Craven_Well Abandonment_20230419

WELL ABAN IUNMVMEN'1' RECORD For Internal Use ONLY:
I.Well Contractor Information: RECEIVED WELL ABANDONMENT DETAILS
1/� ill. /
i / 16-.1't'` /t2/r•'Jtfl tt r I./ 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well o/ttnslitelriget 23 well constriction/depth, ly6 GW-30 is needed. Indicate TOTAL NUMBER of
n wells abandoned:
70 ,7
NC Well Contractor Certification Number NC DEQ/DWR 7b.Approximate volume of water remaining in well(s):2:B S/0/. (gal.)
get/3" 1 / 'Central Office
r't/(J�,-a.Vt✓1L�../Gt-` FOR WATER SUPPLY WELLS ONLY:
Company Name
) 7Gl c 7c.Type of disinfectant used:
77
2.Well Construction Permit#:No r (t-e,[k iiv^ t--(C/f i/ 35
List till applicable well construction permits(i.e. UWCCouniy.jl-ate. Variance,etc.)ifknoun
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 CYBentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial �- �-OR sidential Water Supply(shared) ❑ Concrete Grout El Drill Cuttings
❑Irrigation `"' T" ^ '',) 'a»''
`" ❑ Specialty Grout ❑ Gravel •
Non-Water Supply j 11:%r--'"''' - `� ❑ Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring r p 1 Q ZOntecovery
Injection Well: NS c,)k.'il;L 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge �t 54 ` t 1„ J ,+ Grrntndwater Remediation• }� t,C� � // & 11,�� / �h G l N
t _..e„.,t., f^:''y-s 13 A,A)A1 . is i'ts — 2
❑Aquifer Storage an Recovery).,° ❑Salinity Barrier
❑Aquifer Test ❑Stormwatcr Drainage
DExperimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer❑Geothermal(Heating/Cooling Return) . DOther(explain under 7g) __ -fir-t9J c°C f C''"/lei-`t4 errL. ,13,`/�1,,,:Le[�(7c-c)�/
y� be,vA , if efi 1..S /rL,}fGa("CL'..1� /]/ 5/el:,.t/
4.Date well(s)abandoned: q 1 I L/ 4 2 J ,,,tct /� ) 1
9/-rrui/ of•' > Iii✓�j GC ➢ ii-e - Ca. ILvi6, i.`S 6_Md:�n."�
5a.Well location: / ✓ ✓) /
•
L:✓V--CEL— the ec,( .SGtilel NC'0 b03"L01 8.37 /,i��Y'r l
Facility/Owner Name n/ Facility ID#(if applicable) ! 8.Certification: /�
II ZO U S�it'E'�� (JI`;4yefc,'V 8$7CI A://,
'"l -7e
Physical.Address,City,and Zip Signature of Certified Well Contractor or Well 0Atls. Date
e.1^0"ve 2'_ UGC f — 0 0 Li By signing this,form 1 hereby certift that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards•
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field-one latilong is sufficient)
9.Site diagram or additional well details:
3$. I Lq .0 6 N , 7 7 0 lLd$/ 6 W You may use the back of this page to provide additional well site details or we!!
/` 11 abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)illimitable. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment.you can submit one Ibrm.
10a. For All Wells: Submit this form within 30 days of completion ..• „
6a.Well ID#: .3 6_Tt1," r C' 4 G.ti✓ r,-,,,,`r'
abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: /5.
(ft.) 1617 Mail Service Center,Raleigh,NC:27699-1617
10b. For Injection Wells: In addition to sending the form to the address in Itla
6c.Borehole diameter: 2 -15 .(in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
„ (ft.)6d.Water level below ground surface: Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c.For Water Supply&Injection Wells: In addition to sending the torn to the
6e.Outer casing length(if known): ��� (ft.)
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): N//a (ft.) abandoned.
I
6g.Screen length(if known): - #4/l/j (ft.)

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Scott Werl ey 7a.For Geoprobe/DPT or Closed iLoop 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
3344-A wells abandoned:Tw°t2i
NO Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 1 .0 (gal.)
ECS Southeast, LLP FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: N/A
List all applicable well construction permits(i.e.U/C,County.State,t ariance,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 ❑MunicipaUPublic a Neat Cement Grout S Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout 0 Dry Clay
❑lndustrial/Commercial .T...DResideptial Water Supply(shared) .0 Concrete Grout 0 Drill Cuttings
❑Irrigation `; .*lw r 1 1. „), ❑ Specialty Grout 0 Gravel
Non-Water Supply Well: �q 0 Bentonite Slurry 0 Other(explain under 7g)
-Monitoring A P-R-1-9-itavery- - -- - -_ -
Injection Well: 7L For each material selected above,provide amount of materials used:
[Aquifer Recharge- ^` '�r�'C'-' t'E.;1D5�;;;�,:�o^�l . F9,�hioii�tdtv�terRemediation Bentonite ^' 15 lbs
[Aquifer Storage and Recovery rjt'4GI a L15alinity Barrier
❑AquiferTest ❑StormwaterDrainage neat cement - 25 lbs
❑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) Bentonite - gravity feed from 7.5 to 5 ft bgs
Neat cement- pour from 5 ft bgs to surface
4.Date well(s)abandoned: 2/23/2023
5a.Well location:
MCAS Cherry Point P-995
Facility/Owner Name Facility ID#(if applicable) ertification:
Cherry Point, NC
Physical Address,City,and Zip Signature ofCertifie Well ntractor or Well Owner Da
Craven N/A By signing this fir , I hereby certiJi•that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with I5A 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:
34.88361 N -76.889416 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 OFWELL(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 1 & TW-2 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth 7.5 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lOb.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter 3.25 (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: 3.5 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): 2'5 (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): (ft.) abandoned.
6g.Screen length(if known): 5.0 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016