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Home My WebLink AboutCaldwell_Well Abandonment_20230315 • WELL ABANDONMENT RECORD For Internal Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILS Jeffrey Grant 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 1 GW-30 is needed. Indicate TOTAL NUMBER of 4328-B wells abandoned:one NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 0 (gal.) JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: 2.Well Construction Permit#: WM0100533 List all applicable well construction permits(i.e.UIC,County,Slate,Variance,etc.)if 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 IR 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 0 Irrigation 0 Specialty Grout 0 Gravel Non-Water Supply Well: ____ _ _ 0 Bentonite Slurry ❑ Other_ex lain under 7 e Monitoring f� ORecovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑StormwaterDrainage Bentonite 35 pounds ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Fill the entire length of the borehole with bentonite. 1-23-23 4.Date well(s)abandoned: 5a.Well location: MAR 1 5 2023 Larry &JoAnn HHuffman Facility/Owner Name Facility ID#(if applicable) 8.Certification: iri7 itn;_ e:? IZ % .;j 7 Ur.: 16 & 18 Falls Ave. Granite Falls, 28630 2-19-23 Physical Address,City,and Zip Signa of h' ed ll C tractor Owner Date Caldwell 2775958036 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 1at/long is sufficient) 9.Site diagram or additional well details: 35.799378 N 81.429634 N, 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 records)ifavailable. 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 ID#: TW-2 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 22.5 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Infection Wells: In addition to sending the form to the address in l0a 6c.Borehole diameter: 2.25 _ (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: Dry (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): (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 6f.Inner casing/tubing length(if known): 12.5 (ft.) abandoned. 6g.Screen length(if known): 10 (ft.) Fonn GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 WELL ABANDONMENT RECORD For Internal Use ONLY: I I 1.Well Contractor Information: WELL ABANDONMENT DETAILS Jeffrey Grant 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 1 GW-30 is needed. Indicate TOTAL NUMBER of 4328-B wells abandoned:°^8 NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): '06 (gal.) JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY: Company Name 2.Well Construction Permit#: WM0100533 7c.Type of disinfectant used: List all applicable well construction permits(i.e.U/C,County,State, Variance,etc.)if 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 P1 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 ❑Irrigation ❑ Specialty Grout 0 Gravel Non-Water Supply Well: El Bentonite Slurry__ __ P Other,(explain under 7 __ __ II Monitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation ❑Aquifer Storage and Recovery ❑Salinity Barrier • ❑Aquifer Test ❑StormwaterDrainage Bentonite 50 pounds ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Fill the entire length of the borehole with bentonite. 4.Date well(s)abandoned: 1-23-23 MAR 1 2S L Z03 5a.Well location: Larry&JoAnn HHuffman Facility/Owner Name Facility ID#(if applicable) 8.Certi cation: 16 & 18 Falls Ave. Granite Falls, 28630 2-19-23 Physical Address,City,and Zip Signal a of Certified gtractor or Well Owner Date Caldwell 2775949394 By signing this form, I hereby certify that the well(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 well owner. 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one tat/long is sufficient) 9.Site diagram or additional well details: 35.801045 N 81.429124 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 ID# TW-4 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth 30.4 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Injection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter 2.25 (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 28.98 (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): (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): 20.4 (ft.) abandoned. 6g.Screen length(if known): 10 (ft.) )Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources j Revised 2-22-2016