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Home My WebLink AboutBrunswick_Well Abandonment_20240119 1 WELL ABANDONMENT RECORD For Intemal Use ONLY: i is 1.Well Contractor Information: WELL ABANDONMENT DETAILS Craig Farrow 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 130 is needed. Indicate TOTAL NUMBER of 2208-A wells abandoned: NC Well Contractor Certification Number 7b.Approximate volume of water'remaining in well(s): (gal.) I. i Craigs Well Drilling, LLC FOR WATER SUPPLY WELLS'ONLY: Company Name HTH 7c.Type of disinfectant used: 2.Well Construction Permit#: List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known 1 I b. • 7d.Amount of disinfectant used: 3.Well use(check well use): - - Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultu al - ❑Municipal/Public • 0 Neat Cement Grout IR Bentonite Chips or Pellets 0 Geothermal(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 0 Specialty Grout 0 Gravel Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g) lMonitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation Hole Plug ; 1 bag ❑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) Excavate well, Cut off;top, disinfect, take any measurements possirz,�f�Iith Hole Pl , Cap 4.Date well(s)abandoned: 1/17/24 and seal. gym' R r , �r1 d,,,�J ug ma, 5a.Well location: � JA N 1 9 2024 Danny Gralak lrt;OrT.^.::fen pr;,,.r. ,• , Facility/Owner Name Facility ID#(if applicable) 8.Certification: a �f�,a (��, • 4202 Andrew Jackson Hwy, Leland, NC Fay I; Dtdl'�zL`� 1/17/24 Physical Address,City,and Zip Signa re Certified Well Contractor or Well Owner Date Brunswick Well #1 By signing this form,I hereby certifi,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. 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: 34 17 33 N 78 9 27 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)if available.For multiple injection or non-water supply wells ONLY with the same construction/abandonment,you can submit one form. IOa. 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: 8 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Injection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: (in.) above,also submit one copy of this form within 30 days of completion of well abandonment to the following: I ' No Water Division of Water Resources,Underground Injection Control Program, 6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636 I' I 6e.Outer casing length(if known): (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): (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 it • WELL ABANDONMENT RECORD For Internal Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILS CraigFarrow 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 GWI-36 is needed. Indicate TOTAL NUMBER of 2208-A wells abandoned: NC Well Contractor Certification Number 7b.Approximate volume of waterl1remaining in well(s): (gal.) Craigs Well Drilling, LLC FOR WATER SUPPLY WELLS;ONLY: Company Name HTH 7c.Type of disinfectant used: • 2.Well Construction Permit#: List all applicable well construction permits(i.e.UK',County,State,Variance,etc.)iflarotvn 1 lb. 7d.Amount of disinfectant used:,' 3.Well use(check well use): • Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public 0 Neat Cement Grout •Bentonite Chips or Pellets 0 Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout ❑Dry Clay 0 Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings 0 Irrigation 0 Specialty Grout 0 Gravel Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g) SMonitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation Hole Plug 1 bag ❑Aquifer Storage and Recovery 0 Salinity Barrier ❑Aquifer Test ❑Stormwater Drainage 0 Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure: 0 Geothermal(Closed Loop) ❑Tracer ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Excavate well, Cut off;top, disinfect, take any measurements possib�l^e';, fill wittb.,Fjole,., lug, Cap 4.Date well(s)abandoned: 1/17/24 C A P. V L and seal. 5a.Well location: i' JI IN 1 9 2024 Danny Gralak Facility/Owner Name Facility ID#(if applicable) 8.Certification: (nf36-.2:tic l Prn`:Dos-4"f2 UFi'A G 4202 Andrew Jackson Hwy, Leland, NC i�,YO.` � �.a.eur 1/17/24 etait F Physical Address,City,and Zip Signatu of Certified Well Contractor or Well Owner Date Brunswick Well #2 By signing this form, I 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. 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: 34 17 33 N 78 9 25 `,l, 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)ifavailable.For multiple injection anon-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#: abandonment to the following: Division of Water Resources,Information Processing Unit, 9 1617 Mail Service Center,Raleigh,NC 27699-1617 6b.Total well depth: (ft.) 10b.For Injection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: (in.) above, also submit one copy of this form within 30 days of completion of well abandonment to the following: 1, 6d.Water level below ground surface: 8 (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): (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): (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 I WELL ABANDONMENT RECORD For Internal Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILS Craig Farrow 7a.For Geoprobe/DPT or Closed IL pop 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 2208-A wells abandoned: I NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.) Craigs Well Drilling, LLC FOR WATER SUPPLY WELLS ONLY: Company Name H T H 7c.Type of disinfectant used: 2.Well Construction Permit#: List all applicable well construction permits(i.e.UIG County,State,Variance,etc.)if/amow n 1 lb. 7d.Amount of disinfectant used: 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Mttnicipal/Public 0 Neat Cement Grout I Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay 0 Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings ❑Irrigation 0 Specialty Grout 0 Gravel Non-Water Supply Well: ❑Bentonite Slurry 0 Other(explain under 7g) IMonitoring, ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: DAquifer Recharge ❑Groundwater Remediation Hole Plug 1 bag ❑Aquifer Storage and Recovery ❑Salinity Barrier • 0 Aquifer Test 0 Stormwater Drainage ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) OTracer ❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g) Excavate well, Cut off top, disinfect, take any measurements possible, fill with Hole Plug, Cap 4.Date well(s)abandoned: 1/17/24 and seal. -* a'^r ,,,,, 5a.Well location: •'�'a �a' n^- gujf Danny Gralak �`n P! ZOZ4 Facility/Owner Name Facility ID#(if applicable) 8.Certification: hlrvi7 {41�P'^„F.^'; 4202 Andrew Jackson H Leland, NC ""`"'- 1 ' e �-4.4.8ur GE C�'F � 17/24 Physical Address,City,and Zip Signatu of Certified Well Contractor or Well Owner Date Brunswick Well #3 By signing this form, I hereby certi ,that the well(s) was(were) abandoned in County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 2C.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: 34 17 31 N 78 9 31 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)ifavailable.For multiple injection or non-water supply wells ONLY with the same construction/abandonment,you can submit one form. I 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: 10 (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: (in.) above, also submit one copy of this form within 30 days of completion of well abandonment to the following: Ii 8 Division of Water Resources,Underground Injection Control Program, 6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636 I 6e.Outer casing length(if known): (ft.) IOc.For Water Supply&Infection 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): (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