Brunswick_Well Abandonment_20231228

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.. WELI,ABANDONMENT RECORD‘ For Internal UsO ONLY:
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This form can be used.for singe or t Wells i
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It.Wei Contractor hifnrmation: t\L\ \ . .WELL ABANDONMENT DETA1LS
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' Chris Ruffer . . la.Number of wells being akmdtmed: 1 .
Weir eettracior tsfamennivallnaliilpenanalli.abanihilin;aell.M1!usherliretierty i Rif inulople Internam or t70?1,-1416.4jr supply wells. .ONLY with the some
ootWriretionvbamloonieni.)tur ra vi.1-a.ai!retefiriet.
9223-A
-lb.APPluillniilP vokilne or waterielMlinillghl wilk4 gal (gaL)
NC Well CootrdeterCertilkationtrunisei • i
SAEDACCO . FOR WATER SUPPLY WELLS ONLY:
Company Name 7e.Type of disinfectant uird:Bleach
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2.'4%41 Construction Permit#:L ., . • •, •
4st pplkoble ti.e11 plysitni tie.Cm*.Stare.Piiriar.tv.1ertiore,e16..1ifbutot1
7d.Amount ofilisinfectant useth 1 cup
3,Well use(cheek well use):
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Water Supply Well: .7e.Scaling materials-used(Cheek all that apply):'
ElAgrtcolhtell • OilitnicipaliPublic 12]Neat Cement.qrout hi Bentonite Chips or Pellets.
13Cleuthemcd tHeating,'Cooling-,SuPply) L:111esidential Water Supply(iagle) 13 SOLIC.611111 CItOUt El Dry Clay
• 0 Industrial/Commercial OResidential Water Supply(shared) ' .13.ConereteGrout El Drill Cuttings
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Indention .
• • • .b.Specialty Grout 0"drav51
Nott-Wa(cr.Supply Well' • . • -----. 0 BentOnite•Sluny • El Other(explain ander 7g)
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DMonilonng. . - 1:3Recovety. . •
Injection'Well: ' • lf,For each material selected above,protide amountuf materials toed:
13A4trifer Recharge " OGniundttater Rentediali6n Neat Cem.:4 71b ,t4tr:3 gal,gal. Sand Cem.:lb ,Wtr:gal
ClAituiE6:Storage and Bee:every 1:3Salinity Battier-
Bentonite.:201h ,Wtr:gal..
1:1Aquifer Test EiStOnnwater Drainage • —
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• 1:1Expetintental Technology IDSubsidence Control .7.g.[troll&a brief dClaiiptimi rd•the abandonment procedure:
ClGeotheruntl(Closed Loop) °Tracer
Chipped screen to static water, poured grout and topped off.
ClCuothertnal(Heating/C.0°4m Return)• . C3Other(explain under 7u)
. , ,F.:.7 ,...E.,,,,:.
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4.Bate welks)whaitodoned:12-13-2023 •E.
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a.Weti location: 1
- Cr2 -STS------
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Brunswick Nuclear Plant. ,InfortnaticneProceasoing Unit
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Fil acity/Owner Name natty-tpe orapplkable 8.Certification
) DWOMOCI
Power Plant Rd, Brunswick, NC 28461, Chris •Ruffer 12/13/2023
Physical Address:City...a142in Signature orCertilled Well Cosur4etei er,Well Onnar
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Brunswick • /3'y signing this firm, 1 Itemby certijk-thor the 14110)was(were)almnidoned in
forint). Parcel IdentiliCitiatiNo.(PIN) 0i:device with/SA•NC4C 02C:.0100.or 2C.0200 Well'Construction Starnkirds
• .and thal a copy ofillis record hasibeen provided to the well owner.•
• • Sktatibideand longitudeln.degrcestininutotscconds.or decitutil degrees:
Often Veld,ono latiloagts pillt (ti) 9..Site diagram oi•additio nal well details:
.. . You may.use the back of this page to prosprovide additional well site details or well
' . . N - - -. • - W ahatulotuneni details. You tuay also Alta&additional pages if necessary.
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CONSTRETCTION.fiETAILS OF WE LEM;BEING ABANDONED SUBMITTAL 1•NST1iLICTIONS •
.4frath 40 carz.Ftrydida rilcunial if ailabk.•Fr prelopIe injegkerso ma•winei supply f
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we/is ONLY tool the ii12/11Y ergyartkwqw'aficariktqmor._Ivo COO Arbirrit onefiinn.
• tun Far•All Welts:- Submit this,fomt within 30.days of completion of well
6a.,wetE tim,ESS-34C abandonment to:the:following: ir . .
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Division of Water Resnurcth-,Information Fracessing Unit;
Gb.Total well depth: 22 (ft.) 1617 Mail•Seniee•Center,Raleigh,NC 27699-1617
10b.For Infection Welk: In addition to sending the fount°the addiess in.10a
'abate.also stibmitotte copy of this form within'30 days•of completion of well
6c.Borehole di:under;2 .dtli.1 .
. ablitulciontent to the following'. 1
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Division of Water Resoitrosiicthiderground•hijection Control Program,
6d,Water:levelbelow ground surface: (ft.) ' 1636 Mail Senice'Center,Raleigh,NC 27699-1636
10c.Fur Water Sunnlv&linicetton Welk: In addition to sending the form to
6e...Outer caSing;length.(if known): (ft.)" tito.Oddross(es) abate. also.subniii.one. copy of this ibtm Within 30 days of
conipktion of well abandonment to the county health depurIntent of the county
where abandoned.
6E Inner eosin/tithing length(if known):7 (ft.)
6g.Sext.,en length Of know n):15 (ft.) •
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Farm GW-30 Horn:Carolina Department of Environment mai Natural Resources-Division of Water ltources Revised Avast 20t3
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