Onslow_Well Abandonment_20231122

WEI,.L ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
William J. Miller 7a.For Geoprobe/DPT or Closed Uop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GIN 30 is needed. Indicate TOTAL NUMBER of
2927A wells abandoned: I I
j
NC Well Contractor Certification Number 7b.Approximate volume of water)remaining in well(s): (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLSIONLY:
CompanyName
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc)ifknown
7d.Amount of disinfectant used:;
i
3.Well use(check well use):
Water Supply Well: 7e.Seating materials used(check All that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout 0 Bentonite Chips or Pellets
[]Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout f ❑ Dry Clay
01ndustrial/Cornmercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑-Bentonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 0.1 cubic feet
❑Aquifer Storage and Recovery ❑Salinity Barrier ;
❑Aquifer Test ❑Stormwater Drainage i
❑Experimental Technology El Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) All well material removed. Backfilled with bentonite
and hydrated.
4.Date well(s)abandoned: 11/21/2023 ;' '` .A? '
NOVA
a�: V
5a.Well location: NOV,2 ,n/ 2023
Camp Lejeune NA _
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification: .�;;_;.;.•
Bid 2603, Camp Lejeune, Jacksonville, NC 11/21/2023
Physical Address,City,a d Zip Signature of Certified Well Contractor or Well Owner Date
NA � Unknown
By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 01C.0100 or 1C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well'details:
34.7072350 N -77.3792020 You may use the back of this page to provide additional well site details or well
abandonment details. You inay-also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable. Fa-nrii tiple ityection ornon-watersupply wells
ONLY with the sane constriction/abaiidonnuent,you can submit one forms.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: 2603-TWO1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 14 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 1.0 (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: 4.93 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
6e.Outer casing length(if known): NA (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): 4 (ft.) abandoned.
t
6g.Screen length(if known). 10
I ,
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS,
William J. Miller 7a.For Geoprobe/DPT or Closed-loop Geothermal Wells having the same
Weil Contractor Name(orwell owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. hidicate TOTAL NUMBER of
2927A wells abandoned:r
NC Well Contractor Certification Number 7b.Approximate volume of water`remaining in well(s): (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknona
7d.Amount of disinfectant used:
3.Well use(check well use):
i
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout } ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑hrigation ❑ Specialty Grout a Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
CMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Gravel
❑Aquifer Storage and Recovery El Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Sand
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer 10 Ibs of gravel pack used to abandon well
❑Geothemral(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 02/16/2023
5a.Well location:
Camp Lejeune NA NOV 2
8.Certification: I�
Facility/Owner Name Facility ID#(ifapplicable) - i
Bld 2637, Camp LeJeune, Jacksonville, NC 11/7J/2023
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
NA Q`J�� Unknown By signing this form, I hereby certif}..?that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Constnuction Standards
Sb.Latitude and longitude in degrees/minutes/secondsand that a copy of this record has beers provided to the well owner.or decimal degrees: I I
(if well field,one lat/long is sufficient) i
9.Site diagram or additional well details:
34.7063 N -77.3782 W 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
Anachwell construction record(s)ifanailable.For nmltiple injection ornon-watersupplyvells
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#: 2637-TWO1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
i
10b.For Infection Wells: In additiop to sending the form to the address in 10a
6c.Borehole diameter: 1.0 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
NA Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.)
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known):
NA 10c.For Water Supply&Injection Wells: In addition to sending the form to the
(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): NA (ft) abandoned.
6g.Screen length(if known): unknown (ft) j
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016