Catawba_Well Abandonment_20230127 (7)

WELL ABANDONMENT RECORD For Internal.Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT-DETAILS
Ja Little:
Ge
y ., 7a.For oprobe/DPT or Closed-I:oop.Geothermal Wells having the same .
W611 Contractor Name(or well owner personally abandoning well on his/her property) well consttuction/depth,only 1 GW-30 is needed Indicate TOTAL NUMBER of
2717-A wells abandoned:
Approximate volume water 7b.A of remainin m wells: 6.0 al
NC Well Contractor Certification Number pp f g .
SW E,. Inc. FOR WATER SUPPLY WELLS ONLY:
mp .an y
Co Name 7c.Type of disinfectant used:
2:Well Construction Permit#:' Not Applicable
List all applicable well construction permits(Le:UIC,County,State,'Variance,etc.)ifkn6wn
7d.Amount of disinfectant used:
3.Well use(ch'eck well use): y
Water Supply Well: 7e.Sealing materials used(check all that apply):
OAgdcultural OMunicipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
OGeothemml(Heating/Cooling Supply) OResidential-Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commeroial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑Irri ation. _ '' ❑ Specialty Grout_ ❑Gravel.
Non-Water.Supply Well: a Bentonite Slung ❑Other(explain under 79)
IN Monitoring � ORecovery
Injection Well:.. 7E For each material selected above,provide amount'of materials,used:
❑Aquifer Recharge ❑GroundwaterRemediation '. Appi'ox.'10 gal:Quik-Groutused
❑Aquifer Storage and Recovery ❑Salinity Barrier,
❑Aquifer Test - ❑Stormwater Drainage
(33%of 1 50 Ib.bag of.'Quik=Grout)
OExperimental Technology ❑Subsidence Control 7g.Provide a brief description of the;abandonment procedure:
OGeothermal.(Closed Loop) OTracer
❑Geotiremral(Heating/Cooling Return) []Other(explain under 7g) 1.batch grout mix makesiapproximately 30.gal.;grout
per Quik-Grout specs. (1 50 Ib.bag-and 25 gal. Water)
4.Dateweu(s)abandoned: 1/18/2023 Grout pumped.from bottom of well using.1" tremie.
5a.Well location: pipe until well is filled to ground surface or.above.
Duke Energy Carolinas Not Applicable " - "�,--- ;',�:= ..,
Facility/Owner Name Facility ID#(if applicable) 8.Certification:' 1 1•• �'i�i w�* E ?.,
8320:NC=150, Terrell, NC 28673 ' JAN 2 7 2023 1/'23/23
Physical Address,City,and Zip Siguatute*of Certified Well Contiactor or Well Owner. Date
Catawba . 46180342635.0. inkcf;ro -n 'rzn!4c irg un:i
By signing this form, I hereby.cert &CW4l(s) was;(were)abandoned in
County Parcel Identification No..(PIN) accordance with 15A NC AC 02C.0100 or 2C.0200 Well Corsstructioit Standards
and that d copy of this record has been provided to the 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:
35.6135559' -080.9732255 You may use the back of this page,to!,provide additional well site details or well
N W 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 ornon-watersupply xs/ls
ONLY with the same constructionlabandonment you can submit one form.
6a.We11 ID#: C L F-304 abandoonment to the following:Submit this form0 n-within'30 days,of completio of well .
1.
Division of Water Resources,Information Processing Unit;'
6b.Total well depth: 60.0 (fE) 1617 Mail Service'Center,Raleigh;NC 27699-1617
IOb.For Injection Wells: In addition to sending the'form to the address in 10a
6c.Borehole diameter: 8.0 ur. above;also submit one'copy of this form within 30 days of completion of well
( ) abandonment to the following: j
23.12 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.)
1636 Mail Service Center,Raldeh,NC 27699-1636
6e.Outer casing length(if known): N/A 00 10c.For Water.Suonly&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 lingth(if known): 50'0 (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
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