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Home My WebLink AboutNew Hanover_Well Abandonment_20231113 1: , L ABANDONM,ENT.RECORD ' For internal Use ONLY: I.Well Contractor Information: WY'ELI.ABANDONMENT DETAILS William NI Wiggins 7a.For GeoprobelUPT or Closed-hoop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on hisilter property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of (NCWC) 3470-A wells abandoned:21 0 NC Well Contractor Certification`umber 7b.Approximate volume of water remaining In well(s): (gal.) Mid-Atlantic Drilling, Inc. FOR WATER SUPPLY WELLS ONLY: Company Name 1 `' `" ..,*',._:,is ad ,'' ' 7c.Type of disinfectant used: 1 ! 2.Well Construction Permit f/:'N/A I; NO V 1 y ^ 2n list all applicable t'el!construction permits(i.e.ti/C,County,State.Variance.etc.)if known lr�� 7d.Amount of disinfectant used: to=--- 3.Well use(check well.use): C°,�.'.' .f � ;_r,- Water Supply%Y'eil: -' 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public 0 Neat Cement Grout I S Bentonite Chips or Pellets OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) , 0 Concrete Grout 0 Drill Cuttings ❑Irrigation ❑ Specialty Grout 0 Gravel • Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g) • SMonitoring. ❑Recovery — - Injection%%ell: 7E For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation bentonite chips 501bs . ❑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) ❑Tracer pulled well from ground,and poured hole plug(bentonite Chips)down into sandy hole ❑Geothennal(Ileatina/Cooling Return) ❑Other(explain under 7g) 4.Date wells)abandoned: 9-12-23 1 I , Se.Well location: The Proximity CB LLC N/A Facility/Owner Name Facility IN(if applicable) $.Certirrca• n: ' , 1. 902 N.Lake Park Blvd., Carolina Beach NC 28428 _ 9/18/2023 Physical Address,City,and Zip Signature of Certified Well Contractor or We ( liar Date New Hanover N/A 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 cop)'of this record has been provided to the well owner. Str.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one lot/long is sufficient) 9,Site diagram or additional well details: 34 04' 10.59" N 77'89'48.49 YY, 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.DETAIIS OF'WE LL(S)BEING ABANDONED . SVB\IITTAI.INSTRUCTI N." . Attach well curotntn ionrecords)i!Invadable. For multiple injection arnon•watersrrpplywells ONLY with the'slime canslrucaon abandonment,you cab submit one Prin. IOa.,For All Wells: Submit this form within 30 days of completion of well 6a.Well lUil: MW-I & 2 -abandonment to the tollowing: • L • ' Division of Water Resources,Information Processing Unit, 6b.Total well depth: 12' (ft,) 1617 Mail Service;Center.Raleigh,NC I7699-1617 • I 10b. For Injection Wells; In addition to sending the form to the address in 10a —2.5tr above, also submit one copy of'iris form within 30 days of completion of well 6c.Borehole diameter: (in.) abandonment to the following: ' 3' Division of Water Resources,Underground Injection Control Program, 6d,Water level below ground surface: (ft.) I636'Mail Service Center,Raleigh,NC 27699-1636 0 10c.yor WaterSunnly&Injection Wells: In addition to sending the form to the 6e.Outer casing length(if known): (ft.) address(es)above,also submit one copy of this form within 3S days of completion of well abandonment to the county health department of the county where 6f.Inner casingltubing length(if known): 1" (ft.) abandoned. I • 1"6g.Screen length(if known): (ft.) — Fonn GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 WELL ABANDONMENT RECORD For Internal Ilse ONLY: 1 i I.Well Contractor Information: WELL ABANDONMENT l)E'l%lt.S William M Wiggins 7a.For GeoprobellPT or Closed-Loop Geothermal Wells having the same Well Connector Name(or well owner personally abandonin!well on his/her property) well construction/depth,only 1 GW 30 is needed. Indicate TOTAL NUMBER of (NCWC) 3470-A wells abandoned:3 NC Well Conunctar Certification`umber 7b.Approximate volume of water remaining in well(s): 0 (gal.) - Mid-Atlantic Drilling, Inc. FOR(WATER SUPPLY WELL =WELLS ONLY: f . ' '� Company Name R' `, ,, 7c.Type of disinfectant used: �') ? � 2.Well Construction Permit#: NIA IVQV y ^ ?'-,4y,J List all applicable well construction permits(i.e.UK',Coup.State,I ariunce,etc.)Jknown in ! : CLl2 0 7d.Amount of disinfectant used: •,-,n`^y. � 3.Well use(check well use): e.),., ti = Water Supply Well: 7e.Sealing materials used(cheek all that apply): ,.-'i '�'-�/t,:i ❑Agricultural ❑Municipal/Public 0 Neat Cement Grout I. U Bentonite Chips or Pellets ❑Geothermal(Ileating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings ❑Irrikation 0 Specialty Grout ❑Gravel Non-Water Supply Well: ❑ Bentonite Slurry 0 Other(explain under 7g) Ill Monitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation bentonite chips 501bs • ❑Aquifer Storage and Recovery OSalinity Barrier ❑Aquifer Test ❑Stonnwater Drainage ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: OGeothermal(Closed Loop) ❑Tracer pulled well from ground,and poured hole plug(bentonite Chips)down into sandy hole ❑Geothermal('Heating/Cooling Return) ❑Other(explain under 7g) , 4.Date well(s)abandoned: 9-12-23 5a,Well location: •The Proximity CB LLC, N/A • . Facility/Owner Naine Facility 11111(if applicable) 8.Certification: 902 N.Lake Park Blvd., Carolina Beach NC 28428 • 9/1812023 Physical Address,Ciiy,and Zip Signature of Certified Well Contractor on We tier Date New Hanover N/A By signing this form. 1 hereby cert fy that the well(s)was(were)abandoned in County . Parcel Identification No.(PIN) accordance with I SA NCAC 02C.0100 or 2C.0200 Well Construction Standards and that a copy of this record has been provided to the well owner. Sb.l.atitude and longitude in degrees/minutes/seconds or decimal degrees: - (if well field,one tat/long is sufficient) 9.Site diagram or additional weIl!details: 34 04' 10.59" 77 89'48.49 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. C'ONS'fRUCTHON IWTAII.S OF WILLIS)j)EINC ABANDONED still 11TTAL INSTRUCTIONS Attach well construction record(s)Jaruilahle. For multiple injeciinn ornoir-u•atersupply wells OM t with the same construction abandonment,you can suhmut one form, 10a. For All Wells; Submit this form within 30 days of completion of well 6a.Well ID#: MW-3,4,5 abandonment to the following: • Division of(Water Resources.Information Processing Unit, 6b.Total well depth: 12.5' (ft)- 1617 Mail Service Center.Raleigh,NC 27699-1617 lob.For Infection Wells: In addition to sending the form to the address in IOa 6c. Borehole diameter: —2.5" (In,) above,also submit one copy of;this form within 30 days of completion of well abandonment to the following: i 6d.11'ater level below ground surface: 3' (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Servicer Center,Raleigh,NC 27699-1636 _ O 10c.For Water Supply do Infection Wells: In addition to sending the form 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 1" abandoned, 6E Inner casing/tubing length(if known): (ft.) 1 6g.Screen length(if known): (ft.) 1 Fonn GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016