gal.)
SWE, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name I
7c.Type of disinfectant used: .
2:Wei.I Construction Permit# Not Applicable.
List all opplicable well construction ermits.i ;b7C,County,State Variance etc. i known '
7d.Amount of disinfectant used:
3.Well use(check well'use):
Water Supply Well*' . 7e.•Sealing materials used(check all that apply):"
OAgricultural' OMunicipal/Public ❑Neat Cement Grout ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply)' l Residential Water Supply(single)' • '❑Sand Cement Grout I ❑Dry Clay.
❑Industrial/Commercial ❑Residential Water Supply(shared) "❑Concrete Grout 0-Drill Cuttings
❑Irri ation. ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: IN Bentonite Slung ❑Other(explain under 7g)
DMonitoring ORecovery
Injection Well:.. 7E For each material selected above,provide amount of materials used:
[]Aquifer Recharge ❑GroundwaterRemediation" " Appt.ox..10'gaL Quik-GrODUsed.
-❑Aquifer Storage and Recovery . ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Diainage (33%of 1 50 Ib.bag of Quik=Grout)
OExperimental Technology OSubsidence Control 7g._Provide a"brief description of the abandonment"procedure:
OGeothemtal 1 batch(Closed Loop) OTracer gr out mix . ' 30 .gal..grout
❑Geothemtal.(Heating/Cooling"Return)" .❑Other(explain under 7g)
' makes'approximatel jr "
per"Quik-Grout specs: (1 50 lb..bag and 25 gal. water)
a.Date weu(s)abandoned: 1/6/2023" :Grout pumped.from bottom of well using 1: tremie."
Sa.Well location: . ..
. . � 'pipe until well is filled to ground.surface or above: . "" • .
Duke Energy Carolinas' Not Applicable
Facility/Owner Name FacilityID#(ifapplicable) 8.Cert(tientioo:' I k -
8320 NC=150,:Terrell-, NC 28673---. . ' � r 1116/2"0.23
JAN1 2023"
Physical Address,City,and Zip Signatore'of Certified W ell Contractor or Neil;owner Dale
Catawba. 461803426350:. . f 'i �" ::;,.�0.�"Un:a.• . .
By signing this form,�r)trb�iy cgxtfy atrFlte:well(s) was;(were) abandoned in
County Paicel Identification No.(PIN) accordance with 15A NCAC 02C.-61 DO or 2C10200 Well Construction Standards
and that a copy of this record has been provided tolhe well owner.
5b.Latitude and longitude in degrees/minutes/seconds'or decimal degrees: "
(ifwell field,one lat/long is sufficient) 9:Site,diagram or additional well details:
3,5.61020.98 . . N. =080:9715924 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.
i
CONSTRUCTION DETAILS OF WELL(SJ BEING ABANDONED- SUBMITTAL INSTRUCTIONS
Attach well construction records)ifavailable.For multiple injection-or non-water supply wells
ONLY with the same constructiori/abandonment,you can submit one form.'
10a.-For All Wells: Submit this.form,within 3U,.days of completion of well
'6a.WefID#:A13-81DU abandonmenttothefollowing:
Division of Water Resources,Information Processing Unit,'
60 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)" .
10b.For Injection Wells: In addition to sending the form to the address in l0a
above;also submit one copy of this form within 30 days of completion of well
6c:Borehole diameter: 6'O (in.) 1.
-
abandonment to the following:
4.01 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.)
1636 Mail Service Center,Raleigh;NC 27699-1636
I.
6e.Outer casing length(if known): N/A - 00 16c.For W Ater.Supply&Injection Wells: In addition tb send_ing the fomi to the.
addresses)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): 50'0 (fL) abandoned.
6g.Screen length(if known): 10.0
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016