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Home My WebLink AboutCurrituck_Well Abandonment_20231215 WELL'AD1-1,1�1 D O MEN'1 CORD I For inienlal Use ONLY; : 1.Well Contractor,Information:' WELL•ABANDONMENT DETAIL$ . //�n�{ /�eP".e !''''' - 9a,For Geo robe/DPT or Closed-Lello Geothermal\Vells havingthe same ileit Contractor Name Or well owner personally•abandonitigwell:on his/her p perry) well construction/depth;only•1•GW-30 is needed Indicate TOTAL NUMBER'of - • wells abandoned: NC:Well Contractor Certification NJumbbeer . - 7b.Approximate volume of water re'li.aining in well(s).. t( (gaL) . C / 2 d/r f! . 2 .• . FOR WATER SUPPLY WELT S ONI Y: • Company Name -' •' 7c,Type.of'disinfectantused 1`/�`r/' 2:Well Construction Perinib#: v/ G' List,allapplicrillewellconstructionpermits(l IC,Courity.State Variance,Ito.)ifknown - 7d•Amoutit;of disinfectant used • •3 -•: ' 3.Well use:(checkwelimse): ' Water Supply Well - • • • 7e:•Sealing:Materials:used(chec• k all that_apply)•., . .DAgriculttt al •OMunicipal/Public: ❑Neat Cement Grout . • C Bentonite Chips or Pellets OGeothetmal(Heating/Cooling Supply) t7Residential Water Supply(single) O Sand Cement Grout .❑Dry Clay DIndustnaVVCommeroial • Residential Water Sup ly(shared) 0 Concrete Grout ••• : :0 Drill Cuttings • :Dlmgation •.. C1 Specra]tyGrout Gravel: Non Water<Supply Well - • t 'Bentonite Shlrry 0 Other(exp•lain under 7g)•. _�_• _ —. DMomtonng•' • - - ':ORecovery '_ 1 —•— — Injection Val);,, •7f,_For each material selected above,provide amount•of materials used; ❑AgniferRecharge ' ❑GroundwaterRemediation• GA ifer Stora a and Recover qu g y tjSahYl•....er . DAquifer Test'. ,: : ❑Stormwater.Drainage• - • DExperimentalTechnology ' _ OSubstdeneeControl`• .1 ' 7g:Provid•e-a brief description of the abandonment:procedure; RGeethernial.(Closed:Loap) '47Tracer DGeothermal:(Heating/Cooling Return) • Oother(explain underlg) /W�' �G� 5C : ff r 't / `" /: . 9 4.Date wells)abandoned 7/ ,J . `� is r s +` Sa.Well location k- X4* �.. ,Ft/ . _ • • . . DEC: 1 ;, t_a�-11.1 . • Facility/0rvner:Name FacilitylD#(ifapplica)ble) 8.Cer cation • x� G '- i.i1 V.rf d'P.. * 1 t�f Physical Address Crty and Zip r Signature of Certifie ell Contractor or•W ell Owner Date CQ,44f' fl. ae,416000S6,./.•d6 9 si nin• • this arm,I hereb certi 4hat the•wells ivas were abandoned is y z 's f y . f� (1 (.. ) County .Parcel Identilicationi�o.,(PIN) :accordance with ISr1 NCAC 02C:c0107 or ZC.0200.Well Construction Standards 4 and that a.copybf thisrecord has been provided td'the well owners $b:Latitude and longitude in degrees/minutes/seconds or decimal idegrees: (ifwell'field;one latilong is sufficiem) • 9 Site dia rant or additional well details: g 1‘0 ..5:7• 01 2. • 14 •_ 7� 7c�s 0 1 W You may use the back.of•this page to provide additional Well site details or weal . abandonment details,You may:also a a--eh-additional,pages if necessary,: .. CONSTRUCTIONDETAILS OF WELL(S)•BEINGABANDONID SUBMITTAL INSTRUCTIONS Attaeh hell coiisiuctton reuoid(s)ifavailable.Ri)multiple tnjectton•ornoii-waiersnpply wells • ONLY-with the same canstruotlonlabandonment;.ybu•can submit one form. , • ,, • •.i10a For Alr Wells: :Submit this f.rm within 30.days of completion of well 6a.Well ID#:. abandonment to the following • . Division of Water Resourc s m Inforation':Processing Unit, 6b.Total well d h ept ' r� •(ft) 1617 Mail Serv•ice Cen cc,•Raleigh,NC 27699 1617 10lii For Iniection Wells In additie •to<sending the;form to:the address in r.0a. 6c.Borehole diameter:: 4M (in) • i above also,submit one copy of this orm within 30:days of completion of well l .abandonment;to thefollowmg 6d#.Waterlevel below ground surface .. C . (ft.) f Division:of Water-Resources,Un.erground Injection Control Program, 1636 Mail Service•Cen er;;Raleigh:NC 27699-1636. . • • 1-0c. r Fo Water Supply&Injection ellsdditionto Sending the form to the be:Outer easing length.(if known); 6 (ft.) • ; In a sendig II address(es)above,-also submit one co.y of this form Within 30 days,of completion' • .of well abandonment to the ,coup health departitient of the county where 6f.Inner casia /tubin length.if known abandoned. 6g,Screen length.(ifknown): (ft.). . • Form:Gw-30. North'Carolina Departure t:orEnvironmental Quality-:bivisionof Waterltcsourcds Rcvised.2-22 20ib. . 11• WELL ABANDONMENT RECORD ForIntaml Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILS Daniel C. Veltri 7a.For GeoprobelDPT 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 4368-A ' wells abandoned: NC well Contractor certitiralion Number' 7b.Approximate volume of water remaining in well(s):8 (gal) Maupin Well Drilling LLC FOR WATER SUPPLY WELLS ONLY: ' Company Name 7e.Type of disinfectant used: Hyprochrite 2.Well Construction Permit#:4011464 List all applicable weII construction permits(e.UIC.County,State,Variance,etc.)if known 7d.Amount of disinfectant used:3 oz 3.Well use(check well use): Water Supply Welt 7e.Sealing materials used(check all that apply): ❑Agricultural °Municipal/Public 0 Neat Cement Grout a Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay `_ Olndusnial/Commercial _ ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings Mitigation 0 Specialty Grout 0 Gravel Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g) ❑Monitoring DRecovery Injection Well: 7E For each material selected above,provide amount of materials used: ❑Aquifer Recharge °GroundwaterRemediation Half a Bag of Holeplug ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑Stormwater Drainage °Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geathermal(Closed Loop) °Tracer Poured Holeplug till filled to the top ,❑Geothermal(Heating/Cooling Return) °Other(explain under 7g) _ ti--.:, .e- ;i.•-'•i t ('e—., 6 Nov 2023 '�`C�'�'` 4.Date we ll(s)abandoned: nv-c -, '- Inn j 5a.Well location: Quang Nguyen ir.,,,„„:-;;,"i?,-,:-i 13 Up* FacililylOwncrName Facility lDk(if applicable) 8.Certification: Dvvey;,;cx3 204 Parker Lane, Knott's (sand 27950 / 2-2- ,w 23 Physical Address,City,and Zip Si fi• ell Contractor2 Date Currituck 0077000085y0000 By signing this form,I hereby certify that the well(s)was(were)abandoned in sty - --- — - __Parcel Identification No-(PIN)_ _accordmtce with-15A NCAC 02C.0100 or_2C.0200 We11_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: (if well field one latllong is sufficient) 9.Site diagram or additional well details: 36.50196 N -75.91095 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 WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS Attach well construction record(s)tfavailable.For multiple injection ornon-water supply wells ONLY with the some construction/abandonment,you can submit one form 10a.For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#: abandonment to the following: Division of Water Resources,Information Processing Unit; 6b.Total well depth:23 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Infection Wells: In addition to sending the form to the address in 10a 6a Borehole diameter. ('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 7 ,t (ft.) 1Division of Water Resources, Underground dCenter,Raleigh,N Injection7699-1636 Program, 6e.Outer casing length(if[mown): 1 1/4 (ft,) lOe 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 6L Inner casing/tabing length(if known): (ft,) abandoned. 6g.Screen length(if known): (ft) Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 • 4/ g r!1 • • WELL LL ABANDONMENT 1 RECORD For Internal Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILS Daniel Veltri 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 4368-A wells abandoned. I NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s):3 Gal (gal) Maupin Well Drilling LLC FOR WATER SUPPLY WELLS ONLY: ' Company Name 7c.Type of disinfectant used:Hypochrite 2.Well Construction Permit#:403153 List all applicable well construction permits(Le.UIC.County,State,Variance,etc.)ijknoun 7d.Amount of disinfectant used:3 oz 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public 0 Neat Cement Grout C Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) (Residential Water Supply(single) 0 Sand Cement Grout ❑Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout 0 Drill Cuttings ❑irrigation 0 Specialty Grout 0 Gravel - -- - Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g) ❑Monitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation 25 lb Holeplug ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑Stonnwater Drainage - ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(closed Loop) ❑Tracer Chlorinated well, then gravity feed holeplug t❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) 5 Dec 2023 Q t-. 4.v , ' 1;"-- ',' 4.Date well(s)abandoned: r F r r 5a.Well location: `� ZJG Kyle Fox i^`:.,..�:°..,, G\:1w 3 nth Facility/Owner Name Facility Mt/(if applicable) 8.Certification: Mti3S,�37:, 116 South end Rd, Knolls Island 27950 � � bec 23 Physical Address,City,and Zip Signs u�re otCeRtfied e n r or Date Currituck By signing this form,I hereby certify that the well(s)was(were)abandoned in County Parcel IdemifirationNo.(PIN) accordance with 15A NCAC 02C.0100 or2C.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: 36.510169 N -75.925833 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 Attach well construction record(s)jfavailabte.For multiple injection or non-water supplywells 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#: abandonment to the following. Division of Water Resources,Information Processing Unit, 6b.Total well depth:20 (R.) 1617 Mall Service Center,Raleigh,NC 27699-1617 10b.For Injection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter:4 718 (im.) 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 (fE) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Dater casing length(if known): (th) l0c.For Water Supply&Injection Wells: In addition to sending the fonts 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 6L Inner casing/tubing length(if known): (ft,) abandoned. I 6g.Screen length(if known): (It) Form GW-30 North Carolina Depart entofEnvironmentalQuality-DivisionofWaterResourar Revised 2-22-2016 ., 1 i ' `L