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Home My WebLink AboutWake_Well Abandonment_20230602 Yv ELL ANDONLVENT RECORD 'Far idernaI Use ONLY: 1 .1.WO Contractor Inibrmat(On: WELL ABANDONMENT DETAILS b ®d €J 7a.For Geoprobt/DPT or Ctoeed•Loop Geothermal Wells having the same Via Contactor Nn..R.(or wall*weer tterten{FJ abandoning well on hielher rroeerl,�) well construction/depth,only 1 OW-30 is needed. indicate TOTAL NUMBER of -eN n. ,i t it wells abandoned: v `l 1NC Well Connector Certificatih>n Number Approximate lb.A roximate volume of water remaining in well(s): ® (ftaL) PIJ'L ) - 01c&C� Pole, e . W FOR WATER SUPPLY W IS ONLY: • . Company(Varna 7e Type of dbinfec ant used: IA f VI CAW- I®!'•$d- 1®),,�j Z.Wd1,Cofl Permit#. f List a!l app/lcabkvvll caanntetlun penults(1e.WC.('nand,Slate.Variance,etc.)prawn 7d.Amount of dtsinfeetaat used: 'l / I- i••P 3.Well use(cheek well use): --iv C.',. .�1.-04 `re.. ung a*tern r5 unert(air crs nth tiara CIA.gricultund ollptunicips1/Public Cl Neat Cement G ut . ., , ,j Bentonite Chips or Pellets • DGeothennal(Heating/Cooling Supply) Residential Water Supply(single) '('.1 Sand Cement Ctrp ut.- --L.4.a4 • V 'Q,Qsy`Gioy Qindh hat/Commercial QResidential Water Supply(shared) ❑Concrete Grout J UN • 9 Z^ZQ Drill Cuttings ❑hrigation Cl Specialty Grout Gravel Non Water Supply Well: QMomiitoring ORecov Q Bentonite Slu c,;—, s;)<.n P,nc,,:,:.7.M;Other(explain under 7g) Igjeedoi Well: 7L For each material ii above,provide amount ofmateriaie used: ClAquifer Storage and Recovery ClSalinity Barrier d "�' a if1"i i Lip r d �e CAquifer'Test DStarmwate:Da'iriag &Li 5 l b o d.. Sj QErtperimentalTechnoltlgy QSubsiden eControl 7g.Provide a brief degcrlptba of the ban ment procedure:°Geo:he nta!(Closed Loop) OTracer r �� DOeothermal(Heating/Cooling Realm) QOthe r(explain under 7g) .g f I -r( teti 4.Dateweil(s)abandoned: LI- di - J Sa.Well n:/ ® r r'dl�dCDn en�4J 1. DI L. . Feaiiity/Owner Name FacilityiDfl(ifapplIablc) 8.Certification: ( ( Q01 ; rA, elar 'er ram, 'I P, I i¢ 4.-a-i- 3 Nu/pillAd�d`ress.City,and Zip si oteenntled WeliCoan.aror or Well Owner Date �ICC ill LiQl 7�S County PtreeirdmN&oatIah Na(PIN)0By s/gvb this form,i hereby ccnt6 that the wells)ryas(were)abandoned In nccv,.derree with ls4 attar.per.,ninn or 2tt_.0200 Well rwartr.ctla.,Serotiervie Sb.Ladtude find longitude to dE /rnientedsetendser deeintaidegrees: name taw it�vlfl!'U ircis iecvra vitae ueai�/nvviiivi;iv um?mu oiriior. Orwell field.cme tateong is stdrizis ) 9.Site 41agrnr or additional well details: N W You may use the back of this page to provide additional well site details or well abandonment details. You may also and additional pages if necessary. CONSTRVCD9N DETAILS OF WELL(Si swig ABANDONED suBMiTTAL INSTRUC iONS Artaachue/lcanthttrllonrecord(a)(lawile&For maAlpielejecltoncrn n.watersapplyuv s ONLYtyhh the same entsti adlionabandonmeet,you ran submit oneforrn. RM. Forjkli Welt: Submit this form within 30 days of completion of well 6a.Well IDIf: a I & abandonment to the following: II ifs a et wow Remittal inrornmtion krocessing Un8. 6b.Total well depth: (to1617 Mail Service Center,Raleigh.NC 27699-1617 tab.For Infection Wag: In addition to sending the foam to the address in 10a 6c.Borehole diameter: ,din.) above.also submit one copy of this form within 30 days of completion of weir abandonment to the following: Ca.:wiser lave'ofdow ground sariaae: ;_ _ IA) -._----_- -` L.==4===- -=-=== = a (� /. 16.2eMa116ervlec Cam er.Rale[gb,NC Z7699.1636 a�iuom..m�...®e �rm.a..+..�.��• i v s i t(!s.fads Wa at r eopoy.at toteetdnn Wells: In addition to sending the form tote ._ ��..,_..�r " address(e)above.also si tt nfln silly Of this form within 30 days Of completion . of well abandonment to the county health department of the county where 1 Penn OW-30 NorthCamila*Dsa'm*entof p_nvironntenhl Oaelity-1]ivialnn of Wear Remurant Revised2-22.2016 WELL ABANDONMENT RECORD For Internal Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILS K. Brandon Moore 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 I GW-30 is needed. Indicate TOTAL NUMBER of 2957-A wells abandoned: • NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.) Paragon Environmental Consultants, Inc. FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: HTH Chlorine 2.Well Construction Permit#: GW-091479-2022 List all applicable well construction permits(i.e.WC,Cotnrry,State,Variance,etc.)if known 13 oz 7d.Amount of disinfectant used: 3.Well use(check well use): Water Supply Well: 7e.Sealing mate •als;used(eheek-alLthatgppjy: ❑Agricultural ❑Municipal/Public 0 Neat Cement 6-rout ,S.,' ' y ?+ S`'❑r•Be,ntonite Chips or Pellets OGeothermal(Heating/Cooling Supply) ®Residential Water Supply(single) 0 Sand Cement Grou . 0 Dry Clay ❑Industrial/Cotnmercial ❑Residential Water Supply(shared) B Concrete Grout ,�Lllti E✓ 2023❑Drill Cuttings ❑Irrigation• 0 Specialty rropyi�:, ter` Jr;Ya ❑Gravel Non-Water Supply Well: l us 0 Bentonite urry 1=;-•,;`. ❑'Otlter(explain under 7g) ❑Monitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation Concrete grout 3 cubic yards ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑Stormwater Drainage ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed.Loop) OTracer ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Poured concrete directly into well and filled to top of casing terminated approx. 3' below land surface 4.Date well(s)abandoned: 5-23-23 with a 2'thick concrete cap installed on top. . 5a.Well location: Primax Properties N/A Facility/Owner Name Facility lD#(if applicable) 8.Certification: 11550 Green Level Church Rd. Cary, NC 27519 � ��a-rvt 4Z957-4 5/23/23 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Wake 0736071492 By signing this form, 1 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. 56.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: 35.858566 N 78.897846 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)iiavailable.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#: SW-1 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 200 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 lOb.For Infection Wells: In addition to sending the form to the address in 10a 6c Borehole diameter: 6 (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: N/A (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e Outer casing length(if known) N/A (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): N/A (ft.) abandoned. 6g.Screen length(if known): N/A (ft.) I Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 --